Nokea
A patient is experiencing distress with midlife transition. Which statement provides support that the patient is successfully managing this stressor?
- A. “I won’t give up on my dream to be rich.”
- B. “I wasn’t being realistic when I set being rich as my life’s goal.”
- C. “I’ll never be rich, but I can save enough to live comfortably.”
- D. “Being rich doesn’t necessarily make a person happy.”
Correct Answer: C
Rationale: Successfully managing midlife transitions involves finding realistic and satisfying alternatives to earlier, unmet goals, demonstrating emotional growth and adaptability.
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When asked, “Why do you go to music therapy every morning at 10?” The nurse explains that the nurse’s role in music therapy as:
- A. Fostering and encouraging performance talent
- B. Teaching patients about various styles of music
- C. Noting patient verbal and nonverbal expression of feelings
- D. Selecting and playing numbers that will reduce anxiety and stress
Correct Answer: C
Rationale: The nurse's role in music therapy is to note patient verbal and nonverbal expression of feelings. In music therapy, the focus is on using music as a tool to help patients express themselves, connect with their emotions, and communicate their feelings in a non-verbal manner. The nurse's job is to observe and interpret how the patients are engaging with the music and using it as a medium to express their inner thoughts and emotions. This can help in promoting emotional well-being and providing a space for patients to process their feelings in a therapeutic way.
By discharge, which outcome is appropriate for a patient who hears voices telling them they are evil?
- A. Respond verbally to the voices.
- B. Verbalize the reason the voices say they are evil
- C. Identify events that increase anxiety and promote hallucinations.
- D. Integrate the voices into their personality structure in a positive manner.
Correct Answer: C
Rationale: Identifying triggers for hallucinations is a key step in managing symptoms effectively
A patient tries to gouge out their eye in response to auditory hallucinations. The nurse would analyze this behavior as indicating:
- A. Derealization
- B. Inappropriate affect
- C. Impaired impulse control
- D. Inability to manage anger
Correct Answer: C
Rationale: Self-harm in response to hallucinations reflects impaired ability to control impulses and respond safely to internal stimuli.
Which statement would the nurse use to describe the primary purpose of boundaries?
- A. Boundaries define responsibilities and duties to one’s self in relation to others.
- B. Boundaries determine objectives of the various working stage of the relationship.
- C. Boundaries differentiate the assumed roles of both the nurse and of the patient.
- D. Boundaries prevent undesired material from emerging during the interaction.
Correct Answer: A
Rationale: Boundaries define responsibilities and duties to one’s self in relation to others. Setting boundaries is essential in establishing a safe and professional therapeutic relationship between a nurse and a patient. These boundaries help to create a clear understanding of each person's roles and responsibilities within the relationship. Boundaries also help protect both the nurse and the patient from potential harm, maintain professionalism, and ensure effective communication and focus on the therapeutic goals. By defining these boundaries, the nurse can better maintain appropriate relationships with patients and avoid conflicts of interest or ethical dilemmas.
What would be an appropriate short-term outcome for a patient diagnosed with residual schizophrenia who exhibits ambivalence?
- A. Decide their own daily schedule.
- B. Decide which unit groups they will attend.
- C. Choose between two outfits to wear each morning.
- D. Choose which clinic staff member to work with.
Correct Answer: C
Rationale: Residual schizophrenia can cause ambivalence or difficulty making decisions. Offering simple choices reduces decision-making stress and promotes autonomy.