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A terminally ill patient says, 'I know I'm not going to get well, but still.' and the patient's voice trails off. Which response by the nurse is therapeutic?
- A. What do you hope for?'
- B. No, you're not going to get well.'
- C. Do you have questions about what is happening?'
- D. I'm happy you are being realistic about your future.'
Correct Answer: A
Rationale: This open-ended response is an example of following the patient's lead. It provides an opportunity for the patient to speak about whatever is on his or her mind.
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After the death of his wife, a man tells the nurse, 'I can't live without her. She was my whole life.' Which is the nurse's most therapeutic reply?
- A. Each day will get a little better.'
- B. Her death is a terrible loss for you.'
- C. Remember, she's no longer suffering.'
- D. Your friends will help you cope with this.'
Correct Answer: B
Rationale: The correct response demonstrates the use of reflection, a therapeutic communication technique. A statement that validates the bereaved person's loss is more helpful than clich?©s and it signifies understanding.
A grieving patient tells a nurse, 'It's been 8 months since my spouse died. I thought I would feel better by now, but lately I feel worse. I have no energy. I am lonely, but I don't want to be around people. What should I do?' What is the nurse's best counsel?
- A. Seek psychotherapy.
- B. Become active in a church.
- C. Go to the spouse's grave every day.
- D. Understand this is a normal response.
Correct Answer: D
Rationale: The patient needs understanding and support that the feelings are normal. Loneliness and aimlessness are most pronounced 6 to 9 months after the death.
A patient diagnosed with metastatic brain cancer says, 'I'm dying, but I'm still living. I want to be in control as long as I can.' Which reply shows the nurse was actively listening?
- A. Our staff will do their best to help you feel comfortable.'
- B. Most people do not know how to help and are afraid of death.'
- C. Although your body is frail, your mind and spirit are healthy.'
- D. You want people to stop focusing on your weaknesses.'
Correct Answer: C
Rationale: The patient is asking for acknowledgment that he or she is not totally sick; even in the terminal state, strengths and capabilities are present.
A nurse manager notices that a staff member spends minimal time with a patient diagnosed with AIDS who is terminally ill. The patient says, 'I'm having intense emotional reactions to this illness. Sometimes I feel angry, but other times I feel afraid or abandoned.' The nurse manager can correctly hypothesize that the most likely reason for the staff member's avoidance is triggered by what?
- A. Fear of infection transmission.
- B. Feelings of inadequacy in dealing with complex emotional needs.
- C. Belief that the patient needs time alone with family and friends.
- D. Knowledge that the patient's former lifestyle included high-risk behaviors.
Correct Answer: B
Rationale: Many nurses tend to be more comfortable with meeting physical needs than in focusing on complex emotional needs.
A patient newly diagnosed with pancreatic cancer says, 'My father also died of pancreatic cancer. I took care of him during his illness. I can't go through that.' Select the highest priority nursing diagnosis.
- A. Anticipatory grieving
- B. Ineffective coping
- C. Ineffective denial
- D. Risk for suicide
Correct Answer: D
Rationale: The patient's statement has a subtle message of suicide. Suicide is a risk for people with major losses, including terminal disease.