Nokea
Which measure is critical to achieving desired outcomes in the nurse-client relationship? The nurse:
- A. develops trust in the client.
- B. uses autodiagnosis.
- C. relies on the client liking the nurse rather than limit-setting to achieve structure.
- D. analyzes the relationships among biologic, familial, and sociocultural factors that contributed to the client's disorder.
Correct Answer: B
Rationale: The correct answer is B: uses autodiagnosis. Autodiagnosis is critical in the nurse-client relationship as it involves self-awareness and reflection by the nurse to understand their own biases, emotions, and reactions. This self-awareness allows the nurse to effectively manage their responses, maintain professionalism, and provide quality care to the client. By being aware of their own thoughts and feelings, nurses can better empathize with the client, build trust, and communicate effectively. This approach helps prevent potential conflicts and misunderstandings, leading to better outcomes in the nurse-client relationship.
Summary:
A: Developing trust in the client is important but not the most critical measure.
C: Relying on the client liking the nurse is not professional and may compromise boundaries.
D: Analyzing biologic, familial, and sociocultural factors is important but not as critical as self-awareness through autodiagnosis.
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A client, age 70, was brought into the Emergency Department by family members who reported a fall. During the assessment the nurse became suspicious that the client had suffered physical abuse. The client denied that she had been abused. Her denial is most likely based on her:
- A. Strong belief that nothing could be done to help her
- B. Fear of the possibility of being removed from her family
- C. Feeling that she deserved the physical abuse
- D. Lack of trust that the situation could be changed
Correct Answer: B
Rationale: The correct answer is B: Fear of the possibility of being removed from her family. This is because elderly individuals who are experiencing abuse may fear being separated from their family if they disclose the abuse. This fear of losing their support system can lead them to deny or minimize the abuse. This choice is the most likely reason for the client's denial in this scenario.
Choice A: Strong belief that nothing could be done to help her is incorrect because the client's denial is not based on a belief that nothing could be done, but rather on a fear of being removed from her family.
Choice C: Feeling that she deserved the physical abuse is incorrect as victims of abuse often do not feel they deserve the abuse, but rather may feel ashamed or fearful.
Choice D: Lack of trust that the situation could be changed is incorrect because the client's denial is more likely based on a fear of losing her family, rather than a lack of trust in the situation changing.
A client has been diagnosed with a dementia secondary to cerebral disease. The family members note the client 'has not been as sharp as he once was' and that he has developed urinary incontinence and a gait disturbance. They attributed the first symptom to normal aging but were alarmed by the latter two symptoms. Based on this history, which of the following should come to mind?
- A. Normal pressure hydrocephalus
- B. Vitamin B12 deficiency
- C. Hepatic disease
- D. Tuberculosis
Correct Answer: A
Rationale: Step 1: The client presents with urinary incontinence and a gait disturbance, suggestive of normal pressure hydrocephalus (NPH) due to cerebral disease.
Step 2: NPH is characterized by the triad of cognitive decline, gait disturbances, and urinary incontinence.
Step 3: Symptoms of NPH can mimic normal aging but are distinct from other conditions.
Step 4: Vitamin B12 deficiency (B) primarily presents with anemia and neurological symptoms, not the triad seen in NPH.
Step 5: Hepatic disease (C) typically presents with symptoms related to liver dysfunction, not the triad of NPH.
Step 6: Tuberculosis (D) manifests with respiratory symptoms and constitutional symptoms, not the cognitive decline and gait issues seen in NPH.
A patient diagnosed with a serious mental illness lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, 'I have no money to pay my rent or refill my prescription.' Select the nurses best action.
- A. Involve the patients case manager to provide crisis intervention
- B. Send the patient to a homeless shelter until housing can be arranged
- C. Arrange for a short in-patient admission and begin discharge planning
- D. Explain that one must have active psychiatric symptoms to be admitted
Correct Answer: A
Rationale: Impaired stress tolerance and problem-solving abilities can cause persons with SMI to experience relatively minor stressors as crises. This patient has run out of money, and this has overwhelmed her ability to cope, resulting in a crisis for which crisis intervention would be an appropriate response. Inpatient care is not clinically indicated nor is the patient homeless (although she may fear she is). Telling the patient that she is not symptomatic enough to be admitted may prompt malingering.
A victim of partner abuse, parent of one child, describes the partner as someone who is easily frustrated and more likely to be abusive after experiencing an event in which self-esteem is challenged. The most recent episodes of violence were related to feeling "upset"Â over a job loss. What type of therapy would provide the greatest help to the abuser?
- A. Voluntary individual or group therapy
- B. Court-ordered individual or group therapy
- C. Voluntary couples or family therapy
- D. Court-ordered couples or family therapy
Correct Answer: A
Rationale: The correct answer is A: Voluntary individual or group therapy. This type of therapy would provide the greatest help to the abuser because it focuses on addressing the underlying issues of frustration, self-esteem challenges, and abusive behavior. The key here is that the therapy is voluntary, which means the abuser is more likely to engage and actively participate in the process. In individual or group therapy, the abuser can explore and work on managing emotions, coping strategies, and developing healthier communication skills. Court-ordered therapy (choices B and D) may not be as effective because it could be seen as a punishment rather than a genuine effort to seek help. Couples or family therapy (choice C) may not be appropriate initially as the focus should be on the abuser's personal growth and behavior change.
An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which documentation best indicates the treatment was successful?
- A. No complaints related to sexual function; to return next week.
- B. Patient reports achieving orgasm last week; seems very happy.
- C. Reports satisfaction with sexual encounters; feels partner is supportive.
- D. Reports achieving orgasm occasionally; relationship with partner is adequate.
Correct Answer: C
Rationale: Step 1: Choice C indicates satisfaction with sexual encounters and feeling supported by the partner, which suggest a positive outcome in addressing the inability to achieve orgasm and concerns about the relationship.
Step 2: The patient feeling satisfied and supported signifies improvement in sexual function and relationship dynamics.
Step 3: This documentation reflects a holistic approach to addressing the patient's concerns, focusing on emotional well-being and relationship quality.
Step 4: Overall, choice C demonstrates a comprehensive resolution to the patient's initial complaints and indicates successful treatment.
Summary:
Choice C is the correct answer as it shows improvement in both sexual function and relationship satisfaction. Choices A, B, and D do not address the patient's concerns about the relationship or emotional well-being, making them less appropriate indicators of treatment success.