EAQ Psych - Foundations and Modes of Care

The nurse explores the possibility of joining Narcotics Anonymous (NA) with a client who has a history of drug abuse. What is a major reason that NA is helpful in treating addictive behavior? 1 More change will take place within the group. 2 Group members are supportive of one another's problems. 3 Group members share a common background and history. 4 Addiction problems are dealt with more effectively in a group.

2 Group members are supportive of one another's problems. Although members of the group may become impatient with one another's problems at times, the group is usually supportive. Members share common goals, and the opportunity is available to test out new patterns of behavior. The rate and degree of change are individually based variables. People with addiction problems have varied backgrounds; the only common denominator may be the addiction. Although many clients function well in a group, some clients cannot.

A female client terminally ill with cancer says to the nurse, "My husband is avoiding me. He doesn't love me anymore because of this awful tumor!" What is the nurse's most appropriate response? 1 "What makes you think he doesn't love you?" 2 "Avoidance is a defense. He needs your help to cope." 3 "Do you think he's having difficulty dealing with your illness?" 4 "You seem very upset. Tell me how your husband is avoiding you."

4 "You seem very upset. Tell me how your husband is avoiding you." The response "You seem very upset. Tell me how your husband is avoiding you" validates the client's feelings and encourages the client to look at the basis or reality of the expressed concern. The response "What makes you think he doesn't love you?" ignores the client's statement; the client has already told the nurse the basis for the feelings. The response "Avoidance is a defense. He needs your help to cope" puts the responsibility for the husband's behavior on the client, who may not be able to handle it. The husband may or may not be having difficulty dealing with the client's illness, and this question does not focus on the client's feelings.

A nurse concludes that a client is using displacement. Which behavior has the nurse identified? 1 Ignoring unpleasant aspects of reality 2 Resisting any demands made by others 3 Using imaginative activity to escape reality 4 Directing pent-up emotions at someone other than the primary source

4 Directing pent-up emotions at someone other than the primary source When acting out against the primary source of anxiety creates even further anxiety or danger, the individual may use displacement to express feelings toward a "safer" person or object. Ignoring unpleasant aspects of reality is an example of denial. Resisting any demands made by others reflects an inability to mature and accept responsibility. Using imaginative activity to escape reality is fantasy.

The parents of an adolescent who engages in self-injurious cutting behavior ask the nurse why their child self-mutilates. What should the nurse give as the reason for the cutting? 1 Cry for help 2 Suicide attempt 3 Attention-seeking behavior 4 Way to manage overwhelming feelings

4 Way to manage overwhelming feelings Self-injurious behavior is used to soothe or override painful feelings. Recent studies do not link cutting to suicidal thinking. Cutting behavior is often hidden from others; it is not attention-seeking behavior.

A client tells the nurse in the mental health clinic that the practitioner said that the cornerstone of therapy used in the clinic is cognitive therapy. The client asks what this therapy entails. What concept should the nurse explain as the basis of cognitive therapy? 1 "Unconscious feelings influence actions." 2 "Negative thoughts can precipitate anxiety." 3 "People can act their way into a new way of thinking." 4 "Maladaptive behaviors will continue as long as they are reinforced."

2 "Negative thoughts can precipitate anxiety." Cognitive behavioral therapy (CBT) is a highly structured psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative inaccurate thoughts and changing the rewards for behaviors. Cognitive therapy seeks to discover underlying thoughts that lead to feelings of depression and anxiety; also, it teaches the client to replace these thoughts with more positive, realistic thinking. The response, "Unconscious feelings influence actions," reflects a psychoanalytical approach to treatment. The response, "People can act their way into a new way of thinking," reflects a behavioral approach to treatment. The response, "Maladaptive behaviors will continue as long as they are reinforced," reflects a behavioral approach to treatment.

An 8-year-old child with a terminal illness is demanding of the staff. The child asks for many privileges that other children on the unit do not have. The staff members know that the child does not have long to live. The nurse can best help the staff members cope with the child's demands by encouraging them to do what? 1 Provide as many extra treats as possible because the child is dying. 2 Set reasonable limits to help the child feel more secure and content. 3 Give the child some extra treats so they will feel less anxiety after the child dies. 4 Understand that the dying child has unique needs and that special privileges can provide the necessary security.

