MED SURG CH. 55 EAQ

Which statements by the patient indicate that the patient is experiencing spiritual distress? Select all that apply. 1. "I wonder why I was even born." 2. "I wonder why I am suffering if there is a God." 3. "My family said that my behavior has changed." 4. "My appetite has been much better than it used to be." 5. "I thought God would take care of me; now look at me."

1. "I wonder why I was even born." 2. "I wonder why I am suffering if there is a God." 3. "My family said that my behavior has changed." 5. "I thought God would take care of me; now look at me." When in spiritual distress, patients experience symptoms such as nightmares, sleep disturbances, and alterations in behavior and mood. A patient would also experience questioning his or her relationship with God and the meaning of suffering or existence. Increased appetite should not alert the nurse that the patient is spiritually distressed.

According to Maslow, healthy, self-actualized individuals possess which characteristics? Select all that apply. 1. A sense of ethics 2. A need for privacy 3. Absence of spontaneity 4. Independence or autonomy 5. Accurate perception of reality

1. A sense of ethics 2. A need for privacy 4. Independence or autonomy 5. Accurate perception of reality According to Maslow, healthy, self-actualized individuals possess several characteristics including a sense of ethics; a need for privacy, independence, or autonomy; an accurate perception of reality; and the ability to be spontaneous (not absence of spontaneity).

The nurse is assisting with data collection for a newly diagnosed patient with breast cancer. While assessing the patient's potential for effective coping, which factors would the nurse address? Select all that apply. 1. Age 2. Race 3. Gender 4. Emotions 5. Spirituality 6. Family resources

1. Age 4. Emotions 5. Spirituality 6. Family resources To assess a patient's potential for coping with an illness effectively, the nurse needs to understand that the ability to cope is affected by various factors. These factors include age, emotions, spirituality, family and community resources, self-concept, cultural beliefs, stress, fear, anxiety, loss, grief, and mourning. Race and gender do not affect a patient's ability to cope.

Which option describes the behavioral theory? 1. All behaviors are learned responses. 2. All behaviors are involuntary responses. 3. Behaviors can be changed though psychotherapy. 4. Behaviors are primarily a result of genetic makeup.

1. All behaviors are learned responses. Behavioral theory is based on the idea that all behaviors are learned responses. The idea that behaviors are involuntary responses, can be changed though psychotherapy, and are primarily a result of genetic makeup are not descriptive of behavioral therapy.

The nurse is providing care for a patient who is in denial about a cancer diagnosis. Which action by the nurse would be most appropriate while trying to establish a therapeutic relationship? 1. Allow the patient to deny the illness. 2. Inform the patient that the patient is in denial. 3. Ask the patient to verbalize feelings about the illness. 4. Inform the patient that denying the illness will only make things worse.

1. Allow the patient to deny the illness. The nurse may need to allow the patient to deny the illness and at the same time ask for cooperation in order to establish a therapeutic relationship. Arguing with the patient about denial only reinforces the inappropriate behavior. A therapeutic relationship must be established before the patient can discuss true feelings of fear and anxiety.

"The result of inner tension and anxiety that can affect an individual's ability to function" best defines which term? 1. Crisis 2. Conflict 3. Stressor 4. Maladaptive coping

1. Crisis A crisis results in inner tension and anxiety that can affect an individual's ability to function. A stressor is something that necessitates an adaptive response on the part of the individual. Conflicts can be interpersonal. Maladaptive coping is the ineffective strength to cope effectively.

Which defense mechanisms are used to protect against anxiety? Select all that apply. 1. Denial 2. Isolation 3. Introjection 4. Identification 5. Self-actualization

1. Denial 2. Isolation 3. Introjection 4. Identification Denial is a refusal to acknowledge a real situation and is a defense mechanism. Isolation involves separating an emotion from a thought and is a defense mechanism. Introjection involves internalizing the beliefs of others and is a defense mechanism. Identification occurs when an individual enhances self-esteem by emulating the qualities of others and is a defense mechanism. Self-actualization involves fulfilling one's potential and is not a defense mechanism.

A patient has recently been diagnosed with terminal cancer. While assessing the patient's ability to cope with the crisis of illness, the nurse is careful to identify which maladaptive coping mechanisms and strategies? Select all that apply. 1. Denial 2. Projection 3. Helplessness 4. Somatization 5. Powerlessness

1. Denial 3. Helplessness 5. Powerlessness Denial, helplessness, and powerlessness are maladaptive mechanisms used in an effort to reduce stress and anxiety related to illness. These thinking patterns and behaviors are ineffective and can be self-destructive. Projection and somatization are defense mechanisms used to diminish anxiety and can be beneficial when not used excessively or inappropriately.

When helping patients and their families cope with a serious diagnosis, what should the nurse include when providing patient teaching? Select all that apply. 1. Establish a support system. 2. Decide on a treatment plan. 3. Seek information about your condition. 4. Collaborate with members of the health care team. 5. Getting a second opinion will increase your anxiety.

