Chapter 13: Psychosocial Health & Illness

The nurse is updating a plan of care for a patient who with a nursing diagnosis of Anxiety. Which patient behavior indicates to the nurse that the problem is resolving? 1. Pacing in the hallway at intervals 2. Using relaxation techniques 3. Speaking rapidly when spoken to 4. Avoiding eye contact

Using relaxation techniques

A client is at the clinic and tells the nurse, "I was taking my blood pressure medications and watching my diet, but that didn't help my blood pressure. So now I have stopped the medication and will just eat whatever I want." Which is the most appropriate nursing diagnosis for this client? 1. Anxiety 2. Risk for Hopelessness 3. Ineffective health maintenance 4. Depression

Ineffective health maintenance

An adult patient is diagnosed with lung cancer, and surgery to remove the right lung is recommended. The patient is uncertain about consenting to the surgery because of the risks involved. Which nursing diagnosis is most appropriate for this patient? 1. Decisional Conflict 2. Death Anxiety 3. Powerlessness 4. Ineffective Denial

Decisional Conflict

The nurse is developing a plan of care for a patient who has been admitted with a serious acute illness, which is likely to continue long term. The patient is the parent of three small children. The nurse writes the following intervention: "Facilitate communication between patient and significant other regarding the sharing of responsibilities to accommodate changes brought on by illness." Which purpose does this intervention address? 1. Promotes self-esteem 2. Increases positive body image 3. Facilitates role enhancement 4. Prevents depersonalization

Facilitates role enhancement

The nurse is providing care for a client newly diagnosed with anxiety. Which outcome is most realistic and appropriate in planning care for this client? 1. Describes coping strategies for anxious situations 2. Discusses the reasons for episodes with significant others 3. Establishes two new social relationships 4. Verbalizes the client has been episode free

Describes coping strategies for anxious situations

The nurse is providing care for a patient with cancer who is receiving chemotherapy. Based on Maslow's Hierarchy of Needs, which nursing intervention is the first priority? 1. Assess for and treat pain. 2. Determine if the patient is hungry or thirsty. 3. Explore feelings about dying. 4. Observe client's self-care abilities.

Determine if the patient is hungry or thirsty.

The nurse is seeing a home-care client with a history of mental illness. The client is home after undergoing a mastectomy for breast cancer, which requires regular dressing changes. The client states, "Every time I have a nurse come here, they do this dressing differently. I can't seem to have a nurse that does it right." Which is the best response by the nurse? 1. "I don't know how other nurses do your dressing change, but I will do it correctly." 2. "I have done this type of dressing many times, so you don't need to worry." 3. "How would you like this dressing change done? Tell me how you think it should be done." 4. "It seems you have some concerns about our agency. You may need to talk to the supervisor."

"How would you like this dressing change done? Tell me how you think it should be done."

The nurse is providing care for a group of patients in an acute care setting. Which comment by one of the patients demonstrates an internal locus of control? 1. "My blood sugar wouldn't be out of control if my wife prepared better foods." 2. "I knew I shouldn't have come to this hospital; I'd be better if I hadn't." 3. "God must be getting even with me for some of my past behavior." 4. "I'm just glad to be alive; my accident could've been a lot worse."

"I'm just glad to be alive; my accident could've been a lot worse."

The nurse is providing care for a patient diagnosed with clinical depression. Which statement by the nurse is best when communicating with this patient? 1. "It's a beautiful day today; you'll feel better if you look out the window." 2. "You're having a bad day; I'm sure you'll feel better soon." 3. "Life seems overwhelming at times; would you like to discuss how you're feeling?" 4. "You are very lucky to have such a supportive family."

"Life seems overwhelming at times; would you like to discuss how you're feeling?"

An adolescent female patient sustained facial fractures and a 6-inch laceration on the left side of her face in a motor vehicle accident. The patient tells the nurse that she does not want anyone to see her "looking this way." Which statement by the nurse is most appropriate? 1. "Tell me what you mean by 'looking this way.'" 2. "Okay, I'll restrict your visitors until your face heals." 3. "Your friends and family love you no matter what." 4. "You're young; your face will heal quickly."

