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A patient with burn injuries has demonstrated good coping skills for several weeks. Today, a new nurse is poorly organized and does not follow the patient's usual schedule. By mid-afternoon, the patient is angry and loudly complains to the nurse manager. Which is the nurse manager's best response?
- A. Explain the reasons for the disorganization and take over the patient's care for the rest of the shift.
- B. Acknowledge and validate the patient's distress and ask, 'What would you like to have happen?'
- C. Apologize and explain that the patient will have to accept the situation for the rest of the shift.
- D. Ask the patient to control the anger and explain that allowances must be made for new staff members.
Correct Answer: B
Rationale: When a patient with good coping skills is angry and overwhelmed, the goal is to reestablish a means of dealing with the situation. The nurse should solve the problem with the patient's input by acknowledging the patient's feelings, validating them as understandable, apologizing if necessary, and then seeking an acceptable solution. Often patients can tell the nurse what they would like to have happen as a reasonable first step.
You may also like to solve these questions
Which behaviors are most consistent with the clinical picture of a patient who is becoming increasingly aggressive? (Select all that apply.)
- A. Pacing
- B. Crying
- C. Withdrawn affect
- D. Rigid posture with clenched jaw
- E. Staring with narrowed eyes into the eyes of another
Correct Answer: A,D,E
Rationale: Crying and a withdrawn affect are not cited by experts as behaviors indicating that the individual has a high potential to behave violently. The other behaviors are consistent with the increased risk for other-directed violence.
An adult patient assaulted another patient and was restrained. One hour later, which statement by this restrained patient necessitates the nurse's immediate attention?
- A. I hate all of you!'
- B. My fingers are tingly.'
- C. You wait until I tell my lawyer.'
- D. It was not my fault. The other patient started it.'
Correct Answer: B
Rationale: The correct response indicates impaired circulation and necessitates the nurse's immediate attention. The incorrect responses indicate that the patient has continued aggressiveness and agitation.
Confirmation of a history of what scenario from a patient's record indicates compromised coping skills and the need for careful assessment of the risk for violence?
- A. Childhood trauma
- B. Family involvement
- C. Academic problems
- D. Daily substance abuse
Correct Answer: D
Rationale: The nurse should suspect compromised coping skills in a patient with daily substance abuse. He or she is often anxious, may be concerned about inadequate pain relief, and may have a personality style that externalizes blame. The incorrect options do not signal as high a degree of risk as substance abuse.
A patient is pacing the hall near the nurses' station and swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say what?
- A. What is going on?'
- B. Quiet down immediately. You are scaring others.'
- C. I'd like to talk with you about how you're feeling right now.'
- D. You must go to your room and try to get control of yourself.'
Correct Answer: C
Rationale: Intervention should begin with an analysis of the patient and situation. With the correct response, the nurse is attempting to hear the patient's feelings and concerns, which leads to the next step of planning an intervention. The incorrect responses are authoritarian, creating a power struggle between the patient and nurse.
A confused older adult patient in a skilled care facility is sleeping. A health care worker enters the room quietly and touches the bed to see if it is wet. The patient awakens and hits the health care worker in the face. Which statement best explains the patient's action?
- A. Older adult patients often demonstrate exaggerations of behaviors used earlier in life.
- B. Crowding in skilled care facilities increases individual tendencies toward violence.
- C. The patient interpreted the health care worker's behavior as potentially harmful.
- D. This patient learned violent behavior by watching other patients act out.
Correct Answer: C
Rationale: Confused patients are not always able to evaluate accurately the actions of others. This patient behaved as though provoked by the intrusive actions of the staff member.