Psychiatric Nursing Biological and Behavioral Concepts 2nd Edition Antai-Otong Test Bank
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CHAPTER 34—PSYCHOSOCIAL CARE IN MEDICAL-SURGICAL SETTINGS
- When answering the call light of a client in the inpatient unit of the hospital, you are suddenly made aware that this client is angry about not having the call answered sooner, is uncooperative in terms of stating what he needs and accepting your help, as well as demanding that the hospital administrator “come and straighten out the staff.” Which of the following assessments of the situation is most likely correct?
|a.||the client is somewhat narcissistic and wants to be the center of attention for the nurses|
|b.||the client has some fears and concerns and is seeking control over an aspect of his life|
|c.||this particular client has a problem with delayed gratification, that is, difficulty with waiting|
|d.||the number of nurses on staff is inadequate for the number and acuity of the clients on the unit|
The nurse would assess that the client has some fears and concerns and is seeking control over an aspect of his life. A client may become demanding, angry, and uncooperative as a means of maintaining control. Understanding the meaning of the client’s behaviors helps the nurse to maximize and promote adaptive coping responses in clients in the medical-surgical settings.
- When you ask a newly admitted hospitalized client to remove his personal clothing and to put his personal valuables in the locked personal items area or to send them home with family or friends, you need to realize that the client will most often internally respond to these requests in which of the following ways?
|a.||by self-talk, that this is a normal expectation of being hospitalized|
|b.||as a threat to personal identity and a response to an external stressor|
|c.||with relief that hospital personnel will be able to access his body better|
|d.||in a spirit of cooperation with health care providers who are trying to help|
The client will most often internally respond to this request as a threat to his identity and a response to an external stressor. Stressors include impaired personal identity affected by the removal of personal clothing and other items and the staff’s insistence on traditional hospital clothing.
- Nurses can best decrease feelings of powerlessness in clients by doing which of the following?
|a.||establishing a therapeutic alliance with the client|
|b.||advising the client that some things are within his control|
|c.||doing a thorough assessment of the client’s health problems|
|d.||letting the client decide whether to take pain medication or not|
Nurses can best decrease the client’s feelings of powerlessness by establishing a therapeutic alliance with the client. Therapeutic alliances foster autonomy and decrease feelings of powerlessness. While other options are important, a therapeutic alliance must be developed first.
- When assessing the feelings of a middle-aged man experiencing a new diagnosis of multiple sclerosis and a child hospitalized for cystic fibrosis, you will find that these two clients are experiencing which of the following?
|a.||calm, peace, and an acceptance of circumstances he cannot control|
|b.||very diverse feelings with no shared or like feelings being identified|
|c.||fear of the unknown and sadness of separation from significant others|
|d.||helplessness, hopelessness, and a dependence on the nursing and medical staff|
A middle-aged man and a child, both with a chronic illness, will have similar feelings such as fear of the unknown and sadness about a separation from significant others. Regardless of the source of these feelings, clients need emotional support, opportunities to express feelings, and assistance in maintaining a sense of well-being.
- While working with a client who has renal failure, you find that the client is not only expressing anger and engaging in demanding behavior but, in addition, the client has depression. You realize that these behaviors are:
|a.||clues that the client is at a suicidal point in his illness|
|b.||normal reactions to chronic illness, except for the depression|
|c.||unusual in clients with renal depression and needs further assessment|
|d.||all normal reactions to chronic, debilitating, or life-threatening illness|
Angry, demanding behaviors and depression are all viewed as normal reactions to chronic, debilitating, or life-threatening illnesses. These illnesses require the client to grieve over potential and actual losses. Anger and demanding behaviors are indications of the client’s feelings of fear and helplessness. Depression also results when the client feels helpless.
