lesson 1

A women whose husband is teminally ill says, "I don't want to cry in front of him. I don't wnat him to know how close he is to death or how sad I am." Which response by the nurse would be most therapeutic?

"He might be more comforted than disturbed by your tears"

After the death of his wife, a man tells the nurse, "I can't live without her. She was my whole life." Which is the nurse's most therapeutic reply?

"Her death is a terrible loss for you."

The nurse is assessing a patient using the CAGE Questionnaire. The patient anwers yes to all of the questions. The nurse suspects alcoholism and feels the patient is in denial when the patient is in denial when the patient states which of the following?

"I don't have a problem with alcohol. I can quit anytime I want to."

Which statements by a patient who is terminally ill give the nurse information relevant to spiritual assessment?

"I feel inner peace with my decision to use hospice services." "I plan to use thes last weeks to experience he process of dying as fully as I experienced the richness of living." "Listening to hymns helps deepen my relaxation and the rlief I get from my pain medication."

After being notified that her husband died of heart failure, a wife approaches the nurse who cared for her husband. In the hospital hallway the wife shouts angrily, "He'd still be alive if you'd given him your undivided attention!" Select the nurse's best response.

"I understand you're feeling upset. Let's go to our conference toom, and I'll stay with you until your family comes."

A 45-year-old man is brought to the emergency department presenting with a respiratory rate of 6 and cardiac dysrhythmias. The most appropriate question the nurse should ask the patient's friend is

"Is he using any opiods such as heroin?"

A patient asks for information about AA. Which is the nurse's best response?

"It's a self-hekp grup with the goal of sobriety."

A diabetic patient who is hospitalized tells the nurse, "I don't understand why i can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up." Which response by the nurse is appropriate?"

"Stressors such as illness casue release of hormones that increase blood sugar."

A patient with a history of daily alchol abuse says, "Drinking helps me cope with being a single parent." Which response by thenurse would help the individual conceptualize the drinking more objectively?

"Tell me what happend the lat time you drank."

A nurse talks with a person whose spouse died suddenly while jogging. Which is the appropriate statement for the nurse?

"The loss of your spouse must be very painful for you."

An indivudual was killed during a store robbery 2 weeks ago. The widowed spouse, who is diagnosed with schizoaffective disorder, cries spontaneously whentalking about the death. Which is the nurse's most therapeutic comment?

"The unexpected death of your spouse must be painful.I'm glad you're able to talk to me about your feelings."

A 26 month old child displays negative behaviors. The parent says, "My child refuses toilet training and shouts "NO!" when given direction. What do you think is wrong?"

"This is normal for your child's age. The child is triving for independence."

The nurse has been asked to administer coping mesurement instrument to a patient. What education would the nurse present to the patient related to this tool?

"This tool will help assess recent positive and negative events you are expereiencing."

A family of terminally ill patient ask the nurse, "What can we say when our family member mentions death is coming soon?" Which response could the nurse suggest?

"We feel so sad when we think of life without you."

A terminally ill patient says, "I know I'm not going to get well, but still..." and the patient's voice trails off. Which response by the nurse would be therapeutic?

"What do you hope for?"

A patient diagnosed with metastatic brain cancer says, "I'm dying, but I'm still living, I want to be in control as long as I can." Which reply shows the nurse was actively listening?"

"YOur mind and spiri are healthy, although your body is frail."

A nre patient in an alcohilic rehab says, "I'm just a social drinker. I usually drink one or two at brunch, a few cocktails in the afternon, win at dinner, and a few drinks in the evening." Which response by the nurse will help the patient view the drinking more honestly?

"You describe drinking steadily throughout the day and evening. Am I correct?

Which statement shows a nurse has empathy for a patient who made a suicide attempt?

"You must have been very upset when ou trie to hurt yourself."

A patient tells the nurse, "I'm told that i should reduce stress in my life, but i have no idea where to start." Which would be the best initial nursing response?

"lets talk about whats going on in your life and hen look at possible options

Which finding indicates the successful completion of an individual's griefing process?

After 15 months, a widowed person realistically remembers both the pleasures and disappointments of the relationship with the spouse

Shortly after a man's wife dies, the man approaches the nurse who cared for his wife during her final hours of life and says angrily, "If you had given our undivided attention, she would still be alive." Which analysis applies?