1. Establish a support system. 2. Decide on a treatment plan. 3. Seek information about your condition. 4. Collaborate with members of the health care team. A support system can help the patient cope with the situation. The patient should decide on a treatment plan that best suits his or her needs. The patient should seek information to learn about his or her condition. The patient should have open communication with members of the health care team. Getting a second opinion may help the patient feel more confident about his or her care and lessen discouragement.

While instructing a patient on appropriate conscious coping strategies, the nurse is teaching about relaxation techniques. Which strategies would the nurse include in the instruction for this patient? Select all that apply. 1. Imagery 2. Undoing 3. Sublimation 4. Music therapy 5. Therapeutic touch

1. Imagery 4. Music therapy 5. Therapeutic touch Relaxation techniques are a type of conscious coping strategies. Relaxation techniques include imagery, music therapy, therapeutic touch, and relaxation strategies. Undoing and sublimation are defense mechanisms used to protect against anxiety.

The nurse is caring for a patient who is preparing to undergo explorative surgery and is anxious. The nurse would teach the patient which relaxation techniques? Select all that apply. 1. Imagery 2. Repression 3. Sublimation 4. Music therapy 5. Therapeutic touch

1. Imagery 4. Music therapy 5. Therapeutic touch Relaxation techniques include interventions such as imagery, music therapy, therapeutic touch, and relaxation strategies. Repression is a defense mechanism that involves keeping unacceptable ideas out of the consciousness. Sublimation is a defense mechanism that involves the transformation of unacceptable impulses or drives into constructive or more acceptable behavior.

A patient has recently been diagnosed with a terminal illness and is working through spiritual distress. Which would be the LPN's priority in assisting the patient with this process? 1. Listen, support, and care for the patient during the process. 2. Support the patient's conflict with personal beliefs and spirituality. 3. Allow the patient to question the meaning of suffering or existence. 4. Support the patient as he or she experiences alterations in behavior and mood.

1. Listen, support, and care for the patient during the process. Simply listening, caring, and supporting the patient during the process is the highest priority for the LPN to implement as the patient experiences spiritual distress. The nurse would also support the patient's conflict with personal beliefs and spirituality, allow the patient to question the meaning of suffering or existence, and support the patient as he or she experiences alterations in behavior and mood.

A patient who is obese is constantly pointing out when other people are eating unhealthily. This is an example of which defense mechanism? 1. Projection 2. Introjection 3. Suppression 4. Displacement

1. Projection Projection is transferring unacceptable feelings or impulses to another individual. Introjection is internalizing or taking on the values and beliefs of another individual. Suppression is a conscious or voluntary inhibition of unacceptable ideas, impulses, or memories. Displacement is transferring feelings associated with one source to another that is considered less threatening.

What would the nurse do to identify effective nursing interventions for a patient who is coping with a new illness? 1. Respect the patient's beliefs regardless of the nurse's. 2. Try to disregard any beliefs or customs that conflict with the nurse's. 3. Ignore beliefs, values, and customs that the nurse does not agree with. 4. Provide teaching to the patient regarding the nurse's own beliefs, values, and culture.

1. Respect the patient's beliefs regardless of the nurse's. Effective nursing interventions can be determined only when the nurse understands that the patient is a unique individual. When helping the patient cope with illness, the nurse needs to recognize that the nurse's own racial and cultural background may affect the ability to intervene effectively. It is important for the nurse to respect the patient, regardless of his or her own personal beliefs, values, and culture.

Which statements are true regarding stress? Select all that apply. 1. Stress can promote self-esteem. 2. Stress can be positive or negative. 3. Stress is not perceived as harmful. 4. Health is related to ability to handle stress. 5. Stress is necessary for growth and development.

1. Stress can promote self-esteem. 2. Stress can be positive or negative. 4. Health is related to ability to handle stress. 5. Stress is necessary for growth and development. Mild stress produces mild anxiety and enables individuals to use energy focused exclusively on the problem. The result can be successful problem solving, which in turn promotes self-esteem. Depending on the level of stress and how it is handled, stress can have positive or negative effects on the individual. An individual's level of health is directly related to the ability to adjust to a variety of internal and external stressors. Stress is necessary for growth and development.

Every time a patient gets angry, she starts cleaning the entire room. Which defense mechanism is the patient displaying? 1. Sublimation 2. Substitution 3. Displacement 4. Introjection

1. Sublimation Sublimation is the transformation of unacceptable impulses or drives (anger) into constructive or more acceptable behaviors (cleaning). Substitution is replacing a highly valued, unattainable object with a less-valued, attainable object. Displacement is transferring feelings associated with one source to another that is considered less threatening. Introjection is internalizing or taking on the values and beliefs of a parent.

Which nursing activity best represents assisting a patient in meeting basic needs, according to Maslow's hierarchy of needs? 1. The nurse assists a patient in selecting menu items within a prescribed diet. 2. The nurse ensures that a patient uses a cane when ambulating in the house. 3. The nurse encourages a resident in the nursing home to participate in a group activity. 4. The nurse asks nursing assistants to provide privacy during bathing to promote dignity.

