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A client diagnosed with nephrotic syndrome asks the nurse, 'Why should I even bother trying to control my diet and the edema? It doesn't really matter what I do if I can never get rid of this kidney problem, anyway!' Which should the nurse identify as the most appropriate concern for this client?
- A. Anxiety
- B. Powerlessness
- C. Difficulty coping
- D. Negative self-image
Correct Answer: B
Rationale: Powerlessness is present when the client believes that personal actions will not affect an outcome in any significant way. Because nephrotic syndrome is progressive, the client may feel that personal actions may not affect the disease process. Anxiety is appropriate when the client has a feeling of unease with a vague or undefined source. Difficulty coping occurs when the client has impaired adaptive abilities or behaviors with regard to meeting expected demands or roles. Negative self-image is when there is an alteration in the way that the client perceives his or her body image.
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The nurse is preparing a client for a parathyroidectomy when the client states, 'I guess I'll have to wear a scarf after this surgery.' Considering this statement, which concern should the nurse address?
- A. Denial that the surgery is necessary
- B. Trouble coping with the need for surgery
- C. Issues with potential changes to body image
- D. Anxiety about postsurgical altered function
Correct Answer: C
Rationale: The client's statement reflects a psychosocial concern regarding his or her appearance after surgery, so option 3 is the correct option. The remaining options identify unsuitable problems that are not supported by the provided client data.
An English-speaking Hispanic client has a newly applied long leg cast to stabilize a right proximal fractured tibia. During rounds at night, the nurse finds the client restless, withdrawn, and unusually quiet. Which nursing statement would be most appropriate?
- A. Are you uncomfortable?
- B. Tell me what you are feeling.
- C. You'll feel better in the morning.
- D. I'll get your pain medication right away.
Correct Answer: B
Rationale: Option 2 is open-ended and makes no assumptions about the client's psychological or emotional state. Option 1 is incorrect because males in traditional standard Hispanic cultures practice 'machismo' in which stoicism is valued, so this client may deny any pain when asked. False reassurance is never therapeutic, which makes option 3 incorrect. Option 4 is incorrect because an assessment is necessary before administering medication for pain.
The nurse is assisting with providing a form of psychotherapy in which the client acts out situations that are of emotional significance. Based on this assessment data, which form of therapy should the nurse expect the primary health care provider has prescribed?
- A. Psychodrama
- B. Reality therapy
- C. Psychoanalytic therapy
- D. Short-term dynamic psychotherapy
Correct Answer: A
Rationale: Psychodrama involves the enactment of emotionally charged situations. Reality therapy is used for individuals with cognitive impairment. Both short-term dynamic psychotherapy and psychoanalytic therapy depend on techniques that are drawn from psychoanalysis.
The nurse talks with a child who has been sexually abused by a family member. The child asks the nurse, 'If I tell you something, will you tell anyone my secret?' Which response by the nurse to the client is appropriate?
- A. I will not tell anyone your secret.
- B. I will not tell your mom and dad.
- C. I'll call the nursing supervisor as a witness.
- D. I cannot keep this information a secret.
Correct Answer: D
Rationale: Nurses are mandated reporters and cannot promise confidentiality in cases of abuse, as reporting to authorities is required to protect the child. This response is honest and maintains trust while adhering to legal and ethical obligations.
An older adult client who appears alert, oriented, and well-groomed shares with the nurse, 'Lately, I am seeing things that are not there. It is always people. I am awake and sitting down and I know they are not there, but I see them.' Which response by the nurse is appropriate?
- A. Has anyone in your family ever been diagnosed with schizophrenia?
- B. What medications have you been taking recently?
- C. Don't worry. You may actually have been asleep and dreaming.
- D. The Alzheimer organization offers some tests you may want to take.
Correct Answer: B
Rationale: Inquiring about medications explores potential causes of hallucinations, such as side effects, which is a common issue in older adults. Schizophrenia or Alzheimer’s assumptions are premature, and dismissing as dreaming ignores the client’s awareness.