Anger is a phenomenon experiencced during grieving.

A patient is the primary caregiver of a disabled family memer at home, and has now been unexpectedly hospitalized. What action can the nurse take to enhance the coping ability of the patient?

Ask if ther is another family member who can help at home while the patient is in the hospital.

A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agiatated, and diaphertic. Which medication can the nurse anticipate the HCP to prescribe?

Benxodaiazepine, such as lorazepam (Ativan)

A patient with a history of daily alchol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?

Between 0200 tomorrow and hospitalized day 2 (24 to 48 hours after dinking has stopped)

The treatment eam plans care for a person diagnosed with schizophernia and cannabis abuse. The person has recently used cannabis daily and is experiencing increased hallucinations and delusions. Which principle applies to care planning?

Consider each disorder priary and provide simultaneous treatment

A nurse assesses a confused older ault. The nurse experiences sadness and reflects, "The patient is like one of my grandparents.. so helpless." What feelings does the nurse describe?

Countertansference

The nurse is assessing for coping patterns of a newly admitted patient. What will the nurse include in this assessment?

Current stressors as perceived by the patient, use o drugs and alcohol, recent weight changes

A patient who was admitted 24 hours ago has become increasingly irritable and now says there are bugs on his bed. The nurse suspects

Delirium tremens (DTs)

A patient admitted to an alcoholism rehab program says, "I'm just a scial drinker. I usually have a drink or two at brunch, afew cocktails in the afternoon, and several drinks during the evening." the patient is using which defense mechanism?

Denial

A patient's fiance died in an automobile accident several days ago. The patient reports crying and experiencing feelings of guilt and anger. This behavior is characteristic of which stage of acute grief?

Development of awareness

As death approaches, a patient diagnosed with acquired immunodeficiency syndrome (AIDS) says, "I don't want to see a lot of visitors anymore. Just my parents and my sibling can come in for a while each day." What action should the nurse take?

Discuss the request with the parents and sibling. Suggest that they explain the patient's decision to friends

When working with a patient beginning treatment for alcohol abuse, What is the nurse's most therapeutic approach?

Empathetic, supportive

Strategies that a nurse could use in motivational interview to increase the chances of change include which of the following?

Encouraging the patient to think of ways to change environmental triggers to abuse substances, Asking the patient how they think substance abuse affects their family life, Asking the patient what methods they think would work and encouraging participating in self-help groups

Psychotherapy for individuals at risk for comlicated grief focuses on which goals?

Exploring emotional responses to a loss, solving problems relaed to moving forward in life, learning about the stages and symptoms of griefing

After a management decision to admit terminal care patients to a medical unit, the nursing manager notes that nursing staff on the unit appear tired and anxious. Staff absences from work are increasing. The nurse manager is concerned that staff may be experiencing stress and burnout at work. What action would be best for the manager to take that will help the staff?

Have training sessions to help the staff understand their new responsibilities.

The urse is developing a care plan for a patient with ineffective coping skills. Which intervention would be an example of a problem-focused coping strategy?

Identifying a confidet to share feelings

A person whose spouse died two years earlier tells friends, "I think I'll start going out socially, maybe even take someone to dinner." This comment best demonstrates that the individual is

In a perios of resolution of grief

The school nurse is assessing coping skills of highschool students who attend an alternative school for students at high risk of not graduating. What is the priority concern that the nurse has for this student population?

Increased risk of suicide

The nurse is reviewing the care plan for a patient experiencing difficulty coping with stress. The nurse recognizes that an example of initiating a cognitive restructuring intervention to enhance coping abilities is which of the following?

Indentifying the cause of fear

An adult who was widowed 18 months ago says, "I can now remember good times we shared without getting upset. Sometimes I even think about the disappointments. I've become accustomed to sleeping in our bed alone." The work of mourning:

Is at or near completion

Select the nursing intervention necessary after administering naloxone (NARCAN) to a patient experiencing an opiate overdose.

MOnitor the airway and VS every 15mins

A women in the last trimester of pregnancy drinks 8-12oz of alcohol daily. The nurse plans for the delivery of an infant who is..