1. The nurse assists a patient in selecting menu items within a prescribed diet. According to Maslow, the first set of basic needs includes food and water. Assisting a patient to select menu items helps the patient meet this need. The second set of needs involves safety and security; ensuring that a patient uses a cane helps meet this need. The third set of needs involves friends, groups, and a need for community; encouraging a resident to participate in a group activity meets this need. The fourth set of needs promotes dignity and self-esteem; providing privacy during bathing promotes dignity and meets this need.

The nurse is caring for a patient who sustained extensive musculoskeletal trauma in a motor vehicle accident. The nurse knows that which term is used to describe the patient's biologic and psychologic effort to respond to this trauma? 1. Coping 2. Adaptation 3. Self-esteem 4. Homeostasis

2. Adaptation Adaptation refers to a person's biologic and psychologic efforts to respond to a stressor and affects the whole organism. Coping is the process of responding to stress or a potential stressor. Self-esteem develops from individuals' own evaluations of their competence and of the value others place on them. Stress, response, and adaptation can be thought of as a process aimed at maintaining homeostasis or equilibrium.

Which definition best describes self-esteem? 1. A person's feelings about his or her physical appearance 2. An individual's own evaluation of his or her competence 3. The notions, beliefs, and convictions persons hold about themselves 4. A combination of conscious and unconscious attitudes about one another

2. An individual's own evaluation of his or her competence Self-esteem develops from an individual's own evaluations of his or her competence and of the value others place on him or her. Body image refers to the combination of conscious and unconscious attitudes people have about their own bodies. While body image can affect self-esteem, this is not the best option. Self-concept, not self-esteem, refers to the notions, beliefs, and convictions persons hold about themselves.

The nurse knows that these steps are taken to facilitate the patient's task of dealing with the crisis of an illness. Place these steps in order of priority. 1. Identify problem areas 2. Ask questions to determine the effectiveness of individual coping strategies. 3. Conduct a teaching session with the patient and family to enhance coping skills. 4. Make a nursing diagnosis

2. Ask questions to determine the effectiveness of individual coping strategies. 1. Identify problem areas 4. Make a nursing diagnosis 3. Conduct a teaching session with the patient and family to enhance coping skills. The nursing process is followed to facilitate the patient's task of dealing with the crisis of illness. The first step of the nursing process is data collection. Asking questions to determine the effectiveness of individual coping strategies is a way to assess and collect data relevant to the patient's care. Once data collection is complete, the data can be clustered and problem areas identified. Then, a nursing diagnosis can be chosen by the RN. Based on the nursing diagnosis, appropriate nursing interventions can be selected and performed.

A patient witnessed a murder and then suddenly became blind without an organic cause. The nurse recognizes the patient's loss of vision as which defense mechanism? 1. Denial 2. Conversion 3. Substitution 4. Somatization

2. Conversion Conversion disorders involve turning an emotional conflict into a physical symptom. Denial is a refusal to acknowledge a situation. Substitution involves replacing a highly valued, unattainable object with a less-valued, attainable object. Somatization is the transfer of painful feelings to body parts, thus the person's feelings are expressed in the form of a physical concern.

The nurse sees a fellow nurse being publicly chastised by the nurse manager. Rather than discussing frustrations with the nurse manager directly, the chastised nurse in turn berates a nursing assistant. The nurse witnessing the interactions knows that the originally chastised nurse is demonstrating which defense mechanism? 1. Projection 2. Displacement 3. Compensation 4. Reaction formation

2. Displacement Displacement is transferring feelings associated with one source to another who is considered less threatening. Rather than discussing frustrations with the nurse manager, who is considered threatening, the nurse turns those frustrations on a less threatening target and lashes out. Projection is transferring unacceptable feelings or impulses to another. Compensation is an attempt to make up for a real or an imagined weakness. Reaction formation is avoiding unacceptable thoughts and behaviors by expressing opposing thoughts or behaviors.

After the loss of a spouse, a patient becomes irritable and attributes the loss to a punishment from God for not having been a better spouse. The nurse recognizes that this patient is experiencing which response? 1. Fear 2. Grief 3. Anxiety 4. Mourning

2. Grief Grief is an emotional response that evolves from a sense of loss. Fear is a response to a threat, anxiety is a sense of impending doom or apprehension, and mourning is a process used to resolve grief.

After instructing a patient on the importance of implementing coping strategies and teaching the patient to enhance coping skills, the nurse is evaluating the patient's use of both conscious and unconscious therapeutic coping strategies and mechanisms. The evaluation reveals that each strategy and mechanism listed has been used. Which coping strategies and mechanisms are unconscious? Select all that apply. 1. Meditation 2. Identification 3. Compensation 4. Rationalization 5. Deep breathing

2. Identification 3. Compensation 4. Rationalization Identification, compensation, and rationalization are defense mechanisms used unconsciously to cope with stress and anxiety. Meditation and deep breathing are examples of conscious coping strategies.

