abcd

A client with a mood disorder is being discharged from a psychiatric hospital after agreeing to continue follow-up visits with a therapist. During the last interview with the nurse before discharge, the client says, "I've told you a lot about my life and my problems, but there are a few things that bother me that I've told no one." What is the most therapeutic response by the nurse once it has been determined that the client is not at risk for self-harm or harming others? "The purpose of our getting together is to discuss your problems." "Do you want to work on those during the few minutes we have left?" "What kind of problem have you not shared with me during our time together?" "One purpose of continuing counseling is to allow you to discuss things that bother you."

"One purpose of continuing counseling is to allow you to discuss things that bother you." Clients may introduce new topics during the last session to prevent termination; the nurse should encourage them to discuss these problems as outpatients. Two purposes of the last interview are to summarize and terminate, not to begin discussion of new problems. The last minutes of the last interview are not the appropriate time to introduce new problems.

A 49-year-old client is admitted with a diagnosis of cervical cancer. As the nurse is obtaining her health history, she says, "I haven't had a Pap smear for more than 5 years. I probably wouldn't be in the hospital today if I'd had those tests more often." What is the nurse's most appropriate response? "Please tell me why you waited so long." "You feel as though you've neglected your health." "It's never too late to start taking care of yourself." "Most women hate to have Pap smears done, but they're really important."

"You feel as though you've neglected your health." Stating that the client feels that she's neglected her health indicates recognition of expressed feelings; a nondirective and reflective response encourages verbalization. Stating that it is never too late to start taking care of her health is a judgmental response, because it implies that the client has been negligent. Although it is true that most clients hate to have Pap smears, this statement ignores the client's current emotional needs.

One morning a client with the diagnosis of acute depression says, "God is punishing me for my past sins." What is the best response by the nurse? "Why do you think that?" "You sound very upset about this." "Do you believe that God is punishing you for your sins?" "If you feel this way, you should talk to your spiritual advisor."

"You sound very upset about this." The response focuses on the client's feelings rather than the statement, and it serves to open channels of communication. "Why do you think that?" asks the client to decide what is causing the feelings; most people are unable to explain why they feel as they do. "Do you believe that God is punishing you for your sins?" simply echoes the client's statement and does not reflect feelings or stimulate further communication.

Which questions will allow the nurse to assess a preschool-age child diagnosed with asthma for delayed peer relationships? Select all that apply. 1 "Can your child independently dress each day?" 2 "Does your child use 'baby-like' terms when talking?" 3 "Does your child play with the other children in the playroom?" 4 "Has your child ever thought that the asthma is a punishment?" 5 "Does your child become anxious before respiratory treatments?"

2,3 Peer relationships begin to form during the preschool stage of development. This task can be affected by the diagnosis of a chronic illness, such as asthma. The nurse should assess the child for socialization with peers and overprotection by the family by asking if the child uses "baby-like" terms when talking and about interactions with other children in the playroom. Information obtained from these questions will allow the nurse to plan care that enhances the child's ability to socialize with other children. Mastery of self-care skills may also be affected; therefore, the nurse would ask the parent if the child is able to independently dress each day. Preschool-age children learn through preoperational thought which includes magical thinking; therefore, the nurse should assess information related to the child believing the diagnosis is a punishment. The child's body image may also be impacted; therefore, the nurse should assess for anxiety prior to respiratory treatments. However, assessment of these last three aspects addresses other concerns than peer relationships.

How does an individual overcome conflicting thoughts that arise during an Electra complex? By identifying with the parent of the same sex

A child with an Electra complex fantasizes about the parent of the opposite sex as his or her first love interest. This conflicting thought is overcome by identifying with the parent of the same sex as a way to win recognition and acceptance.

A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information? Low purine Low calcium High phosphorus High alkaline ash

A low calcium intake is recommended. Calcium and phosphorus are components of these stones; foods high in calcium and phosphorus should be avoided. Low purine and high alkaline ash diets are indicated for clients with gout.

Which drug used to treat acne has a bleaching effect? Isotretinoin Minocycline Tetracycline Benzoyl peroxide

Benzoyl peroxide Benzoyl peroxide has a bleaching effect on sheets, bedclothes, and towels. Isotretinoin is associated with photosensitivity, nasal irritation, dry skin and mucous membrane. Minocycline and tetracycline are systemic antibiotics that may cause photosensitivity reactions, vaginal candidiasis, and gastrointestinal upset.

Which behavior is seen in children at the undifferentiated stage of spiritual development, as propounded by Fowler?