Microcephalic and cognitiely imparied

The nurse assesses the outcomes of a motivational interview on a patient with a dual diagnosis of alcoholism with DTs and determines that the communication was nontherapeutic. What should the nurse's next priority be?

Notify provder to obtain order for oxazepam (Serax) and vitamin B infusion

Which actiond by a nurse contribute to protecting the rights of patients who are terminally ill?

Offer choices that promote personal control, provide interventions that convey respect, support the patients quest for spiritual growth

The nurse recognizes a potential health threat to an alcoholi patient who is using the drug disulfiram (Antabuse) when the nurse reads in the health record that the patient is also which of the following?

On blood thinners, Ingesting alcohol, Using mouthwash

A patient who recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. What action should the nurse take?

PLan to reinforce and repeat teaching about diabetes management.

The nurse is caring for a patient who is experiencing alcohol withdrawal. What is the main priority for this patient?

Promote a safe, calm, and comfortable environment

A APteint hospitalized injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diapherotic. Which nursing intervention has priority?

Provide 1-1 supervision

A patient newly diagnosed with pancreatic cancer says, "My father also died of pancreatic cancer. I took care of him during his illness. I can't go through that." Select the highest priority nursing diagnosis.

Risk for suicide

A patient admitted yesterday for injuries sustanied in a fall while intoxicated believes snakes are crawling on the bed. The patient is anxious agitated, and diaphorectic. What is the priority nursing diagnosis?

Risk of injury

A nurse worked t a hospital for several months, resgined, and then took a position at another hospital. In the new position, the nurse often volunteers to be the med nurse. After several serious medication errors, an investigation reveals that the nurse was diverting pstient narcotics for self-use. What early indicator of the nurse's drug use was evident?

Seeking to be assigned as medication nurse

A patient has not bee sleeping well because he is worried about losing his job and not being able to support his family. The nurse takes the patient's vital signs and notes a pulse rate 112 beats/min, respirations are 26/min, and his blood pressure was 166/88 instead his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first?

Slow and deepen breathing via using a positve repeated word

During history-taking, a patient tells the nurse that he is addicted to alprazolam (Xanax) and that he takes six 1mg tablets a day. He quit cold turkey yesterday and now presents with extreme agitation, increased heart rate, and panic. The nurse suspects which disorder?

Stress Reaction

A patient who was admitted for a heroin overdose received naloxone (Narcan) which improved the breathing pattern. Two hours later, the patient reports muscle aches, abdominal cramps, gooseflesh and says, "I feel terrible." Which analysis is correct?

Symptoms of opiate withdrawal are present.

After therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?

The nurse feels unusually happy when the patients mood begins to lift

A nurse working with a patient whose spouse recently died uses cheer and humor to lift the person's spirits. At one point, the widowed person smiles briefly. What analysis of this scenario is correct?

The nurse needs supervision; the communication technique was not appropriate

An older patient presents to the outpatient clinic with a chief complaint of headache and insomnia. Ingatheing history, The nurse notes which factors as contributing to this patient's cheif complaint?

The patient has recently lost her spouse and needed to move in with her daughter

A patient was admitted 48 hours ago for inuries sstained while intoxicated. The patient is shaky, irratible, anxious, and diaphoretic. The pulse rate is 130 beats/ min. The patient shouts, "Snakes are crawling on my bed. I've got to get out of here." What is the most accurate assessment of the situation?

The patient ihas symptoms of alchol withdrawal delirium.

To prevent Wernicke's encephalopathy from heavy alcohol use, the nurse anticipates an order for which medications?

Thiamine and B complex IV

When a person first begins drinking alchol, two drinks produce relaxation and drowsiness. After one year of drinking, four drinks are needed to achieve the same relaxed, drowsy state. Why does this change occur?

Tolerance develops

A grieving patient tells a nurse, "It'd been eight months since my spouse died. I thought I would feel better by now, but lately I feel worse. I have no energy. I am lonely, but I don't want to be around people. What should I do?" What is the nurse's best counsel?

Understand this is a normal response

In the ER, a patient's vital signs are: BP 66/40, Pulse 140, RR 8/min, The patient overdosed on illegally obtained Hydromorphine (Dilaudid). Select priority outcome.

Within 8 hourse, VS will satbilize as evidence by BP greater than 90/60, P less than 100, and R ar or above 12.