The nurse is assisting in the development of a plan of care for a patient with inadequate coping. Which patient problem should be addressed as a priority in the plan of care, using Maslow's hierarchy of needs? 1. Feeling "ugly" since surgery 2. Inability to perform sexually 3. Feeling abandoned by God 4. Anxiety about chemotherapy reactions

2. Inability to perform sexually The inability to perform sexually should be addressed first, because it is a physical need. Anxiety, poor self-image, and a feeling of abandonment by God are all psychological needs. According to Maslow, psychosocial needs are prioritized after physiologic needs.

A child that has been potty trained for 1 year begins to wet her pants several times a week when her new baby brother is brought home from the hospital. This is an example of which defense mechanism? 1. Undoing 2. Regression 3. Repression 4. Somatization

2. Regression Regression involves withdrawing to an earlier level of development to benefit from the associated comfort levels of the previous level. Undoing is actually or symbolically attempting to cancel out an action that was unacceptable. Repression is an unconscious defense mechanism in which unacceptable ideas, impulses, and memories are kept out of consciousness. Somatization is the transfer of painful feelings to body parts; as a result, the person's feelings are expressed in the form of a physical symptom.

A patient has been a victim of sexual assault but is unable to recall the event. Which defense mechanism is the patient displaying? 1. Conversion 2. Repression 3. Somatization 4. Displacement

2. Repression Repression can be defined as an unconscious defense mechanism in which unacceptable ideas, impulses, and memories are kept out of the consciousness. Conversion is the turning of an emotional conflict into a physical symptom. Somatization is the transfer of painful feelings to body parts, thus the person's feelings are expressed in the form of a physical concern. Displacement involves transferring feelings from one source to another that is considered less threatening.

Which term describes any physiologic or psychological tension that threatens a person's total equilibrium? 1. Fear 2. Stress 3. Anxiety 4. Esteem

2. Stress Stress is any physiologic or psychological tension that threatens a person's total equilibrium. Fear is a response to a threat. Anxiety is a sense of impending doom or apprehension. The word esteem means to respect.

A patient who has aggressive tendencies is pursuing a demolition job. Which defense mechanism describes this patient transforming aggression into a more acceptable behavior? 1. Undoing 2. Sublimation 3. Substitution 4. Compensation

2. Sublimation Sublimation is defined as the transformation of unacceptable impulses or drives into constructive or more acceptable behavior. Undoing is the attempt to cancel out an action that was unacceptable. Substitution is replacing a highly valued, unattainable object with a less-valued, obtainable object. Compensation is an attempt to make up for a weakness.

The licensed practical nurse (LPN) is sharing with patients the steps to help them deal effectively with the initial diagnosis of illness and to make the best possible decisions for themselves and their families. The nurse would explain that which would be the patient's first step in this process? 1. Seek out information. 2. Take the time he or she needs. 3. Get the support he or she needs. 4. Talk with members of the nurse's health care team.

2. Take the time he or she needs. Allowing the patient to take the time he or she needs and to make the best possible decisions for him or her and the family would be the first step in helping the patient deal with the initial diagnosis of illness. When the patient is ready, the nurse would help the patient and family to seek out information and get the support they need. The nurse would also talk with members of the health care team to determine how best to help the patient and family cope.

The nurse is caring for an adolescent patient who is being treated for poor self-concept. Which statement by the patient indicates to the nurse that the patient is using the defense mechanism of identification? 1. "I think I'm going to try out for cheerleading this year." 2. "I've joined the basketball team and now I feel better about myself." 3. "I just bought a whole new wardrobe that resembles my older sister's." 4. "There is no way I can ever see myself as good enough when my parents are always so critical."

3. "I just bought a whole new wardrobe that resembles my older sister's." Identification is the emulation of admirable qualities in another to enhance one's own self-esteem. Compensation, as exemplified by trying out for cheerleading, is used as an attempt to make up for real or imagined weakness. Denial, saying she feels better about herself, is the refusal to acknowledge a real situation. Rationalization, as explaining her response to her parents' criticism, is the use of logic, reasoning, and analysis to avoid unacceptable feelings.

A patient has refused to receive a blood transfusion due to religious beliefs. Which is the nurse's best response? 1. "I will ask the hospital chaplain to help you with this decision." 2. "You should explore other religious views before making this decision." 3. "I realize that this is a difficult decision for you, and I respect your decision." 4. "The health care provider has ordered blood, so I must begin the transfusion."

3. "I realize that this is a difficult decision for you, and I respect your decision." The nurse must respect the patient's culture, values, and beliefs despite personal beliefs. The chaplain should not be asked to visit with a patient unless the patient requests the visit. Suggesting that the patient change religious beliefs shows a judgmental attitude and is disrespectful toward the patient's decision. The patient has the right to refuse treatment, so beginning the transfusion would not be appropriate.

The nurse is assessing the needs of a patient who has recently been diagnosed with a terminal illness. Which statement made by the patient best indicates that they are experiencing spiritual distress? 1. "I have so many things that I need to take care of before dying." 2. "I am very concerned as to how my children are going to handle this news." 3. "I thought that I was a good person; I don't know what I did to deserve this." 4. "I am still trying to cope with the news and would like to be alone right now."

