(HESI PREP) Basic Psychosocial Needs
A client whose child has died is withdrawn, has flat affect, makes minimal eye contact, and states, "I can't live without my child." What is the most appropriate response by the nurse?
"I would like to sit with you and talk about your child." This choice is the focused therapeutic response that would generate client-focused discussion. Calling someone else is not client focused and nursing intervention based. Stating that this is a normal response is nontherapeutic, and calling the health care provider is incorrect because the it is within the nurse's scope of practice to resolve this issue.
When a nurse enters a client's room, the client frowns and states, "I've had my damn light on for 20 minutes. It's about time you got here. I'm sick of this place and the staff." The nurse's best response would be:
"You seem upset this morning." To be therapeutic, the nurse should respond to the content of the client's statements. This client is obviously angry. A restatement or summary of what the nurse heard the client say is appropriate. By making an introduction or apologizing, the nurse would ignore the client's expressed feelings. Repeating the client's statement as a question indicates either skepticism about the client's statement or ignorance of the client's needs and would likely fuel the client's anger.
A client admitted for investigation of a tumor asks the nurse, "Do you think I have cancer?" Which response by the nurse is most therapeutic?
"You sound concerned about what the tests results might be." This response allows the client to express the client's feelings and promotes further discussion. Referring the client to the healthcare provider ends the discussion and prevents exploration of the client's feelings. Generalizing about tumors shifts the focus from the client. The statement about the need for tests is true but doesn't focus on the client's feelings and concerns.
The healthcare provider has indicated that a client has a poor prognosis for recovery, and the family is very concerned. How would the nurse best support the family?
Accommodate their grieving, explain what is happening, and encourage involvement in the care. The family is grieving, and it is important to acknowledge and listen to them. They need to know what is happening. They also need to be encouraged to be involved in the client's care to give them an opportunity to connect and feel actively involved. It is difficult for them to give up hope and be realistic regarding the prognosis; they need to have time. Reassuring the family that it is normal to feel concerned is not therapeutic. Encouraging the family to stay positive is not realistic at this time.
A client is experiencing stress in a change of role from married to divorced. The client states that the in-laws blame the client's drinking for the divorce. The client states, "These days, a couple of glasses of wine in the evenings helps calm my nerves." What is the best coping strategy for the nurse to offer the client?
Practice deep breathing and muscle relaxation. The client is experiencing stress due to a role change subsequent to the recent divorce. Using previously learned relaxation techniques would be an appropriate way of decreasing stress without using alcohol as a temporary fix. Ceasing contact with significant others is extreme and would not be recommended. Similarly, suggestions to rely on work colleagues would not be appropriate. While assertiveness techniques may be helpful in the long term, short term stress is well managed with relaxation techniques.
The nurse is trying to establish a trusting relationship with a client experiencing pain. When the client asks for pain medication, the nurse notes that it is not time to give the medication. What is the best action by the nurse to facilitate a trusting relationship?
Tell the client when the medication is due and return promptly at that time. When the nurse follows through on a commitment made to a client, it fosters trust within the therapeutic relationship. Trust is a foundational quality within the therapeutic nurse-client relationship.
The nurse provides care to a client with severe burns. During the recuperation phase, the client becomes withdrawn. For what potential contributor to the client's change in demeanor should the nurse assess?
changes in body image and self-esteem During the recuperation phase, the client is likely to consider the body image implications of this injury. Sensitivity to body image and self-esteem issues are anticipated concerns. The client has suffered through the most difficult part. There are fewer concerns regarding dependence and coping abilities in the recuperation phase. The pressure from family and friends to be more social would be a reaction to the client's withdrawing from social interactions rather than a causative factor of the withdrawal.
