Nokea
A patient has come to the clinic to discuss the stress she is experiencing because of failing two exams at school. Initially, she described her failures as 'the worst thing that has ever happened to me,' and she stated, 'There is absolutely nothing I can do to pass this course now.' In response to the nurse's questions, the nurse finds out there are three more equally weighted exams scheduled for the course in question. The nurse and patient collaborate and decide to use interventions to facilitate emotion-focused coping. Which additional comment from the patient would the nurse identify as providing support for this decision?
- A. You've got to figure out something for me to do to get me out of this situation!
- B. This is a waste of time because absolutely nothing you or I can do will make it any better.
- C. I overreacted; surely together we can figure out something for me to do.
- D. This is the worst thing that could ever happen to me. I'm nothing but a failure.
Correct Answer: C
Rationale: The correct answer is C because the patient's statement shows a shift in perspective from hopelessness to a willingness to collaborate and problem-solve. By acknowledging the possibility of working together to find a solution, the patient demonstrates openness to coping strategies. Choice A displays frustration without a willingness to participate actively. Choice B reinforces hopelessness and a defeatist attitude. Choice D reinforces negative self-perception without any indication of openness to change. In summary, choice C aligns with emotion-focused coping by showing a willingness to explore solutions collaboratively.
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A client with signs and symptoms of double pneumonia states,"I will not agree to hospital admission unless my shaman is allowed to continue helping me." Which would be an appropriate nursing intervention?
- A. Tell the client that the shaman is not allowed in the emergency department.
- B. Have the shaman meet the attending physician at the hospital.
- C. Have the family talk the client into admission without the shaman.
- D. Explain to the client that the shaman is responsible for the client's condition.
Correct Answer: B
Rationale: The correct answer is B. Having the shaman meet the attending physician at the hospital is the most appropriate nursing intervention because it allows for collaboration between traditional beliefs and modern medical care. This approach respects the client's cultural and spiritual preferences while ensuring the client receives necessary medical treatment. It also helps establish a supportive and holistic care environment.
Choice A is incorrect because denying the shaman access may lead to resistance from the client and hinder effective communication and trust-building. Choice C is inappropriate as it disregards the client's autonomy and may create conflict within the family. Choice D is incorrect as blaming the shaman for the client's condition is disrespectful and unprofessional.
A client with a long history of alcohol use disorder has been diagnosed with Wernicke-Korsakoff syndrome. With which member of the mental health-care team would the nurse collaborate to meet this client's described need?
- A. The psychiatrist to obtain an order for neurocognitive disorder medications.
- B. The psychologist to set up counseling sessions to explore stressors.
- C. The dietitian to help the client increase consumption of thiamine-rich foods.
- D. The social worker to plan transportation to Alcoholics Anonymous.
Correct Answer: C
Rationale: The correct answer is C: The dietitian to help the client increase consumption of thiamine-rich foods. Wernicke-Korsakoff syndrome is caused by thiamine deficiency, commonly seen in individuals with alcohol use disorder. Thiamine supplementation is essential in managing this condition. Collaborating with a dietitian can ensure the client receives proper education and guidance on increasing thiamine intake through diet.
Incorrect choices:
A: The psychiatrist for neurocognitive disorder medications - While medications may be prescribed for symptoms, addressing the underlying thiamine deficiency is crucial.
B: The psychologist for counseling sessions - Counseling can be beneficial, but addressing the nutritional deficiency is a priority.
D: The social worker for transportation to AA - Important for ongoing support, but addressing the nutritional needs comes first to manage Wernicke-Korsakoff syndrome.
While caring for a family, the nurse determines that first-order changes have occurred with which of the following?
- A. The children are all in school, and the parent returns to work.
- B. The daughter leaves home to attend college.
- C. The son marries his long-time sweetheart and moves into his own home.
- D. The grandmother who has been living in the household dies.
Correct Answer: A
Rationale: The correct answer is A because first-order changes refer to small, incremental adjustments within the system. In this scenario, the parent returning to work while the children are all in school signifies a gradual shift in the family dynamic. The other choices involve significant and more disruptive changes like a daughter leaving for college, a son getting married and moving out, and the death of a family member, which are considered second-order changes that lead to more substantial shifts in the family system.
A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client motions to the nurse to come over so he can tell the nurse how things have been going since he was discharged. While talking with the client, the nurse determines that the client's therapy has been effective when the client states which of the following?
- A. I am still experiencing quite a bit of stress at home and at work; things are different at home than they were in the hospital.
- B. When my mother-in-law comes over now, I go out to my workshop and work on one of my projects.
- C. I'm still drinking coffee; I can't quit after drinking it all these years.
- D. I've learned having a beer after I get home from work helps me relax.
Correct Answer: B
Rationale: The correct answer is B because the client's behavior of going to the workshop to work on projects when his mother-in-law visits indicates a healthy coping mechanism to manage stress. This shows that the therapy has been effective in helping the client find a constructive way to deal with his anxiety triggers. Choice A indicates ongoing stress, which suggests therapy may not be effective. Choice C shows a habit that has not changed, indicating little progress. Choice D suggests the use of alcohol as a coping mechanism, which is not a healthy or sustainable way to manage anxiety.
When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to
- A. report drowsiness.
- B. eat a tyramine-free diet.
- C. avoid alcoholic beverages.
- D. adjust dose and frequency based on anxiety level.
Correct Answer: C
Rationale: The correct answer is C: avoid alcoholic beverages. This is because alprazolam is a central nervous system depressant, and alcohol also has depressant effects. Combining the two can potentiate sedation and respiratory depression. Reporting drowsiness (A) is important but not specific to alprazolam. Eating a tyramine-free diet (B) is relevant for certain medications like MAOIs, not alprazolam. Adjusting dose and frequency based on anxiety level (D) is not recommended as it can lead to misuse or dependence.