3. "I thought that I was a good person; I don't know what I did to deserve this." Spiritual distress can be characterized by the patient feeling as if he or she is being punished. Patients may feel that the illness is unfair and that a higher power has betrayed them. Saying "I have so many things that I need to take care of before dying," "I am very concerned as to how my children are going to handle this news," or "I am still trying to cope with the news and would like to be alone right now" are normal responses to illness and do not indicate spiritual distress.

A patient has a history of physical and emotional abuse from her husband and has been using various defense mechanisms to cope with the situation. The nurse plans to instruct the patient about the patient's use of the defense mechanism, reaction formation. Which explanation should be included? 1. "Each time you yell at the nurses you are using reaction formation." 2. "Reaction formation is being used when you complain of unexplainable leg pain." 3. "Reaction formation is being used when you constantly praise your husband even though he is abusive." 4. "When you are questioned about the abuse your husband inflicts, you are emotionless. This is an example of reaction formation."

3. "Reaction formation is being used when you constantly praise your husband even though he is abusive." Reaction formation is exhibited by overcompensation for fear of the opposite. Unacceptable thoughts and behaviors are avoided by expressing opposing thoughts or behaviors. Somatization is the transfer of painful feelings to physical pain on body parts that is unexplainable. Displacement is when feelings associated with one source (abusive husband) are transferred to another source that seems less threatening (nurses). Isolation is the separation of emotions from an associated thought or memory.

The LPN is working with a patient and his family who are experiencing a great deal of fear related to an impending surgery to repair a congenital heart defect. Which is the nurse's priority action for this patient and family? 1. Provide basic information to the patient and family. 2. Begin anticipating the patient's needs before discharge. 3. Allow the patient and family to express the fear openly. 4. Determine the amount of emotional support provided by the family.

3. Allow the patient and family to express the fear openly. The simple act of allowing the patient and his family members to express their fears openly may actually help diminish the fear. The patient and family may require more than only basic information. The nurse would also begin anticipating the patient's needs before discharge and determine the amount of emotional support provided by the family, but these are not the priority actions.

A patient with a terminal diagnosis of cancer continues to tell the nurse, "Those doctors don't know what they're talking about. I don't have cancer. I will be good as new in a few days." Which action by the nurse would be the most beneficial to the patient? 1. Tell the patient that the doctors are correct in their diagnosis. 2. Explain to the patient that denial can lead to negative consequences. 3. Allow the patient to deny the illness while asking the patient for cooperation. 4. Show the patient the pathology report again to help promote acceptance of the disease.

3. Allow the patient to deny the illness while asking the patient for cooperation. If the patient is in denial of an illness, it may be necessary to allow the individual to deny the illness and at the same time ask for cooperation. Denial is maladaptive when the patient's behavior interferes significantly with obtaining appropriate care. Arguing with patients about the denial only reinforces the inappropriate behavior. The patient is aware of the diagnosis and is in denial of the illness. Therefore, showing the pathology report to reiterate the fact that the patient is ill will not likely help the patient accept the illness.

A person is a living being with several dimensions. The dimension that involves an individual's ability to formulate thoughts, process information, and solve problems is which dimension? 1. Physical 2. Affective 3. Cognitive 4. Behavioral

3. Cognitive The cognitive dimension involves an individual's ability to formulate thoughts, process information, and solve problems. The physical dimension includes the biologic and physiologic aspects of a person. The physical dimension refers to the individual's internal environment, and it is integrated with the cognitive, affective, behavioral, and social dimensions. The affective dimension involves an individual's ability to experience and express feelings and emotions. The behavioral dimension reflects a person's individuality and involves the integration of the physical, cognitive, and affective dimensions.

The LPN is assisting in preparing a presentation on Maslow's hierarchy of needs. Which human needs are the priority for fulfillment because they must be satisfied first? 1. Self-actualization as a person 2. Security, stability, and protection 3. Food, water, air, shelter, and sex 4. Love, affection, and a sense of belonging

3. Food, water, air, shelter, and sex According to Maslow's hierarchy of needs, the need for food, water, air, shelter, and sex must be satisfied before other needs are met. Then, the needs of self-actualization as a person, security, stability, protection, love, affection, and sense of belonging can be satisfied.

A patient who had a mastectomy related to breast cancer states, "My husband will not be attracted to me now that I have had the surgery." This is an example of which type of loss? 1. Actual loss 2. Occurred loss 3. Perceived loss 4. Anticipatory loss

3. Perceived loss Perceived loss is only recognized by the patient and usually involves an ideal. Perceived loss can be related to how the patient thinks others view her. Actual loss is a loss that has actually occurred and can be recognized by others. Anticipatory loss is a sense of loss experienced before the actual loss has occurred.

The LPN is working with a patient who is struggling to cope with a loss. The LPN recognizes that the priority action to begin the process of coping would be to encourage the patient to take which step? 1. Develop mechanisms to cope with the loss. 2. Prevent the development of maladaptive coping methods. 3. Permit the patient to feel the full emotional impact of the loss. 4. Determine how strongly the patient's sense of self was connected to the loss.