- Which of the following behaviors by the nurse and other staff members is most crucial to the effectiveness of treatment for clients with debilitating, life-threatening, or chronic illnesses?
|a.||restricting the visits of family and friends to conserve the energy of the client|
|b.||providing a schedule that is as similar as possible to the client’s usual schedule|
|c.||taking charge of all decisions to free up energy for clients to use in fighting disease|
|d.||providing a way for clients to express feelings and to maintain some control and dignity|
It is most crucial that nurses and other staff members provide a way for clients with debilitating, life-threatening, or chronic illnesses to express feelings and to maintain some control and dignity. Clients must have an active role in their care. Restricting visitors will only increase anxiety and feelings of isolation. Clients can be encouraged to collaborate with the health care personnel in developing a schedule.
- When working with ill children and their parents, the nurse will keep in mind that the age group with the greatest risk of injury and emotional, social, and academic deficits associated with the experience of illness and hospitalization is which of the following groups?
|a.||infants and toddlers||c.||latency age children|
|b.||grade school children||d.||adolescents|
Infants and toddlers are at greatest risk for injury and emotional, social, and academic deficits associated with the experience of illness and hospitalization. Younger children tend to experience attachment and separation anxiety. The infant must develop trust, and the toddler must develop a sense of autonomy in order to be able to successfully complete future stages of growth and development.
- When caring for hospitalized infants who are ill, the nurse will work hard to foster the child-parental relationship mainly for which of the following reasons?
|a.||Hospital bills are being paid by the parents’ insurance or out of their pockets.|
|b.||Parents will allow the nurses to care more for the ill infant if they are involved.|
|c.||Harmful stress effects on infants are buffered by healthy child-parent relationships.|
|d.||These infants belong to the parents and not to the hospital, nurses, or nursing staff.|
Healthy child-parent relationships can buffer the deleterious effects of stress on infants. Family dynamics influence the child’s response to hospitalization and illness.
- The nurses and other staff members in the hospital seem to be ignoring the call light of a client who is angry, demanding, and somewhat verbally aggressive with the staff. By neglecting to respond, the staff will most likely cause which of the following reactions by the client?
|a.||The client will complain to the administrator of the hospital.|
|b.||The anger and aggression on the part of the client will escalate.|
|c.||Greater effort will be made to try to please the staff to get attention.|
|d.||An improvement in behavior will occur to avoid the punishment of being ignored.|
The likelihood of aggression increases when clients feel they are being ignored or discounted. Hurried and unconcerned responses to the client may create or increase feelings of anger, powerlessness, fear, and dependency.
- Your colleagues are complaining about the demanding behavior of a client who has a diagnosis of chronic obstructive pulmonary disease (COPD). Your best response at this time is to do which of the following?
|a.||Point out that the client’s stay will not last forever.|
|b.||Listen without adding anything to the conversation.|
|c.||Agree that clients with COPD can be very frustrating and offer to care for this client.|
|d.||Share that clients with COPD tend to be demanding due to the anxiety related to dyspnea.|
Clients with COPD can be very demanding, which is related to their routinely experiencing intense anxiety, particularly during an extreme dyspneic episode. Their lack of control over the illness, fear of not being able to breathe, and the effect of the bronchodilators increase the anxiety. It will be helpful for your peers to understand the reason the client is demanding.
- Which of the following interventions by the nurse will best help prevent a demanding hospitalized client with a diagnosis of chronic obstructive pulmonary disease (COPD) from escalating negative responses?
|a.||asking the client to make a list of five concerns and needs they want met by the nurse|
|b.||using a calm, concerned approach, speaking in a confident, caring voice, and listening|
|c.||telling the client that the time of the nurse is limited and that all demands cannot be met|
|d.||setting limits with the client, telling the client that talk can begin when he calms down|
The nurse’s best approach to help prevent a demanding hospitalized client from escalating negative responses is to use a calm, concerned approach, speak in a confident, caring voice, and listening. Managing demanding behavior requires active listening skills and patience to understand the meaning of the client’s complaints and frustration. Speaking in a calm, concerned, and caring voice demonstrates that you are interested in what is happening to the client and promotes trust in the relationship.