"Tell me what you mean by 'looking this way.'"

The nurse is providing care for several patients on a medical-surgical unit. To which patient statement is the nurse most alerted for making a mental health referral? 1. "Since finding out I have cancer, I feel nervous and uneasy all the time." 2. "I can feel down about my job, but if I go to the gym and exercise, I feel better." 3. "When things really bother me, I just put them right out of my head and go on." 4. "Things at home are just piling up. I just feel so alone and empty inside of me."

"Things at home are just piling up. I just feel so alone and empty inside of me."

The nurse is providing care for a patient with a history of depression. The patient states, "Sometimes I just don't believe in using all the medications the doctor orders for me, so I use a lot of over-the-counter herbal medications." Which is the most appropriate response by the nurse? 1. "Yes, there are many good herbal therapies, but you'll want to let your doctor know about these therapies in addition to the medications ordered for you." 2. "Some over-the-counter medications work very well for depression; however, you cannot take them without your doctor's permission." 3. "You shouldn't be treating yourself because you don't know how these medications work with your depression." 4. "I think it's a great idea! If they make you feel better, then continue doing what you're doing."

"Yes, there are many good herbal therapies, but you'll want to let your doctor know about these therapies in addition to the medications ordered for you."

The nurse is developing a plan of care for a client with anxiety. Which are appropriate nursing interventions the nurse can use for assisting the client in reducing anxiety? Select all that apply. 1. Assist the client to identify triggers and situations that create anxiety. 2. Be vague in answering questions because of not knowing how the client will react. 3. Develop coping strategies and behavior modification techniques with the client. 4. Remind the patient not to engage in any negative thinking to avoid anxiety. 5. Teach the client relaxation techniques to be used as required or needed.

1.Assist the client to identify triggers and situations that create anxiety. 3.Develop coping strategies and behavior modification techniques with the client. 5.Teach the client relaxation techniques to be used as required or needed.

Which are the best communication strategies a nurse can use to encourage patients to share personal and sensitive information during the interviewing process? Select all that apply. 1. Be aware of personal biases and opinions with regard to the patient's information. 2. Ask very specific yes and no questions to keep the patient focused and attentive. 3. Start by asking very broad questions, and then proceed to more specific questions. 4. Avoid any questions related to culture- and gender-specific details about the person. 5. Use an open and positive tone of voice, facial expression, and body language.

1.Be aware of personal biases and opinions with regard to the patient's information. 3.Start by asking very broad questions, and then proceed to more specific questions. 5.Use an open and positive tone of voice, facial expression, and body language.

A client is admitted to the psychiatric unit of a local hospital. During the nursing assessment, the nurse finds the client poorly groomed, wearing dirty clothes, and tearful, and the client reports weight loss with poor appetite. The nurse formulates a nursing diagnosis of Depressed Mood. Which are the most appropriate nursing outcomes for this client? Select all that apply. 1. Eats a well-balanced diet 2. Depressed mood resolves by discharge 3. Bathes, washes, and maintains grooming and hygiene 4. Develops a spiritual belief system or engages in a religious affiliation 5. Is able to discuss lifestyle and living arrangements by the time of discharge

1.Eats a well-balanced diet 3.Bathes, washes, and maintains grooming and hygiene

Which assessment findings might suggest that the patient has low self-esteem and requires more in-depth assessment? Select all that apply. 1. Infrequent eye contact 2. Straight posture 3. Being overly critical of others 4. Careful grooming 5. Clear personal identity

1.Infrequent eye contact 3.Being overly critical of others

The school nurse at the elementary school is preparing a presentation for parents on promoting self-esteem in children. Which are some self-esteem promotion strategies the nurse will teach at the presentation? Select all that apply. 1. Treat children with respect. 2. Be firm and consistent in applying rules. 3. Do not allow children to make decisions independently. 4. Provide frequent positive and negative criticism. 5. Insist children to exhibit maturity of privileges.

1.Treat children with respect. 2.Be firm and consistent in applying rules.