2 Set reasonable limits to help the child feel more secure and content. Reasonable limits are necessary because they provide security and help keep the child's behavior within acceptable bounds. Relationships, not special privileges, should provide the necessary security. Providing treats is an unrealistic approach that allows the child to manipulate the situation

A 3-year-old child is brought to the emergency department by the mother, who reports that her child fell down the stairs and sustained injuries to the right arm and leg. During the physical assessment, the nurse identifies a number of old bruises on the child's back, buttocks, and upper arms. What should the nurse say to the child to obtain additional information? 1 "Why did you fall down the stairs?" 2 "Did you really fall down those stairs?" 3 "Show me how you fell down the stairs." 4 "Your mommy must have told you to say you fell down the stairs."

3 "Show me how you fell down the stairs." The response "Show me how you fell down the stairs" will allow the child to show what happened; it removes the pressure of verbalization. Children have difficulty answering "why" questions; asking why the child fell may add to the guilty feelings of the abused child. Asking, "Did you really fall down those stairs?" will confuse the child because it might become necessary to verify a lie. The response "Your mommy must have told you to say you fell down the stairs" will confuse the child because of his or her dependence on the mother; the child may be afraid of contradicting the mother.

A client is scheduled for several diagnostic studies. Which behavior best indicates to the nurse that the client has received adequate preparation? 1 Asks that the tests be explained again 2 Checks the appointment card repeatedly 3 Arrives early and waits quietly to be called for the tests 4 Paces up and down the hallway on the morning of the tests

3 Arrives early and waits quietly to be called for the tests The client's early arrival indicates an expected degree of anxiety; the quiet waiting indicates that the client has been told what to expect. A request for the tests to be explained again indicates an inadequate explanation or the inability of the client to remember the explanation that has been given. Checking the appointment card repeatedly and pacing up and down the hallway on the morning of the tests indicate a high degree of anxiety that may denote a fear of the tests because they have not been adequately explained.

A nurse with burnout asks the nurse manager, "What can I do to prevent burnout in the future?" What is the best response by the nurse manager? 1 "Hone your problem-solving skills." 2 "Ignore situations that can be changed." 3 "Improve your time-management skills." 4 "Develop a wide variety of coping strategies."

4 "Develop a wide variety of coping strategies." The response "Develop a wide variety of coping strategies" will help the nurse learn how to cope with stress; different defenses can be used in a variety of situations. Problem-solving may identify a problem after it exists; it is not a strategy for preventing a problem. Learning to ignore or avoid people or situations that cannot be changed, not those that can be changed, can help prevent professional burnout. Development of effective time-management skills is just one coping strategy to be used.

A woman who is frequently physically abused tells the nurse in the emergency department that it is her fault that her husband beats her. What is the most therapeutic response by the nurse? 1 "Maybe it was your husband's fault, too." 2 "I can't agree with that—no one should be beaten." 3 "Tell me why you believe that you deserve to be beaten." 4 "You say that it was your fault—help me understand that."

4 "You say that it was your fault—help me understand that." Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior. "Maybe it was your husband's fault, too" is a declarative statement that is closed, will limit dialog, and is not therapeutic. When the nurse voices her opinion saying, "I can't agree with that—no one should be beaten", the nurse is shutting off communication with the client. Nurses are to be nonjudgmental and not offer an opinion, and should ask open-ended questions to facilitate communication with the client. Asking a "why" question is generally not therapeutic because most clients cannot respond to these questions with logical explanations

A clinic nurse observes a 2-year-old client sitting alone, rocking and staring at a small, shiny top that she is spinning. Later the father relates his concerns, stating, "She pushes me away. She doesn't speak, and she only shows feelings when I take her top away. Is it something I've done?" What is the most therapeutic initial response by the nurse? 1 Asking the father about his relationship with his wife 2 Asking the father how he held the child when she was an infant 3 Telling the father that it is nothing he has done and sharing the nurse's observations of the child 4 Telling the father not to be concerned and stressing that the child will outgrow this developmental phase

3 Telling the father that it is nothing he has done and sharing the nurse's observations of the child The nurse provides support in a nonjudgmental way by sharing information and observations about the child. This child exhibits symptoms of autism, which is not attributable to the actions of the parents. Asking the father about his relationship with his wife or how he held the child when she was an infant indirectly indicates that the parent may be at fault; it negates the father's need for support and increases his sense of guilt. Telling the father not to be concerned and stressing that the child will outgrow this developmental phase is false reassurance that does not provide support; the father recognizes that something is wrong.