- While helping an ill, hospitalized client with their activities of daily living, you find yourself identifying a lack of motivation, a lack of compliance, and a lack of hope as themes in what the client is doing and saying. Your priority would be to further assess this client for which of the following problems?
|a.||depression||c.||external locus of control|
|b.||helplessness||d.||oppositional defiant behavior|
The nurse’s priority should be to assess the client to determine if the client is depressed. Individuals who are depressed often demonstrate a lack of motivation, a lack of compliance, and a lack of hope. Recognizing the symptoms of depression can help the nurse to develop effective interventions that will help the client develop adaptive coping behaviors. Research has documented that people who do not have emotional well-being are more likely to suffer from cardiovascular disease.
- You are working with a client who has experienced a myocardial infarction and is now participating in a rehabilitation program. The client is at home and coming in for the rehabilitation program three times a week. The client tells you about his work as a lawyer in which he was working at least 12 hours a day, 6 days a week, and comments about how different being home is from when he was in the office. From what the client has said, you realize that this client needs ongoing assessment since he is at high risk for which of the following?
|b.||noncompliance||d.||disturbed body image|
Medical-surgical clients who are experiencing major role or lifestyle changes often feel helpless, hopeless, and depressed. Assessing depressive symptoms is critical to reducing complications such as hypertension, hyperglycemia, or cardiac arrhythmias related to noncompliance and suicide.
- While working with a preschool child whose mother has recently died, the nurse learns that the child thinks the mother is really a fairy princess who is taking a long sleep and will wake up as soon as the child discovers the right magic words. The nurse realizes that this child is exhibiting which of the following types of thinking?
|a.||bizarre and individualistic thinking|
|b.||normal magical thinking for this age|
|c.||confused thinking, possibly due to cartoons|
|d.||delusional thinking as a defense mechanism|
This is a normal response in preschoolers. Some children may perceive death as magical and believe that the dead will eventually wake up and return to life.
- When caring for dying clients, priority interventions should be directed at which of the following essential client outcomes?
|a.||belief in a higher power||c.||emotional and physical comfort|
|b.||belief in discovery of a cure||d.||control of the symptoms of illness|
When caring for dying clients, priority interventions should be to promote the client outcome of emotional and physical comfort. The question focuses on an outcome and the outcome should relate to the problem, which at this time is the fact that the client is dying. The outcome of emotional and physical comfort addresses the quality of the dying experience and addresses physical and spiritual needs. Belief in a higher power or discovery of a cure does not change the fact that the client is dying nor the dying experience.
- Clients often experience agonizing life events such as the loss of a significant person in their life. Nurses who feel comfortable working with clients on spirituality issues during these periods will need to focus on helping clients with which of the following?
|a.||finding a higher power to believe in|
|b.||discovering meaning and purpose in life|
|c.||finding writings in a religious book that apply|
|d.||discovering something to believe in beyond death|
The nurse who feels comfortable with spiritual issues can help clients to discover meaning and purpose in life. A spiritual assessment can be conducted to identify the clients’ belief systems, affirmations, coping behaviors, and psychosocial resources. Spirituality can then be used to reinforce coping mechanisms and facilitate the grieving process.
- In order to understand a client’s feelings and attitudes about death and dying as well as to strengthen the dying client’s healthy responses, what should nurses do first?
|a.||compare ideas about death and dying with the client who is dying|
|b.||extensively read the literature about how clients feel about death and dying|
|c.||explore their own personal early memories of events involving death and dying|
|d.||talk to families of clients who are dying, or who have experienced a death, within a recent time period|
First, nurses should explore their own personal early memories of events involving death and dying. Self-awareness will strengthen the nurses’ ability to respond to dying clients. Exploring one’s own early memories of personal reactions to events involving death and dying is critical to understanding the client’s feelings and attitudes about death and dying.
- You are working with a client who has stomach cancer and is demonstrating signs and symptoms of pain. It has been 8 hours since the client took any pain medication. You have noticed that his blood pressure is elevated and he is groaning softly as you enter the room, but he refuses your offer of pain medication. Which of the following interventions would be best at this time?
|a.||Tell the client that he is in control of how much pain medication he takes.|
|b.||Ask the supervising nurse to talk with this client about a need to take pain medication.|
|c.||Explain that taking medication for control of pain is alright and begin to explore his feelings.|
|d.||Accept the client’s decision for now, explaining that if he changes his mind, it is alright.|
The intervention that would be best at this time is for the nurse to explain that taking medication for control of pain is alright. The nurse can then begin to explore feelings with the client. Exploring the client’s feelings about pain will help the nurse to understand the client’s resistance to taking pain medication.