3. Permit the patient to feel the full emotional impact of the loss. The grief process cannot begin until the patient allows himself or herself to feel the full emotional impact of the loss. Although developing healthy mechanisms to cope with the loss, preventing maladaptive coping methods, and determining how strongly the patient's sense of self was connected to the loss are important interventions, coping mechanisms will not allow the patient's grief process to begin.

After assisting with collection data on the mental health of a patient, the nurse is clustering data regarding external environmental factors. Which stressor identified by the nurse is external? 1. Obesity 2. Low self-esteem 3. Poor living conditions 4. Elevated blood pressure

3. Poor living conditions The external environment includes physical and social elements that are external to and interactive with the individual. Poor living conditions are a part of the patient's external environment. Internal environment refers to physical and biological states inside the individual. Obesity, low self-esteem, and elevated blood pressure are related to the patient's internal environment.

A child starts sucking her thumb when her new baby brother comes home from the hospital. Which defense mechanism is being displayed by the child? 1. Denial 2. Undoing 3. Regression 4. Repression

3. Regression Regression is the withdrawing to an earlier developmental level for purposes of comfort. Denial is a refusal to acknowledge a situation. Undoing is the attempt to cancel out an unacceptable action. Repression is an unconscious defense mechanism in which unacceptable ideas, impulses, and memories are kept out of the consciousness.

Which statement is correct regarding psychological responses to illness? 1. Responses are gender specific. 2. Responses are unique to each culture. 3. Responses are unique to each patient. 4. Responses are specific to each disease process.

3. Responses are unique to each patient. Responses to illness are unique to the individual. Each individual in a group of people with the same gender, culture, and illness will have a unique response.

A staff member tells the nurse that she is having a hard time understanding the difference between grief and mourning. Which response by the nurse would best help the staff member to understand the difference between grief and mourning? 1. "Grief forces the individual to accept the situation." 2. "Grief and mourning are basically the same, and the terms are used interchangeably." 3. "Grief is an action, and mourning is a feeling. People generally undergo both together." 4. "Although the two go together, grief is an emotional response, and mourning is the action carried out to address the grief."

4. "Although the two go together, grief is an emotional response, and mourning is the action carried out to address the grief." Grief is the subjective, emotional response that evolves from a sense of loss. Mourning is the process through which grief is faced and ultimately resolved or altered over time.

Which statement by the patient would indicate to the nurse that the patient is in spiritual distress? 1. "I am ready to die when it's my time to go." 2. "The preacher is coming over to see me today." 3. "I feel like I have finished everything I need to in this life." 4. "I don't understand why this is happening to me. I don't deserve this."

4. "I don't understand why this is happening to me. I don't deserve this." Spiritual distress can be characterized by patients questioning the meaning of suffering or existence; experiencing a sense of conflict between their personal beliefs (or desires) and their relationship with their God; or experiencing symptoms such as nightmares, sleep disturbances, and alterations in behavior and mood. Feelings that the illness is a punishment or that the illness is unfair are a sign of spiritual distress. Healthy spirituality conveys an understanding and acceptance of beliefs and practices and their relation to death.

A patient who is being instructed on conscious coping strategies states, "I don't understand how listening to music is going to help me." Which is the nurse's best response? 1. "Music therapy can permanently remove stress." 2. "Music therapy works the same way as other conscious coping strategies." 3. "Music stimulates the subconscious, which will help you express your feelings." 4. "Music therapy helps you relax and facilitate positive imagery, which will help relieve stress."

4. "Music therapy helps you relax and facilitate positive imagery, which will help relieve stress." Music therapy is a conscious relaxation technique that can help the patient cope by enhancing the relaxation response and facilitating positive imagery. This coping method provides only temporary relief of stress. The patient should be given an explanation of what music therapy is. The nurse should address the patient's question directly, rather than by comparing it to other conscious coping strategies. Music does not stimulate the subconscious.

A mother of a preschool child asks the nurse, "Why does my child start crying as soon as we come into the examination room?" Which is the nurse's best response? 1. "Maybe we should take her to a different room." 2. "It's common for children to cry at the health care provider's office." 3. "Next time you bring your child, it would be helpful to let her know what to expect ahead of time." 4. "The last two times your child was seen here she was given shots. Now the exam room is a negative stimulus that triggers a reflex response of crying."

4. "The last two times your child was seen here she was given shots. Now the exam room is a negative stimulus that triggers a reflex response of crying." The behavioral theory conveys that all behaviors are learned responses and that conditioning is a type of learning. A conditioned response occurs from a stimulus (examination room) with reinforcement (shots). Eventually, a reflex response results from the stimulus. The parent's question and concern should be addressed with an explanation before any other action is taken.

Which patient need is a priority according to Maslow's hierarchy of needs? 1. A patient feels sad and depressed since the death of a loved one. 2. A patient has been unable to look at her mastectomy site since surgery. 3. A patient is being discharged but has no family or friends to help at home. 4. A patient has lost 9 pounds after experiencing gastroenteritis and is dehydrated.

