Nokea
A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. Which behaviors indicate the client is emotionally accepting the impending death?
- A. Revising the client's will and planning a visit to a friend
- B. Alternating between crying and talking openly about death
- C. Seeking second, third, and fourth medical opinions
- D. Refusing to follow treatments and stating they won't help anyway
Correct Answer: A
Rationale: Revising the will and planning a visit to a friend are indicative of emotional acceptance of impending death as they demonstrate realistic, productive, and constructive ways of using the remaining time. Alternating between crying and talking openly about death may suggest depression rather than acceptance. Seeking multiple medical opinions shows disbelief, denial, or desperation rather than acceptance. Refusing treatments and stating they won't help reflects anger and hopelessness, not acceptance.
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According to Erikson's theory, which behavior would the nurse expect a preschooler to exhibit?
- A. The child develops the superego.
- B. The child plays beside other children.
- C. The child concentrates on work and play.
- D. The child becomes casual about body appearance.
Correct Answer: A
Rationale: According to Erikson's theory, a preschooler develops the superego or conscience during the initiative versus guilt stage. This stage occurs around ages 3 to 6 years old. The development of the superego is crucial for the child to start understanding and internalizing societal and parental values. Choice B is incorrect because playing beside other children typically occurs during the autonomy versus shame and doubt stage, which is seen in toddlers. Choice C is incorrect as concentrating on work and play is more characteristic of the industry versus inferiority stage, typically seen in school-aged children. Choice D is incorrect because becoming casual about body appearance is more aligned with the identity versus role confusion stage, which is seen in adolescents who have a marked preoccupation with appearance and body image.
A client who is newly diagnosed with multiple sclerosis is obviously upset and asks, 'Am I going to die?' Which response would the nurse make?
- A. Most individuals with your disease live a normal life span.
- B. Is your family here? I would like to explain your disease to all of you.
- C. The prognosis varies, as most individuals have remissions and exacerbations.
- D. Why don't you speak with your health care provider to get more details?
Correct Answer: C
Rationale: The most appropriate response to the client's question regarding their prognosis is to acknowledge the variable nature of multiple sclerosis by stating that 'The prognosis varies, as most individuals have remissions and exacerbations.' This response provides realistic information while offering some hope. Choice A ('Most individuals with your disease live a normal life span.') gives false reassurance as repeated exacerbations may affect life span. Choice B ('Is your family here? I would like to explain your disease to all of you.') does not directly address the client's question and involves the family unnecessarily. Choice D ('Why don't you speak with your health care provider to get more details?') deflects the responsibility and does not address the client's immediate concerns about their prognosis.
A terminally ill client repeatedly talks about her son's upcoming wedding and how much she wants to attend. Which stage of the Kübler-Ross theory of death and dying is the client displaying?
- A. Anger
- B. Denial
- C. Bargaining
- D. Acceptance
Correct Answer: C
Rationale: The client is displaying the stage of bargaining in the Kübler-Ross theory of death and dying. During the bargaining stage, individuals attempt to negotiate for more time or a different outcome in the face of impending death. In this scenario, the client expressing a desire to attend her son's wedding and discussing it frequently reflects a form of bargaining for additional time to be present for the event. Anger, on the other hand, involves extreme expressions of emotion ranging from irritation to rage. Denial is characterized by an inability to accept the reality of the situation. Acceptance signifies coming to terms with the circumstances and may lead to decreased interest in people and surroundings.
Which behavior is most typical for clients with borderline personality disorder?
- A. Arrogant
- B. Eccentric
- C. Impulsive
- D. Dependent
Correct Answer: C
Rationale: The correct answer is 'Impulsive.' Clients with borderline personality disorder often exhibit impulsive, potentially self-damaging behaviors. Arrogance is more characteristic of narcissistic personality disorder, eccentric behavior aligns with schizotypal personality disorder, and dependent behavior is typical of dependent personality disorder. Therefore, the key feature of borderline personality disorder is impulsivity.
Which response would the nurse make to a client who says, 'The voices say I'll be safe only if I stay in this room, wear these clothes, and avoid stepping on the cracks between the floor tiles'?
- A. Ask whether the voices are male or female and how many there are.
- B. Reassure the client by stating, 'I understand that these voices are real to you, but I want you to know that I don't hear them.'
- C. Offer false reassurance by saying, 'Don't worry"?I've locked the door to your room and won't let anyone in.'
- D. Encourage the client to leave the room and keep busy to distract from the voices.
Correct Answer: B
Rationale: The response, 'I understand that these voices are real to you, but I want you to know that I don't hear them,' demonstrates empathy and validation of the client's experience while also gently bringing in the nurse's reality. This response acknowledges the client's feelings without reinforcing the hallucinations. Asking about the characteristics of the voices (Choice A) can inadvertently validate the hallucinations. Offering false reassurance (Choice B) may not be helpful as it does not address the client's distress. Encouraging the client to leave the room and keep busy (Choice D) is nontherapeutic as it disregards the client's experience and may increase anxiety.