Which interventions by the nurse might help the patient maintain a sense of personhood during hospitalization? Select all that apply. 1. Addressing the patient by the first name 2. Making eye contact if it is comfortable for the patient 3. Always offering an explanation before beginning a procedure 4. Speaking to others about the patient so that the patient can hear you 5. Asking if the patient has cultural practices that impact their care

2.Making eye contact if it is comfortable for the patient 3.Always offering an explanation before beginning a procedure 5.Asking if the patient has cultural practices that impact their care

There are many theories and treatments for depression. Based on current research, which is considered to be the most effective treatment for serious depression? 1. Psychotherapy 2. Antidepressant medications 3. Education 4. Social support networks

Antidepressant medications

nurse understands the necessity of focusing nursing care on the entire person. Which focus is considered most appropriate for the nursing profession? 1. Biomedical focus 2. Psychosocial focus 3. Biopsychosocial focus 4. Physical focus

Biopsychosocial focus

The nurse is providing care for a patient admitted with severe depression and identifies a nursing diagnosis of Hopelessness on the patient's plan of care. Which outcome is appropriate for this diagnosis? 1. Displays stabilization and control of mood 2. Sleeps 6 to 8 hours per night with report of feeling rested 3. Does not engage in risky, self-injurious behavior 4. Eats a well-balanced diet to prevent weight change

Displays stabilization and control of mood

A patient admitted with depression has a nursing diagnosis of Chronic Low Self-Esteem. Which Nursing Outcomes Classification (NOC) outcome is essential for this nursing diagnosis? 1. Decision Making 2. Distorted Thought Content 3. Role Performance 4. Depression Level

Depression Level

Which nursing intervention specifically helps reduce a patient's anxiety? 1. Teaching the importance of adequate nutrition and hydration 2. Giving clear facts pertaining to the patient's circumstances 3. Promoting small-group activities to improve self-esteem 4. Monitoring the patient for the risk of suicide

Giving clear facts pertaining to the patient's circumstances

The nurse is updating the plan of care for a patient scheduled to undergo a mastectomy for breast cancer. Which nursing diagnosis does the nurse anticipate in expectation of the body changes associated with the upcoming surgery? 1. Deficient Knowledge 2. Impaired Adjustment 3. Hopelessness 4. Grieving

Grieving

The nurse is working with a group of clients who recently experienced health alterations that impacted physical and psychosocial functioning. When the nurse addresses self-concept, which statement best describes self-esteem? 1. View of oneself as a unique human being 2. One's mental image of one's physical self 3. One's overall view of oneself 4. How well one likes oneself

How well one likes oneself

A client who is 45 years of age has a history of anxiety and comes into the emergency department with chest pain. The patient is diagnosed with a myocardial infarction (MI). The patient tells the nurse, "This is the most ridiculous thing I've ever heard of. I eat well, exercise, and am too young to have a heart attack." Which reaction does the nurse recognize the patient is most likely experiencing? 1. Fear related to the diagnosis 2. Decisional conflict 3. Ineffective denial 4. Overreaction

Ineffective denial

A patient diagnosed with testicular cancer is undergoing chemotherapy, which leaves him unable to help care for his young children. As a result, his spouse misses work whenever the children are ill. The spouse is becoming increasingly distressed over the situation. Which experience does the nurse identify? 1. Role strain 2. Interpersonal role conflict 3. Role performance 4. Interrole conflict

Interrole conflict

A frail, older adult patient admitted with dehydration to a medical-surgical unit is exhibiting confusion, distractibility, memory loss, and irritability. Which is the most important action for the nurse? 1. Recognize these symptoms as signs of normal, physiologic aging. 2. Obtain a urine specimen before notifying the primary care provider. 3. Be sure the patient is placed in a room occupied with another patient. 4. Interview the patient in order to perform screening for clinical depression.

Interview the patient in order to perform screening for clinical depression.

The nurse understands that which is the best description of personal identity? 1. It is a continually evolving sense of individuality and uniqueness. 2. It involves the same information as the demographic data. 3. It is a part of the person's genetic and cultural heritage. 4. It includes individual information guarded to avoid identity theft.