4. A patient has lost 9 pounds after experiencing gastroenteritis and is dehydrated. According to Maslow, food and water are two of the five basic needs that must be met for survival, thus making it a priority. Feeling sad and depressed since the death of a loved one, having no family or friends to help at home after discharge, and being unable to look at a mastectomy site since surgery are psychological, not physiological, needs and are not necessary for basic survival.

The spouse of a patient who is undergoing chemotherapy says using music therapy and yoga helps with stress reduction. The nurse recognizes that the spouse is using which strategy? 1. Denial 2. Imagery 3. Substitution 4. A relaxation technique

4. A relaxation technique Relaxation techniques are a type of conscious coping strategy. These are purposeful behaviors used to make an unfamiliar situation into one that is considered more controllable and predictable. Denial is the subconscious blocking out of emotional experiences; a person who does yoga and uses music therapy is not blocking out an emotional experience. Imagery is a type of relaxation technique that involves using the imagination to focus away from the stressful experience. Substitution involves replacing a highly valued, unattainable object with a less-valued, attainable object.

The informed nurse prioritizes care based on the hierarchy used to describe and define human needs created by which psychologist? 1. Hans Selye 2. Skinner 3. Albert Bandura 4. Abraham Maslow

4. Abraham Maslow Abraham Maslow was a psychologist who was among the first to describe and define human needs in the form of a hierarchy. The word stress was first used in biology by the endocrinologist Hans Selye, who investigated the physiologic responses of living organisms to changes in the internal environment. B. F. Skinner and Albert Bandura were behavioral theorists who based their theories on the idea that all behavior is learned and is a series of habitual responses to familiar stimuli.

The nurse is providing care for a patient of Middle Eastern descent. How can the nurse best respect the cultural needs of the patient? 1. Research Middle Eastern culture and beliefs. 2. Ask the patient which specific country he or she is from. 3. Contact the hospital chaplain to assess the needs of the patient. 4. Ask the patient if he or she has any spiritual or cultural requests.

4. Ask the patient if he or she has any spiritual or cultural requests. The nurse should consider the cultural background of patients and their families. Asking the patient if he or she has any requests is the most appropriate way to assess cultural needs. It should not be assumed that patients have particular beliefs due to the continent or country they are from. It is not necessary to contact the chaplain; the nurse can assess the needs of the patient.

A child who is angry with his teacher comes home and yells at his siblings. Which defense mechanism is the child exhibiting? 1. Denial 2. Projection 3. Substitution 4. Displacement

4. Displacement Displacement involves transferring feelings from one source to another that is considered less threatening. Denial is a refusal to acknowledge a real situation. Projection is the transferring of unacceptable feelings or impulses to another individual. Substitution is replacing a highly valued, unattainable object with a less-valued, obtainable object

The nurse is assisting with data collection on the developmental status of an adolescent patient. Based on the knowledge of normal growth and development, which ability recently acquired by the patient would the nurse expect? 1. Dealing with frustration 2. Celebrating positive things 3. Handling interpersonal conflict 4. Having independent thoughts and behaviors

4. Having independent thoughts and behaviors During adolescence, teenagers learn to develop as individuals, become independent, and begin to think for themselves. Handling interpersonal conflict should be accomplished during preschool years. Middle childhood is when learning to deal with frustration and unfavorable events and learning to celebrate good things and feelings of pleasure occur.

The nurse is assisting with data collection regarding the coping status of a patient who was recently sexually assaulted. The patient is not able to answer questions about the assault and does not remember it even happening. When reviewing the health history, the nurse should expect to obtain what information? 1. Health history that states that the patient is in denial. 2. Health history that reports that the patient exhibits undoing. 3. Health history that reports that the patient exhibits regression. 4. Health history that states that the patient is repressing the event.

4. Health history that states that the patient is repressing the event. Repression is an unconscious defense mechanism in which unacceptable ideas, impulses, and memories are kept out of consciousness. Denial is the refusal to acknowledge a real situation. Undoing is actually or symbolically attempting to cancel out an action that was unacceptable. Regression is withdrawing to an earlier level of development to benefit from the associated comfort levels of the previous level.

The nurse is assisting with the plan of care for a patient who is dealing with the crisis of illness. The nurse knows that which goal is most related to the patient's current problem? 1. Utilizing coping strategies 2. Achieving optimal physical health 3. Maintaining an optimal quality of life 4. Managing and successfully coping with the illness

4. Managing and successfully coping with the illness The goal for a patient with the crisis of illness is to help him or her manage and successfully cope with the illness. This goal is directly related to the patient's problem. Instructing the patient on utilizing coping strategies is a nursing intervention, once the patient is able. Achieving optimal physical health and maintaining an optimal quality life are both goals, but they are not directly related to the patient's problem.

