Nokea
A client diagnosed with cancer is placed on permanent total parenteral nutrition as a means of providing nutrition. Which is the rationale for the nurse to include psychosocial support when planning care for this client?
- A. Death is imminent.
- B. The client will need to adjust to the idea of living without eating by the usual route.
- C. Total parenteral nutrition requires disfiguring surgery for permanent port implantation.
- D. Nausea and vomiting occur regularly with this type of treatment and will prevent the client from participating in social activity.
Correct Answer: B
Rationale: Permanent total parenteral nutrition is indicated for clients who can no longer absorb nutrients via the enteral route. These clients will no longer take nutrition orally. The remaining options are inaccurate. There is no indication in the question that death is imminent. Permanent port implantation is not disfiguring. Total parenteral nutrition does not cause nausea and vomiting.
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Which reaction toward the physical symptom would the nurse observe in a client with conversion disorder?
- A. Anger
- B. Apathy
- C. Anxiety
- D. Agitation
Correct Answer: B
Rationale: In conversion disorder, the nurse would observe apathy toward the physical symptom. The development of the symptom serves as an unconscious method of reducing anxiety. The symptom is accepted passively, known as 'la belle indifférence.' There is no anger observed as symptoms are passively accepted. Similarly, there is no direct anxiety related to the physical symptom, as the conflict is resolved through the symptom development. While many individuals might experience agitation and seek to identify the cause of physical symptoms, in conversion disorder, there is an unusual calmness or indifference towards the physical manifestation, indicating apathy rather than other emotional responses.
The spouse of a dying client states to the nurse, 'I don't think I can come anymore and watch her die. It's chewing me up too much!' Which is the most therapeutic response the nurse should make to the spouse?
- A. It's hard to watch someone you love die. You've been here with your wife every day. Are you taking any time for yourself?
- B. Focus on your wife's pain rather than yours. I know it's hard, but this isn't about what's happening to you, you know.
- C. I know it's hard for you, but she would know if you're not there, and you would feel so very guilty all of the rest of your days.
- D. I think you're making the right decision. Your wife knows you love her. You don't have to come every day. I'll take care of her.
Correct Answer: A
Rationale: The most therapeutic response is the one that is empathetic and that reflects the nurse's understanding of the client's, in this case, the husband's, stress and emotional pain. In the correct option, the nurse suggests that the client take time for himself. Option 2 is an example of a nontherapeutic and judgmental attitude that places blame. Option 3 makes statements that the nurse cannot know are true (the client's wife may not in fact know if the husband visits), and it predicts feelings of guilt, which is inappropriate. Option 4 fosters dependency and gives advice, which is nontherapeutic.
Which of the following examples indicates that the nurse is giving recognition as a form of therapeutic communication?
- A. You need to take your medicine now, Adam.
- B. Jill, your father is trying to make amends with you.
- C. The physician wants to meet with you and your husband, Amy.
- D. Linda, you brushed your hair this morning.
Correct Answer: A
Rationale: Recognition is a form of therapeutic communication in which the nurse points out a positive aspect of the client's behavior. Noting that a client brushed her hair herself indicates that the nurse recognizes the client's attempts at self-care. This recognition shows the client that the nurse is paying attention and may be open to further communication. Choices A, B, and C do not demonstrate recognition. Choice A focuses on a directive statement, Choice B involves informing the client about a situation without acknowledging their actions, and Choice C informs the client about a meeting without providing recognition for any behavior.
What feeling is likely to result from withdrawn behavior?
- A. Anger
- B. Paranoia
- C. Loneliness
- D. Boredom
Correct Answer: C
Rationale: Withdrawn behavior involves avoiding social interactions and isolating oneself. This isolation can lead to feelings of loneliness as the individual lacks connection and companionship. While anger or paranoia may contribute to withdrawal, loneliness is a common emotional consequence of prolonged social isolation. Boredom may also arise from withdrawal if meaningful activities and social engagements are reduced.
A client is discussing her problematic marital relationship with the nurse. Which statement by the nurse is an example of the nontherapeutic communication technique of giving reassurance?
- A. I think you should try marital counseling. I've had to do that myself once and it helped.
- B. Why don't you see a conflict resolution specialist? I can give you that information.
- C. I agree with you. He should not argue with you when he has problems at work that are not your fault.
- D. Everything will be okay if you talk to him about how it makes you feel.
Correct Answer: D
Rationale: Giving reassurance, such as saying 'Everything will be okay,' is nontherapeutic because it dismisses the client's concerns and may minimize their feelings without addressing the underlying issue.