- When assessing hospitalized, chronically ill adolescents, the nurse should pay particular attention to which of the following concerns characteristic of adolescents?
|a.||decreased peer contact and acceptance|
|b.||fear of dying and not completing life’s goals|
|c.||separation from and abandonment by parents|
|d.||worry about siblings and the effect on siblings|
The nurse should pay particular attention to the adolescent’s concern over decreased peer contact and acceptance. Adolescents are struggling to gain independence, identity, and separation from families. While some may still be concerned about separation from family, the major issue is acceptance by peers. Personal appearance, athletic abilities, and acceptance by peers are major components of the adolescent’s self-concept.
- When working with a hospitalized child or adolescent who is ill, the nurse needs to keep in mind that siblings of the ill child most often feel which of the following?
|a.||guilt and depression||c.||needed and overly invested|
|b.||overlooked and resentful||d.||helpless, hopeless, and loving|
Siblings of ill, hospitalized children or adolescents often feel overlooked and resentful due to the amount of parental attention given to the sick child’s immense needs. Often the healthy children must cover additional household chores because of the absence of the parents. The nurse should encourage parents to involve the other children in family decisions and acknowledge them for their role in the family’s adjustment. Quality time should be spent with them to facilitate their healthy growth and development.
- A recently admitted young adult client who was in an accident resulting in a cervical spinal cord injury is exhibiting anger and intense hostility toward his family, his friends, and the staff. The family wants an explanation from the nurse about why the client is so angry and hostile. Which of the following initial actions would be best on the part of the nurse?
|a.||Explain that this reaction is probably due to neurological irritation that will subside.|
|b.||Tell the client that he needs to moderate his response and not upset significant others.|
|c.||Explain that this reaction is normal and model an accepting and understanding approach.|
|d.||Alert the physician to the concerns of the family and to the extent of the anger and hostility.|
The nurse’s initial action should be to explain that this reaction is normal and model an accepting and understanding approach. Normal grief reactions to spinal cord injury include crying spells, depression, anger, and intense hostility towards loved ones and staff. Clients with a spinal cord injury suffer intense loss and grief, the resolution of which can be facilitated by using an accepting and understanding approach.
- A client with a diagnosis of AIDS is brought to the clinic with symptoms of disorientation, recent memory difficulties, and agitation. The client is also having visual hallucinations. The nurse needs to do which of the following at this time?
|a.||Determine if the client has a diagnosis of a mental disorder in addition to a diagnosis of AIDS.|
|b.||Talk with family, significant others, and friends who may know what is going on with the client.|
|c.||Assess blood pressure, pulse, and neurological signs and report them immediately to the physician.|
|d.||Review the client’s medication and the identity of any prescribed or illegal drugs that have recently been taken.|
The nurse should assess the client’s blood pressure, pulse, and neurological signs and report them immediately to the physician. Disorientation, recent memory difficulties, agitation, and visual hallucinations are indications that the client is experiencing the classic symptoms of AIDS delirium which can be life threatening.
- A client with a diagnosis of breast cancer is scheduled for a mastectomy. The client asks the nurse about reconstructive surgery. Which of the following could the nurse share with the client as truthful and helpful in regard to reconstructive surgery?
|a.||Reconstructive surgery is usually done several months after the mastectomy heals.|
|b.||There are alternatives to reconstructive surgery that are less invasive and just as good.|
|c.||Reconstructive surgery often results in painful lymphedema and limited use of the arm.|
|d.||Women having reconstructive surgery fare better with physical function and self-esteem.|
The nurse could share research has shown that women who elect to have reconstructive surgery have higher self-esteem and do better with physical function. Also women who have the reconstructive surgery experience fewer body image disturbances.
