Adaptive Quiz Study Set - Therapeutic Communication
A client whose spouse recently died appears extremely depressed. The client says, "What's the use in talking? I'd rather be dead. I can't go on without my spouse." What is the best response by the nurse? "Would you rather be dead?" "What does death mean to you?" "Are you thinking about killing yourself?" "Do you understand why you feel that way?"
"Are you thinking about killing yourself?" The response "Are you thinking about killing yourself?" is the most important assessment to make, because suicide is a possibility with every depressed client. The client has already said that he would rather be dead, and the response addresses only part of the client's statement. The response "What does death mean to you?" is a philosophical approach that will not encourage discussion of feelings. The client is probably unable to explain why he feels the way he does.
A nurse is counselling a parent about the changes a toddler may exhibit after the death of a family member. What should the nurse include in the counselling? Select all that apply. "The toddler will be resilient over the loss." "The toddler will understand the cause of the loss." "The toddler may have bowel or bladder disturbances." "The toddler may express changes in sleeping patterns." "The toddler will get disrupted in developing an autonomous sense of self."
"The toddler may have bowel or bladder disturbances." "The toddler may express changes in sleeping patterns." The nurse should tell the parent that after the death of a family member, toddlers will express the sense of absence they feel through changes in eating and in sleeping patterns, fussiness, or bowel and bladder disturbances. Older adults, not toddlers, show resiliency over the loss of a family member. Toddlers do not understand the cause of the loss. The loss of a family member may disrupt the development of autonomy in young adults.
A client who recently was told by her primary healthcare provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. The nurse determines that the client is experiencing which stage of death and dying? Anger Denial Bargaining Acceptance
Denial The client has difficulty accepting the inevitability of death and is attempting to deny the reality of it. In the anger stage the client strikes out with "Why me?" and "How could God do this?" type of statements. The client is angry at life and still angrier to be removed from it by death. In the bargaining stage the client tries to bargain for more time. The reality of death is no longer denied, but the client attempts to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and peacefully awaits it.
A client arrives at the clinic and tells the nurse about various aches and pains since her spouse's death 3 months ago. The client appears depressed and tense. What is the initial nursing intervention? Facilitating a discussion of the spouse's death Focusing on teaching the client relaxation exercises Asking the practitioner for a psychiatric consultation Helping the client recognize ambivalence toward the spouse
Facilitating a discussion of the spouse's death Facilitating a discussion of the spouse's death will encourage the client to speak about the spouse and begin moving toward resolving the loss. Although relaxation exercises may be beneficial, the focus should be on the expression of feelings. A psychiatric consultation is not indicated by the data at this time. The data do not indicate ambivalence toward the spouse.
A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. Dementia Multiple losses Declines in health A milestone birthday An injury requiring hospitalization
Multiple losses Declines in health Depression in the older adult is most often associated with the loss of family members and friends (e.g., death, relocation) and declines in mobility, health, and income. A decline in health, particularly when associated with a chronic illness, frequently precipitates depression in older adults. Dementia is a cognitive problem. Research does not correlate the onset of depression with a milestone birthday in older adults. A traumatic injury does not precipitate the onset of depression in the older adult as often as does a chronic illness.
Often when a family member is dying, the client and the family are at different stages of grieving. During which stage of a client's grieving is the family likely to require more emotional nursing care than the client? Anger Denial Depression Acceptance
Acceptance In the stage of acceptance, the client frequently detaches from the environment and may become indifferent to family members. In addition, the family may take longer to accept the inevitable death than does the client. Although the family may not understand the anger, dealing with the resultant behavior may serve as a diversion. Denial often is exhibited by the client and family members at the same time. During depression, the family often is able to offer emotional support, which meets their needs.
Which psychosocial nursing actions are appropriate when providing client care after a community disaster? Select all that apply. 1 Performing triage of injuries 2 Administering first aid to wounds Offering choices whenever possible Establishing rapport through active listening Requesting assistance from crisis counselors
Administering first aid to wounds Offering choices whenever possible Establishing rapport through active listening Requesting assistance from crisis counselors Psychosocial nursing actions appropriate when providing care after a community disaster include offering choices whenever possible, establishing rapport through active listening, and requesting assistance from crisis counselors. Performing triage of injuries and administering first aid to wounds are not psychosocial nursing actions.
A 68-year-old client who has metastatic carcinoma is told by the practitioner that death will occur within a month or two. Later the nurse enters the client's room and finds the client crying. Before responding, which factor should the nurse consider? Crying relieves depression and helps the client face reality. Crying releases tension and frees psychic energy for coping. Nurses should not interfere with a client's behavior and defenses. Accepting a client's tears maintains and strengthens the nurse-client bond.
Crying releases tension and frees psychic energy for coping. Crying is an expression of an emotion that, if not expressed, increases anxiety and tension; the increased anxiety and tension use additional psychic energy and hinder coping. Crying does not relieve depression, nor does it help a client face reality. It is not universally true that nurses should not interfere with a client's behavior and defenses. In most instances the client's defenses should not be taken away until they can be replaced by more healthy defenses. The nurse must interfere with behavior and defenses that may place the client in danger, but the client's current behavior poses no threat to the client. It is not always true that accepting a client's crying maintains and strengthens the nurse-client bond. Many clients are embarrassed by what they consider a "show of weakness" and have difficulty relating to the individual who witnessed it. The nurse must do more than just accept the crying to strengthen the nurse-client relationship.
A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. What is the most therapeutic nursing intervention for this client at her follow-up appointment? Focusing on the client's physical needs Encouraging the client to verbalize her feelings about the loss Reminding the client that she will be able to become pregnant again Encouraging the client to think of herself, her husband, and their future
Encouraging the client to verbalize her feelings about the loss Focusing on the client's physical needs demonstrates understanding of grief work; however, the nurse should first help the client resolve the current problem. Although is the client's physical needs are important, they comprise only a part of the necessary interventions; the client needs help to cope with her loss. Reminding the client that she will be able to become pregnant again does not demonstrate understanding of the grieving process; the current loss must be dealt with before the client can move on to planning for the future. Encouraging the client to think of herself, her husband, and their future does not demonstrate understanding of the grieving process; the current loss must be dealt with before the client can move on to planning for the future.
A nurse discusses the plan of care with a depressed client whose husband has recently died. The nurse determines that it will be most helpful to do what? Involve the client in group exercises and games. Encourage the client to talk about and plan for the future. Talk with the client about her husband and the details of his death. Motivate the client to interact with male clients and the nursing staff.
Talk with the client about her husband and the details of his death. Discussing the partner and the partner's death will help the client work through the grief process. Involving the client in group exercises and games refocuses the client's attention away from addressing feelings; the client probably does not have the physical or emotional energy to get involved with group activities. The client must cope with the past and present before addressing the future. Motivating the client to interact with male clients and the nursing staff refocuses the client's attention away from addressing feelings; the client probably does not have the physical or emotional energy to get involved with others.