The nurse is teaching a group of parents about the stages of growth and development their children should pass through. The parents demonstrate understanding by stating that which stage of growth and development is considered a time for learning to deal with frustration and unfavorable events while also learning to celebrate good things and to feel pleasure? 1. Adolescence 2. Early adulthood 3. Early childhood 4. Middle childhood

4. Middle childhood Middle childhood is a time for learning to deal with frustration and unfavorable events while also learning to celebrate good things and to feel pleasure. During adolescence, teenagers learn to develop as individuals, become independent, and begin to think for themselves; they have to learn how to delay gratification, relax, and interact with peers of both sexes. In early adulthood, most people find a life partner and life work and may begin a family. Infancy and early childhood are times when nurturing is critical and exploration of the world begins. As children grow and progress through school, they must learn the rules of society. Preschoolers must learn to handle joint decision-making and interpersonal conflicts.

A patient who unconsciously hates his father continuously tells how great the father is. Which defense mechanism is the patient demonstrating? 1. Denial 2. Displacement 3. Compensation 4. Reaction formation

4. Reaction formation Reaction formation is avoiding unacceptable thoughts and behaviors by expressing opposing thoughts or behaviors. Denial is refusal to acknowledge a situation. Displacement is transferring feelings from one source to another. Compensation is attempting to make up for a weakness.

A patient who is a college football player recently had an injury and is undergoing physical therapy. Which factor is most likely to negatively affect the patient while coping with the injury? 1. Age 2. Emotions 3. Spirituality 4. Self-concept

4. Self-concept Self-concept can be affected by changes in self-esteem and body image. People such as football players, who rely on their physical characteristics to make a living, may not be able to cope well with an illness or injury that affects body image. Age, emotions, and spirituality can affect coping, but are less likely to affect coping of a young adult who plays college football.

Notions, beliefs, and convictions that individuals hold about themselves are referred to using which term? 1. Coping 2. Body image 3. Self-esteem 4. Self-concept

4. Self-concept Self-concept refers to the notions, beliefs, and convictions individuals hold about themselves. Coping is the process of responding to stress or a potential stressor. Body image refers to the combination of conscious and unconscious attitudes individuals have about their own bodies. Self-esteem develops from individuals' own evaluations of their competence and of the value others place on them.

A patient recently diagnosed with metastatic breast cancer questions the meaning of suffering and existence. What this patient is experiencing can be best described using which term? 1. Fear 2. Grief 3. Anxiety 4. Spiritual distress

4. Spiritual distress Spiritual distress is experienced when (1) patients question the meaning of suffering or existence; (2) patients experience a sense of conflict between their personal beliefs (or desires) and their relationship with their God; or (3) patients experience symptoms such a nightmares, sleep disturbances, and alterations in behavior and mood. Fear denotes a response to a specific threat. Fears vary according to the developmental status and age of the individual. Terminally ill patients may be struggling with fears of death and dying. Grief is the subjective, emotional response that evolves from a sense of loss. Anxiety is a vague and sometimes intense sense of impending doom or apprehension that may appear to have no clearly identifiable cause. Anxiety may lead to physical and psychologic stress and may be caused by real or imagined fear resulting from loss.

Beginning with the most basic, place the following nursing actions in order of priority according to Maslow's hierarchy of needs. 1. The nurse explains to a patient the use of call lights and emergency bathroom lights. 2. The nurse encourages family members to visit with a patient and hold the patient's hand. 3. The nurse encourages a patient to problem solve and to gain independence in his own care. 4. The nurse administers tube feedings to a patient who is unable to swallow since a brain injury. 5. The nurse assists a patient select a product that minimizes visible effects after a mastectomy.

4. The nurse administers tube feedings to a patient who is unable to swallow since a brain injury. 1. The nurse explains to a patient the use of call lights and emergency bathroom lights. 2. The nurse encourages family members to visit with a patient and hold the patient's hand. 5. The nurse assists a patient select a product that minimizes visible effects after a mastectomy. 3. The nurse encourages a patient to problem solve and to gain independence in his own care. The categories of Maslow's hierarchy of needs beginning with the most basic needs are physiological (water and food), safety (security), love and belonging (affection), esteem (self-esteem), and self-actualization (self-mastery).

A patient regularly seen at the clinic states that his mother-in-law has Alzheimer disease and needs to move in with him and his wife for safety reasons. He tells the nurse that he knows she needs somewhere to stay but doesn't think he will be able to take care of her. A week later, the patient develops paralysis with no medical cause. Which is the best explanation for this response? 1. The patient is displacing his feelings. 2. Substitution has been used to replace his stress. 3. Compensation is being used to cope with the anxiety. 4. The patient is using conversion as a defense mechanism.

4. The patient is using conversion as a defense mechanism. Conversion is turning an emotional conflict (the need for his mother-in-law to move in versus his desire and ability to care for her) into a physical symptom (paralysis), which provides the individual with some sort of benefit. Displacement is the transfer of feelings associated from one source to another that is considered less threatening. Substitution is replacing a highly valued, unattainable object with a less-valued, attainable object. Compensation is an attempt to make up for real or imagined weaknesses.