- Depression in older adults who have suffered a cerebral vascular accident (CVA) can be due to many reasons. Recent research shows that up to 50% of all CVA clients have depression resulting from which of the following causes?
|a.||loss of self-esteem due to extensive physical and mental impairments|
|b.||the medication prescribed for the prevention of complications from the CVA|
|c.||changes in the client’s roles within the family, friend, work, and community network|
|d.||increased secretion of damaging chemicals related to hypoxia, swelling, and ischemia|
Recent research indicates that up to 50% of all clients who have suffered a CVA have depression resulting from impaired neurotransmitter secretion. There is increased secretion of damaging chemical substances related to the hypoxia, swelling, and ischemia within the areas of the brain that are damaged.
- The nurse is providing care for a client who recently returned from the Gulf War. The client lost both of his legs when his jeep hit a land mine. The client reveals to the nurse that he frequently has nightmares about the incident and wakes up in a panic. The nurse caring for this client should recognize that the client is most likely experiencing post-traumatic stress disorder (PTSD). The best action for the nurse to take would be to:
|a.||Assure the client that everything will be alright.|
|b.||Request a consultation from the psychiatric nurse clinical liaison.|
|c.||Have the client transferred immediately to the psychiatric ward.|
|d.||Ask the physician for an order for a sleeping medication for the client.|
The best action by the nurse would be to request a consultation from the psychiatric nurse clinical liaison. The PNCL will need further assess the client to determine appropriate treatment if he has PTSD. The client should not be referred to the mental health unit until his physical condition is stabilized. A sleeping medication will not address the underlying problem if the client has PTSD.
- You are caring for a young adolescent female admitted to the pediatric unit for a tonsillectomy. While assisting the client with morning care, she tells you that her mother bought her a training bra and that she had her first period 2 months ago. Which of the following questions by the nurse would be effective in assessing the client’s self-concept?
|a.||“Who is your favorite movie star in Hollywood?”|
|b.||“How do you feel about the changes in your body”|
|c.||“Do the other children at school make fun of you?”|
|d.||“Why are you unhappy about getting your period?”|
The most appropriate question would be for the nurse to ask the adolescent about her feelings regarding the changes in her body. This will provide information on the client’s self-perceptions. The client’s favorite movie star is irrelevant and does not provide specific information about the client’s feelings. Asking about the response of other children changes the subject. Asking the client why she is unhappy is inappropriate because she may not be able to explain why she is unhappy, plus the client never indicated being unhappy.
- A client seen in the outpatient clinic for his annual physical states to the nurse, “My acne is so bad I don’t think I will ever get a date.” The best response by the nurse would be which of the following?
|a.||Ask if the client’s siblings have acne.|
|b.||Listen attentively to the client’s concerns.|
|c.||Tell the client about medications to treat acne.|
|d.||Change the subject and talk about the client’s positive features.|
The most appropriate response is to listen attentively to the client’s concerns. Listening attentively promotes trust in the therapeutic nurse-client relationship. Asking about siblings is changing the subject and not dealing with the client’s feelings. The nurse may later tell the client about available medications after the client has expressed concerns.
- Your client was admitted for day surgery because of difficulty getting pregnant. The client begins to share with you some of her concerns about sex and the problems she and her husband have experienced. She tells you that she doesn’t understand why she can’t get pregnant. Once you have completed your assessment and allowed the client to express her feelings, your primary task would be to do which of the following?
|a.||identify all of the client’s sexual problems|
|b.||refer the client to the hospital’s sexologist|
|c.||refer the client and spouse to a psychotherapist|
|d.||provide health education regarding sexual health|
Your primary task is to provide sexual health education since some of the client’s statements indicate a lack of knowledge. The nurse may never identify all of the client’s sexual problems. Referral to a sexologist or psychotherapist may be done later if necessary.
- A client is admitted for an amputation of the right foot as a result of diabetes. The client states to the nurse, “I don’t know what the impact will be on my family and my job if I lose my foot. This is going to cripple me.” Your best response would be to say which of the following?
|a.||“Yes, go on.”|
|b.||“You have a very good surgeon.”|
|c.||“I understand how you are feeling.”|
|d.||“I’m sure everything will be alright.”|
The best response by the nurse is to offer a broad opening by giving a general lead. Telling the client to go on, encourages the client to continue expressing feelings about his fears. Discussing the surgeon changes the subject. Telling the client that the nurse understands does not address the client’s feelings. Giving false reassurance is a barrier to therapeutic communication.