The nurse is teaching a group of high school students about risk-taking behaviors. Which topic would be considered an example of healthy behaviors?
preventative vaccinations Preventative vaccinations are not associated with a risk-taking behavior. Vaccinations are used as vehicles to prevent communicable diseases rather than living dangerously. The other choices are all associated with risk-taking behaviors: smoking, drinking, and motor vehicle accidents. These are especially important to discuss with young adults.
A nurse has migrated to a different country and started working there. Which factor is important for effective functioning?
cultural habituation Cultural habituation reduces the extent to which people must take environmental cues into account; a predictable environment and being able to perceive the world as coherent are essential for human functioning. Assigning people to specific categories because of their culture, race, or ethnic emblems is stereotypical thinking; it is misleading and denies individuality. Ethnocentrism reflects a fear of difference from one's belief system, and consequent derision or disqualification of people and practices that do not conform to one's own view. Cultural shock is the acute experience of not comprehending the culture in which one is situated.
During the termination phase of a nurse-client relationship, which intervention may lead to client confusion?
introducing new issues to the client The nurse shouldn't introduce new issues during the termination phase, because doing so may confuse the client. This phase is a time for wrapping up the relationship. It's appropriate for the nurse to refer the client to support groups or other resources. Reviewing what's been accomplished during the relationship is a goal of the termination phase. The client may express sadness during the termination phase, and this is a normal response to which the nurse should respond therapeutically.
A nurse cares for a client who believes in Hinduism. The nurse understands that Hindus believe illness is caused by which type of behavior?
past and current life actions According to Hinduism, illness is the result of past and current life actions. The right hand is seen as holy, and eating and intervention need to be done with the right hand to promote clean healing. The spiritual health belief in Hinduism is not that illness is from consumption of dirty food, unhygienic habits, or poor worship of God.
Which statement is a correct reason for nurses to become culturally sensitive and develop their cultural competency skills?
Cultural sensitivity and consideration of client diversity are necessary to provide ethical nursing care. Becoming sensitive to clients of different cultural backgrounds is necessary in order to provide ethical care. In addition, nurses must develop cultural competency to care for these clients effectively. People of different cultures make the decision of acculturation or preservation of their own culture. A nurse cannot be familiar with beliefs of all subcultures; however, it is important to have a framework for better understanding and appreciating persons from different cultures. Codes of ethics challenge nurses to provide ethical care, but this does not explain the relationship between ethical care and culturally sensitive care.
Which nursing action would be most beneficial to a client and her spouse who state they wish to go through labor without the use of analgesics or anesthetic agents?
Act as an advocate for the couple and verbalize their wishes to nurses and physicians. Nurses are ethically responsible for giving childbearing families the autonomy to make informed choices about the care they receive. This also fosters a collaborative relationship with the family. Nurses must advocate for clients to have autonomy in decision making and provide respect and informed choice to ensure that clients and their families are empowered to take responsibility to make decisions. It is the nurse's role to guide and support choices rather than direct. A client should never be left alone in labor. Providing information about or encouraging the use of drugs may leave the client and family feeling as though the nurse is not supportive of the couple's choices by encouraging actions that are contradictory to the family's birth plan.
A client who is being treated for nonhealing diabetic foot ulcers tells the nurse angrily, "I'm so frustrated with my doctors. The wound care doctor tells me this won't heal and I need to have my toes amputated, and another doctor tells me I need to keep going with the antibiotics and dressing changes so I can save my foot. I just want to go home!" After listening to the client's concerns, what should the nurse do?
Contact the client's case manager to set up a care conference. The nurse is ultimately responsible to coordinate the client's care while hospitalized; therefore, it is the nurse's responsibility to arrange a care conference to help get the client's questions, concerns, and frustrations addressed. Assuring the client that the HCPs know what they are doing does not address the client's concern or frustration with receiving conflicting information. While it is true that the client is ultimately responsible for health, asking the client to accept the consequences is a form of blaming the client. The HCPs' progress notes will not provide information that will address the client's concern or resolve the conflicting courses of action that the two HCPs are proposing.
