Nokea
During a grief-processing group, an elderly patient stated, “For the first time since my husband died, I’m having more good days than bad.” This statement suggests that the patient has:
- A. Reached the phase of reestablishment
- B. Determined she is ready to terminate the support group
- C. Completed her “grief work” successfully
- D. Replaced old memories with new ones.
Correct Answer: C
Rationale: The correct answer is C: Completed her "grief work" successfully. This statement indicates progress in the grieving process, moving towards acceptance and healing. The patient acknowledging having more good days than bad reflects a positive shift in coping with the loss, indicating that she has processed her grief and is beginning to adapt to life without her husband. This suggests that the patient has worked through her emotions, memories, and adjustments related to the loss, reaching a point where she is experiencing more peace and acceptance.
Summary:
A: Reestablishment is not the correct choice as it does not specifically address the completion of the grief work.
B: Determining readiness to terminate the support group is premature, as the patient may still benefit from continued support.
D: Replacing old memories with new ones is not supported by the patient's statement and does not necessarily indicate successful grief processing.
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A teenage boy has lost his best friend as a result of a hunting accident. His parents report that he is eating and sleeping very little and expresses little interest in school. They are concerned that he talks about the accident repeatedly. These behaviors are generally seen as:
- A. Expressing responsibility for his friends death
- B. Attempts to avoid dealing with his pain
- C. Expressions of a normal grief reaction
- D. Indications of a risk for self-harm
Correct Answer: C
Rationale: The correct answer is C: Expressions of a normal grief reaction. The teenage boy's behaviors of poor appetite, insomnia, lack of interest in school, and repetitive discussions about the accident are common manifestations of grief. This grief reaction is a normal response to losing a close friend in a traumatic manner like a hunting accident. It is important to acknowledge and validate his emotions during this difficult time.
Incorrect Choices:
A: Expressing responsibility for his friend's death - This choice suggests guilt or blame on the part of the boy, which is not evident in the scenario.
B: Attempts to avoid dealing with his pain - The boy's behaviors indicate he is processing his grief rather than avoiding it.
D: Indications of a risk for self-harm - While it is important to monitor for signs of self-harm, the behaviors described are more indicative of grief rather than immediate self-harm risk.
When a hospitalized patient dies, his wife stares blankly and states, "It can’t be." This indicates:
- A. Despair and protest
- B. Shock and disbelief
- C. Anger and hostility
- D. Disorganization and confusion
Correct Answer: B
Rationale: Correct Answer: B (Shock and disbelief)
Rationale:
1. The wife's blank stare and statement "It can’t be" suggest a state of disbelief and being stunned by the news of her husband's death, indicating shock.
2. Shock is a common initial reaction to unexpected and distressing events, such as the sudden death of a loved one.
3. This choice is the most fitting based on the wife's reaction of disbelief and being unable to accept the reality of the situation.
Summary:
A: Despair and protest - Despair involves a sense of hopelessness, not evident in the wife's initial reaction. Protest implies a more active response, while the wife's reaction is passive.
C: Anger and hostility - There is no indication of anger or hostility in the wife's initial response; rather, it is characterized by disbelief.
D: Disorganization and confusion - While the wife may feel disorganized and confused later, her initial response reflects more shock and disbelief than disorganization
About an hour after the patient has ECT, he complains of having a headache. The nurse should:
- A. Notify the physician stat.
- B. Administer an as needed (prn) dose of acetaminophen.
- C. Take the patient through a progressive relaxation sequence.
- D. Advise going to activities to expend energy and relieve tension.
Correct Answer: B
Rationale: The correct answer is B: Administer an as needed (prn) dose of acetaminophen. After ECT, it is common for patients to experience headaches as a side effect. Administering acetaminophen will help alleviate the headache and provide relief for the patient. It is important to address the patient's discomfort promptly and effectively.
Choice A is incorrect because headaches after ECT are a common side effect and do not typically require immediate physician notification. Choice C is incorrect as progressive relaxation may not address the immediate headache symptoms. Choice D is also incorrect as physical activities may exacerbate the headache rather than provide relief. Administering acetaminophen is the most appropriate and efficient intervention in this situation.
The desired outcome for a patient experiencing insomnia is, "Patient will sleep for a minimum of 5 hours nightly within 7 days." At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. The nurse will document the outcome as:
- A. Consistently demonstrated.
- B. Often demonstrated.
- C. Sometimes demonstrated
- D. Never demonstrated.
Correct Answer: C
Rationale: The correct answer is C: Sometimes demonstrated. The rationale is that the patient is not consistently meeting the desired outcome of sleeping for a minimum of 5 hours nightly within 7 days. Although the patient is sleeping for an average of 4 hours nightly, the 2-hour afternoon nap indicates that the patient is not achieving the desired outcome consistently. Therefore, the nurse would document the outcome as "Sometimes demonstrated" to reflect that the patient is making progress towards the goal but has not fully achieved it. Choices A, B, and D are incorrect because the patient's sleep behavior does not align with being consistently, often, or never demonstrated based on the desired outcome criteria.
The patient states, "Everybody picks on me. They frobitz me." The patient’s communication exhibits:
- A. A neologism
- B. Loose associations
- C. Delusional thinking
- D. Circumstantial speech
Correct Answer: A
Rationale: The correct answer is A: A neologism. A neologism is a made-up word or phrase that only has meaning to the individual. In this case, "frobitz" is not a known word in the English language, indicating a neologism. This suggests possible language or thought disorder. B: Loose associations involve disconnected or tangential thoughts. C: Delusional thinking involves fixed false beliefs. D: Circumstantial speech includes excessive, irrelevant detail before reaching the main point.