- You are the nurse on the hospital unit and caring for a client who is terminal. The client’s spouse and children have been at his bedside for two days. When the client expires, one of the daughters begins screaming and crying, “He’s alright, he’s just asleep. Daddy wouldn’t leave us.” The other family members try to console the daughter. You are aware that because the client is a hospice client there is a standing do not resuscitate (DNR) order. You understand that the daughter’s response is an example of which of the following?
The daughter’s response is that of denial, which is often the first step in the grieving process. Denial is an assertion that an allegation is false when it is in fact true. The other options are incorrect. Anxiety is a reaction to a real or perceived threat. Regression is returning to an earlier stage of development. Rationalization is offering a socially acceptable reason for an action or feeling in place of the real, less socially acceptable, one.
- The nurse caring for a client diagnosed with terminal cancer recognizes that a client’s initial response to the diagnosis will depend primarily on which of the following?
|a.||how the client’s family will react to the diagnosis|
|b.||the relationship the client has with the extended family|
|c.||the client’s normal coping strategies and available support|
|d.||whether the diagnosis was made early in the disease process|
The ability to cope is primarily based on the individual’s normal coping strategies and whether there is an available support system. If the client has coped well to stressful situations in the past, the client may be able to face this new stressor in a healthy manner. The available support system assists the individual to handle stressful situations. The client’s family reactions and relationship with extended family may be important, but they do not affect the initial response. The timing of the diagnosis does not specifically impact the initial response.
- The nurse is caring for a client admitted for a hernia repair. The chart indicated that the client is currently receiving an MAOI for depression. When reviewing the client’s menu list, which meal should the nurse inform the client would be contraindicated because of the client’s current medications?
|a.||glass of orange juice, broiled chicken, green beans, and a slice of bread|
|b.||cup of tea, liver, rice with gravy, peas, a slice of bread, and ice cream|
|c.||glass of water, baked fish, rice, broccoli and carrots, and a cup of orange sherbet|
|d.||cup of tea, steak smothered with onions, mashed potatoes, carrots, and a cup of fruit|
The client is unable to have liver because of the tyramine content. Clients receiving MAOIs should not eat foods or liquids high in tyramine. The other choices would be appropriate because they do not include foods high in tyramine.
- A young client is brought to the emergency room after a rape assault. The nursing interventions would include which of the following? Select all that apply.
|a.||gather lab samples for forensic|
|b.||address the client’s physical needs|
|c.||encourage the client to forget the incident|
|d.||assist the client in identifying the perpetrator|
|e.||encourage the client to accept her part in the rape|
|f.||encourage the client to express feelings regarding the incident|
ANS: A, B, F
Nursing interventions when caring for a rape victim include gathering lab samples for forensic, addressing the client’s physical needs, and encourage the client to express feelings regarding the incident. The nurse should never encourage the client to forget the incident, the client must work through feelings of fear, anxiety, depression, and guilt. The rape client is a victim and is not responsible for what has happened. If the nurse was not present at the rape, the nurse would not be able assist the client in identifying the perpetrator.
- A client on the medical unit complains angrily and is constantly demanding. He makes numerous requests such as bring fresh water, close the door, bring new pillows, and the food tastes bad. Which nursing interventions should be implemented to allow the client to express anger? Select all that apply.
|a.||assist the client to describe feelings|
|b.||state your observation of the expressed anger|
|c.||inform the client that the nurses are doing their best|
|d.||encourage the client to share what preceded the anger|
|e.||discourage the client from expressing the anger verbally|
|f.||tell the client that he will be medicated if he does not calm down|
ANS: A, B, D
Nursing interventions to allow the client to express anger include acknowledging your observation of the anger, assisting the client to express feelings, and identifying the precipitating event. Threatening the client with medication is a form of assault. The nurse defending the other staff is nontherapeutic communication and does not address the client’s anger. The client should not be discouraged from verbalizing the anger.