Nokea
The nurse is talking in the lounge with other nurses about grief and loss. The nurse understands which to be true regarding grief and loss? Select all that apply.
- A. The process of grief is detrimental to physical and emotional health.
- B. Age, gender, and culture are a few factors that influence the grieving process.
- C. The nurse must explore his own feelings about death before he may effectively help others.
- D. The nurse should discourage expression of grief and loss because it may upset other clients nearby.
- E. The nurse can help the family develop ways to relieve loneliness and depression following the death of a loved one.
Correct Answer: B,C,E
Rationale: Grief is influenced by age, gender, and culture (B), nurses must process their own feelings about death (C), and helping families cope with loneliness/depression (E) is appropriate. Grief is not inherently detrimental (A), and discouraging expression (D) is counterproductive.
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A client who is to be discharged to home with a temporary colostomy states to the nurse, 'I know I've changed this thing once, but I just don't know how I'll do it by myself when I'm home alone. Can't I stay here until the surgeon puts it back?' Which therapeutic response should the nurse make to best deal with the client's concerns?
- A. This is only temporary, but with your level of anxiety you need to hire a nurse companion until your surgery.'
- B. So you're saying that, although you've practiced changing your colostomy bag once, you don't feel comfortable on your own yet?'
- C. Well, your insurance will not pay for a longer stay just to practice changing your colostomy, so you'll have to fight it out with them.'
- D. Going home to care for yourself still feels pretty overwhelming? I will schedule you for home visits until you're feeling more comfortable.'
Correct Answer: D
Rationale: The client is expressing feelings of fear and helplessness. Option 4 assists with meeting this client's needs. Option 1 provides information that the client already knows and then problem-solves by using a client-centered action, which would probably overwhelm the client. Option 2 is restating, but this response could cause the client to feel more helpless because the client's fears are reflected back to the client. Option 3 provides what is probably accurate information, but the words 'just to practice' can be interpreted by the client as belittling.
During the nursing assessment, the client states, 'My surgeon just told me that my cancer has spread, and I have less than 6 months to live.' Which nursing response would be the most therapeutic?
- A. I am sorry. Would you like to discuss this with me some more?'
- B. I am sorry. There are no easy answers in times like this, are there?'
- C. I hope you'll focus on the fact that your doctor says you have 6 months to live and that you'll think of how you'd like to live.'
- D. I know it seems desperate, but there have been a lot of breakthroughs. Something might come along in a month or so to change your status drastically.'
Correct Answer: A
Rationale: The client has received very distressing news and is most likely still experiencing shock and denial. In option 1, the nurse invites the client to ventilate feelings. Option 2 is social and expresses the nurse's feelings rather than the client's feelings. Option 3 is patronizing and stereotypical. Option 4 provides social communication and false hope.
A family member of a client diagnosed with a brain tumor states that he is feeling distraught and guilty for not encouraging the client to seek medical evaluation earlier. Which information should the nurse incorporate when formulating a response to the family member's statement?
- A. A brain tumor presents with few sights/symptoms.
- B. It is true that brain tumors are easily recognizable.
- C. Brain tumors are never detected until very late in their course.
- D. The signs/symptoms of a brain tumor may be easily attributed to another cause.
Correct Answer: D
Rationale: Signs and symptoms of a brain tumor vary depending on location, and they may easily be attributed to another cause. Symptoms include headache, vomiting, visual disturbances, and changes in intellectual abilities or personality. Seizures occur in some clients. These symptoms can be easily attributed to other causes. The family requires support to assist them during the normal grieving process. Options 1, 2, and 3 are inaccurate statements.
The nurse is caring for a client with a history of schizophrenia. The nurse asks the client if he is ready to eat his lunch. The client responds, 'Rain, train, down the drain, Jane's brain.' The nurse recognizes this type of speech pattern as which type?
- A. echolalia
- B. word salad
- C. neologisms
- D. clang association
Correct Answer: D
Rationale: Clang association is characterized by words chosen for their sound (e.g., rhyming or alliteration) rather than meaning, as seen in the client's response.
The nurse provides care for a client diagnosed with substance abuse. The nurse recognizes the client is using projection as a defense mechanism when the client makes which statement?
- A. There is genetic predisposition in my family to alcoholism.
- B. My spouse takes handfuls of medications, and I don't do that.
- C. I have one or two glasses of wine at dinner with my spouse.
- D. Many psychologists do not believe addiction is a disease.
Correct Answer: B
Rationale: Projection involves attributing one's own undesirable behaviors to others. The client blaming their spouse for excessive medication use reflects projection by deflecting their own substance abuse issues onto another person.