Children have no concept of right or wrong to guide their behaviors The first stage of spiritual development, as described by Fowler, is the undifferentiated stage. During this stage children have no concept of right or wrong to guide their behaviors. The beginnings of faith are established as they develop trust in their parents or primary caregivers. Imitation of religious behavior without comprehending any meaning takes place in the intuitive-projective stage during toddlerhood. As children grow older and approach adolescence, they reason and question some of the established parental religious standards. They realize that prayers are not always answered and so they abandon some practices. A reverence for religious matters and articulation of faith takes place in the mythical-literal stage during the school-age years

A client has been taking methadone 40 mg/day for treatment of an opioid addiction. During a methadone clinic visit she tells the counselor that she is 3 months pregnant and receiving prenatal care. The counselor notifies the nurse in the prenatal clinic about the client's addiction history. What should the nurse in the prenatal clinic recommend that the client do? Withdraw the methadone slowly over the next several weeks. Continue the prescribed methadone to prevent withdrawal symptoms. Temporarily discontinue the methadone to improve maternal and neonatal outcome. Leave the methadone maintenance program during the pregnancy and reenter it after the birth.

Continue the prescribed methadone to prevent withdrawal symptoms. Methadone is the only medication approved for the treatment of pregnant women with opioid addiction. Although methadone crosses the placenta, it is considered safer for the newborn than the acute opioid detoxification that would result if the methadone was not administered

As a nurse enters a room and approaches a client who has schizophrenia, the client shouts, "Get out of here before I hit you! Go away!" What does the nurse conclude provoked the client's aggressive behavior? Voices are directing his behavior. He felt confined when the nurse walked into the room. He was afraid of doing harm to the nurse if the nurse came closer. He thought that the nurse was similar to someone who had frightened him in the past.

He felt confined when the nurse walked into the room. Clients acutely ill with schizophrenia frequently do not trust others; feeling trapped may be frightening, causing them to lash out. There is no indication that voices are speaking to the client in this instance. Clients acutely ill with schizophrenia usually are more concerned with what is happening to them and are not able to be concerned about others. Although the nurse may have reminded the client of a threatening person from his past, it is not the primary motivation for this behavior.

A 3-year-old is placed in a bilateral hip spica cast for the treatment of developmental dysplasia of the hip. The nurse should teach the parents to monitor their child and report to the practitioner the occurrence of what? Warm toes Leg numbness Skin desquamation Generalized discomfort

Leg numbness Numbness is a neurologic symptom that should be reported immediately because it indicates pressure on the nerves and blood vessels. Warm toes indicate intact circulation to the lower extremities. Peeling skin (desquamation) is the result of inadequate skin care or a drug reaction, but not cast placement.

An 8-year-old child is being given insulin glargine before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack? Offer a snack to prevent hypoglycemia during the night. Give the child a snack if signs of hyperglycemia are present. Avoid a snack because the child is being treated with long-acting insulin. Keep a snack at the bedside in case the child gets hungry during the night.

Offer a snack to prevent hypoglycemia during the night. Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night.

A 6-year-old child treated for acute glomerulonephritis has improved and is soon to be discharged. What should the nurse plan to offer the parents in preparation for the discharge? Samples of no-salt-added diets for the child to continue at home Suggestions about activities to keep the child mobile for longer periods Instructions about when the child should return for a workup for a kidney transplant Phone numbers to reach the nurse on the unit so the parents may call if there are any questions

Samples of no-salt-added diets for the child to continue at home Foods high in sodium and salty treats are usually limited to control or prevent edema and hypertension until the child is asymptomatic. The mother should contact the healthcare provider, not the nurse on the unit, for follow-up care.

According to Freud, which aspect of one's life helps in the development of personality? The need for self-knowledge The need for sensual pleasure The need for trust and identity The need for moral development

The need for sensual pleasure According to Freud, sexual instincts or sensual pleasure is significant in the development of our personalities. From childhood to later stages of development, a child obtains pleasure from different parts of the body. Self-knowledge is not a theory, but an aspect of the personality that develops gradually as an infant learns about independent existence. Erikson proposed the psychosocial development of personality, wherein he states that a child tries to master key conflicts, like trust versus mistrust and identity versus role confusion, at different stages in life. Kohlberg, who explains that children develop moral reasoning in two stages, describes moral development.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. On what fact should the nurse base her response? Hypothyroidism is a gradual slowing of the body's function. There will be a decrease in pituitary thyroid-stimulating hormone (TSH). There may not be enough thyroid tissue to supply adequate thyroid hormone. Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones.

There may not be enough thyroid tissue to supply adequate thyroid hormone. After a subtotal thyroidectomy the thyroxine output may be inadequate to maintain an appropriate metabolic rate. Hypothyroidism is a decrease in thyroid functioning, not a slowing of the entire body's functions. In hypothyroidism the level of TSH from the pituitary usually is increased. Atrophy of the remaining thyroid tissue does not occur.

What does the nurse recall is the major defense mechanism used by an individual with a phobic disorder?

avoidance The person transfers anxieties to activities or objects, usually inanimate objects, which are then avoided to decrease anxiety. Splitting is the compartmentalization of opposite affective states and the inability to integrate the positive and negative aspects of others or self. Regression, the return to an earlier, more comfortable level of development, is not the defense mechanism used by someone with a phobia. Conversion, the transfer of a mental conflict to a physical symptom, is not the defense mechanism used by someone with a phobia.