It is a continually evolving sense of individuality and uniqueness.

The nursing diagnosis Disturbed Personal Identity is identified for a newly admitted patient. Which is an example of an individualized goal for that patient? 1. Distorted Thought Control 2. Anxiety Level 3. Self-Mutilation Restraint 4. No Self-Injury, Consistently Demonstrated

No Self-Injury, Consistently Demonstrated

A female client tells the nurse, "I see how people look at me with my crooked back and short leg. No one has to tell me that I'm not pretty." Which conclusion does the nurse draw from the client's statements? 1. The client has an overinflated sense of self-esteem. 2. The client possesses a well-developed self-concept. 3. The client is dealing with an overactive imagination. 4. The client is experiencing a state of low self-concept.

The client is experiencing a state of low self-concept.

The nurse is assessing a patient admitted with a newly diagnosed bleeding duodenal ulcer. The patient is exhibiting physiological signs of anxiety and seems to have difficulty concentrating. During the interview, the patient tells the nurse that he is often "short of breath" and states, "I lie awake nights worrying about everything." The patient has been unable to work or care for family for the past 6 months. Which is the nurse's priority after documenting this information in the nurses' notes? 1. Provide emotional support for the patient using reflective listening technique. 2. Do nothing; people with duodenal ulcers typically cannot work. 3. Question the patient's family about the information received from the patient. 4. Notify the primary care provider, and ask for a referral to a mental health professional.

Notify the primary care provider, and ask for a referral to a mental health professional.

An adolescent patient is admitted to the hospital. The nurse is aware the patient has no medical restriction on visitation. Which group of potential visitors is it most important for the nurse to encourage to help maintain the patient's social identity while hospitalized? 1. Peers 2. Grandparents 3. Siblings 4. Parents

Peers

An older adult patient is admitted from a skilled nursing residence to a medical-surgical unit is exhibiting confusion, distractibility, memory loss, and irritability. The patient has a medical diagnosis of Dehydration. Which finding leads the nurse to suspect dementia, rather than depression or dehydration, as the source of the symptoms? 1. Rambles, speaks incoherently, answers questions inappropriately 2. Speaks slowly with delayed response to questions, but responds appropriately 3. Awakens early in the day yet sleeps almost constantly during the day 4. Sometimes has difficulty concentrating on details of the present situation

Rambles, speaks incoherently, answers questions inappropriately

A patient undergoing fertility treatments for the past 9 months learns that despite in vitro fertilization she still is not pregnant. This patient is at risk for experiencing a crisis in which component of self-concept? 1. Body image 2. Self-esteem 3. Personal identity 4. Role performance

Self-esteem

The nurse is providing care for patient who comes to the emergency department experiencing headache, palpitations, nausea, and dizziness. After determining that the patient has tachycardia and trembling, the nurse suspects anxiety. Which level of anxiety does the nurse recognize? 1. Mild 2. Moderate 3. Severe 4. Panic

Severe

A patient who lost their job last month has now been told that the patient's spouse wants a divorce. The patient states, "I know I don't have much to offer a spouse who wants more from life, and now I'm not even bringing home any money." Which nursing diagnosis is most appropriate for the patient? 1. Chronic Low Self-Esteem 2. Situational Low Self-Esteem 3. Disturbed Personal Identity 4. Disturbed Body Image

Situational Low Self-Esteem

The nurse on a psychiatric unit is providing care for a client with severe depression. The client states, "I just cannot go on. It is hopeless for me, and there is no end in sight. My family would be better off without me burdening them." For which condition does nurse recognize this client as being most likely at risk? 1. Ineffective coping 2. Denial 3. Impaired recovery 4. Suicide

Suicide

The nurse is assessing a patient for depression. Which sets of behavioral symptoms may indicate depression to the nurse? 1. Preoccupation with loss, self-blame, and ambivalence 2. Anger, helplessness, guilt, and sadness 3. Anorexia, insomnia, headache, and constipation 4. Tearfulness, withdrawal, and present substance abuse

Tearfulness, withdrawal, and present substance abuse