A nurse cared for a terminally ill patient for over a month and always looked forward to spending time with the patient. whne the atient died, the nurse experienced sadness and felt mildly depressed. Eventually, the nurse explains these feelings to a mentor. The mentor should counsel the nurse:

about the experience of disenfranchised grief

A patient was admitted last night with a hip fracture sustained in a fall while intoxicated. The patient points to the Buck's traction and screams, "somebody tied me up with ropes>" The patient is experiencing

an illusion

A 26 month old child displays negative behavior, refuses toilet training, and often shouts no when fiven directions. Using freuds satges of psychosexual development, a nurse would assess the child's behavior is based on which stage?

anal

A widow grieving her husband's sudden death tells the nurse, "I'm not feeling well. Yesterday, I saw my husband walk through the door, stop, and smile at me. Then he just faded away." Which is the nurse's most appropriate action?

counsel the widow that vizualizations are anormal part of grieving

Termination of a therapeutic nurse-patient relationship with a patient has been successful when the nurse:

discusses with the patient changes that have happened during the relationship and evaluates the outcomes

A nurse manager notices that a staff member spends minimal tie with a patient diagnosed with AIDS who is terminally ill. The patient says, "I'm having intense emotional reactions to this illness. Sometimes I feel angry, but other times I feel afraid or abandoned." The nurse manager can correctly hypothessize that the most likely reason for the staff member's avoidance is:

feelings of inadequacy in dealing with complex emotional needs

After the death of a spouse, an adult repeatedly says, "I should have made him go to the doctor when he said he didn't feel well." This individual is experiencing:

guilt

The mourning process is more difficult when the bereaved

has experienced a number of previous losses

Which statement most accurately describes substance adiction?

it is a lack of control over use. Tolerance, craving, and withdrawal symptoms occur when intake is reduced or stopped

Which assessment findings best collaborate to the withdrawal from CNS depressants?

nausea, vomitting, diaphoresis, anxiety, and tremors

A recently widowed patient tells the health care provider, "I have so much epigastric discomfort. I wonder if I have an ulce." Diagnostic test are negative. The symptom demonstrates

normal phenomenon of mourning

Which is an important nursing intervention when giving care to a patient withdrawing from a CNS stimulant?

obsere for depression and suicidal ideation

The sposue of a patient in hospice care angrily tells the nurse, "The care provided by the side and other family members is inadequate, so I must do everything myself. Can't anyone do things right?" The palliative care nurse should

provide teaching about anticipatory grieving

A terminally ill patient tells the nurse, "LIfe has been good. I am prod of being self-educated. I overcame adversity with willpower. I always gave my best and expected things to turn out well. I intend to die as I lived: Optimisticaly." The nurse planning care for this patient recognizes a critical need to:

support the patient's use of personal resources to meet challenges

The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to

switch from sympathetic mode of the autonomic nervous system to he parasymphathetic mode.

A patient tells he nurse, "my doctor thinks my problems with stress relate to the neagtive way i think about things, and he wants me to learn a new way of thinking." Which response would be in keeping with the doctor's recommendations?

teaching the patient to recognize, reconsider, and reframe irrational thoughts

A patient comes to n outpatient appointment obviously in toxicated. The nurse should...

tell the patient, "We cannot see you today becasue youve been drinking."

Children of a widowed parent confer with the nurse; their surviving parent repeatedly relates the details of finding the deceased parent not breathing, performing cardiopulmonary resuscitation (CPR), going to the hospital by ambulance, and seeing the pronouncement of death. The family asks, "What can we do?" The nurse should counsel the family:

that repeating the story is helpful and a necessary part of grieving

after an automobile accident. The patient is ataxic with slurred speech and mild confusion. The blood alcohol level is 400mg/dl (0.40%). Considering the relationship between behavior and blood alcohol level, Which conclusion can the nurse draw?

the patient has a high tolerance to alchohol.

A child drowned while swimming in a local take four years ago. Which bhavior indicaes that the parents are effectively coping with their loss? The parents:

throw flowers on he lake at each anniversary date of the accident

During the third week of treatment, the spouse of a patient in an alcoholism rehabiliation program says, "After discharge, I'm sure everything will be just fine." Which remark by the nurse will be most helpful to the spouse?

"Although sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol."