Nokea
A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate?
- A. Arms crossed
- B. Staring at the nurse
- C. Smiling inappropriately
- D. Eyes casted downward
Correct Answer: D
Rationale: Nonverbal communication is usually considered more powerful than verbal communication. Downward-casted eyes suggest feelings of worthlessness or hopelessness.
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A student nurse caring for a patient diagnosed with major depressive disorder reads in the patient's medical record, 'This patient shows vegetative signs of depression.' Which nursing diagnoses most clearly relate to the vegetative signs?
- A. Imbalanced nutrition: less than body requirements
- B. Chronic low self-esteem
- C. Sexual dysfunction
- D. Self-care deficit
- E. Powerlessness
- F. Insomnia
Correct Answer: A,C,D,F
Rationale: Vegetative signs of depression are alterations in the body processes necessary to support life and growth, such as eating, sleeping, elimination, and sexual activity. These diagnoses are more closely related to vegetative signs than to diagnoses associated with feelings about self.
A patient diagnosed with major depressive disorder tells the nurse, 'Bad things that happen are always my fault.' To assist the patient in reframing this overgeneralization, how should the nurse respond?
- A. I really doubt that one person can be blamed for all the bad things that happen.
- B. Let's look at one bad thing that happened to see if another explanation exists.
- C. You are being exceptionally hard on yourself when you say those things.
- D. How does your belief in fate relate to your cultural heritage?
Correct Answer: B
Rationale: By questioning a faulty assumption, the nurse can help the patient look at the premise more objectively and reframe it as a more accurate representation of fact. The incorrect responses are judgmental, irrelevant to an overgeneralization, and cast doubt without requiring the patient to evaluate the statement.
A patient says to the nurse, 'My life does not have any happiness in it anymore. I once enjoyed holidays, but now they're just another day.' How would the nurse document the patient's statement?
- A. Vegetative
- B. Anhedonia
- C. Euphoria
- D. Anergia
Correct Answer: B
Rationale: Anhedonia is a common finding in many types of depression and refers to feelings of a loss of pleasure in formerly pleasurable activities. Vegetative symptoms refer to somatic changes associated with depression. Euphoria refers to an elated mood. Anergia means without energy.
A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, 'No one cares about me anymore. I'm not worth anything.' Select an appropriate initial outcome.
- A. The patient will verbalize realistic positive characteristics about self by (date).
- B. The patient will consent to take antidepressant medication regularly by (date).
- C. The patient will initiate social interaction with another person daily by (date).
- D. The patient will identify two personal behaviors that alienate others by (date).
Correct Answer: A
Rationale: Low self-esteem is reflected by making consistently negative statements about self and self-worth. Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best when framed positively; identifying two personal behaviors that might alienate others is a negative concept.
A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
- A. You look nice this morning.
- B. You are wearing a new shirt.
- C. I like the shirt you're wearing.
- D. You must be feeling better today.
Correct Answer: B
Rationale: Patients with depression usually see the negative side of things. The meaning of compliments may be altered to 'I didn't look nice yesterday' or 'They didn't like my other shirt.' Neutral comments such as an observation avoid negative interpretations. Saying 'You look nice' or 'I like your shirt' gives approval (nontherapeutic techniques). Saying 'You must be feeling better today' is an assumption, which is nontherapeutic.