(PrepU) Psychosocial Well-Being: Nursing Concepts
During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be?
"Play helps children to develop cognitively, socially, physically, and emotionally." It is important to recognize that the child is busy with other activities but that this does not replace the need to engage in play. Children need time to play because it helps them to develop cognitively, socially, physically, and emotionally. Play at this age embodies the needs for rules and structures. Engaging in group activities allows children to be part of a social group.
A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond?
"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." The best response would be to remind the boy that there are many children with muscular dystrophy that could be found at the local support group. Teenagers do not like to be told that they "have" to do anything. Telling the boy that he needs to be active or simply suggesting activities does not address his concerns.
The father of a 4-year-old is concerned his child is not telling the truth and blaming others for things that have happened. Which response should the nurse prioritize after the father shares that the child is blaming someone named "Andrew" for a broken tool, and they have no idea who this is?
"Your son may have a friend named Andrew, but it could be an imaginary friend." The preschool-aged child may have imaginary playmates who are very real to them. The imaginary friend often has the characteristics that the child might wish for. Sometimes the child blames the imaginary friend for breaking a toy or engaging in another act for which the child does not want to take responsibility. The child should not be punished because the child is not intentionally telling a lie. At this age the child can think about things without actually seeing them.
Which is the most restrictive setting in the continuum?
Acute inpatient hospitalization Of the settings listed, acute inpatient hospitalization involves the most intensive treatment and is considered the most restrictive setting in the continuum. Inpatient treatment is reserved for acutely ill clients who, because of a mental illness, meet one or more of three criteria: (1) high risk for harming themselves, (2) high risk for harming others, or (3) unable to care for their basic needs.
A new mother is in the second developmental stage of becoming a mother and is becoming independent in her actions. Which action by the nurse would best foster this stage?
Demonstrating how to do cord care on the newborn When a mother enters the independent period of the second stage of becoming a mother, the nurse can assist her best by supporting her and praising her when she cares for the newborn. By demonstrating cord care to her, it empowers her to do the cord care the next time it is needed. The nurse's job is to not take over but to assist the mother in caring for her newborn.
A patient has a deficiency of the neurotransmitter serotonin. The nurse is aware that this deficiency can lead to:
Depression. Serotonin helps control mood and sleep. A deficiency leads to depression.
A nurse is providing education to pregnant clients in birth education classes. Which nursing interventions would the nurse include to promote positive learning? Select all that apply.
Encourage the clients to remain positive about the pregnancy. Provide information about all procedures in the birthing process. Clients should be encouraged to be positive throughout pregnancy. Providing all information about the birthing process will aid in being positive and informed. The nurse should encourage clients to have a support person. It may not be appropriate to be promote "self" time or being alone, or to change the home environment.
Which is an advantage of group therapy over individual therapy for a client with a borderline personality disorder?
Group therapy provides the client with relationship opportunities upon which to test behavior modifications Group therapy differs from individual therapy in that it is more effective for treating problems with interpersonal relationships, such as for the client with a borderline personality disorder. It offers multiple relationships to assist the individual in growth and problem solving and allows psychiatric clients a greater opportunity for reality testing and experiencing mutual concern and support.
A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient?
Increased risk of GI bleeding The interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors causes increased risk of GI bleeding, which should be monitored for. Interaction of anticholinergics with cholinesterase inhibitors causes decreased effectiveness of anticholinergics. Interaction of theophylline with cholinesterase inhibitors causes increased risk of theophylline toxicity. Interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors does not decrease the GI absorption of the drug.
A nurse is caring for a client who is experiencing alcohol withdrawal. Which statement best indicates that the client understands the need for long-term treatment?
"I will begin with inpatient treatment and participate in an aftercare program." Inpatient treatment and participation in an aftercare program are the only options that address the client's long-term treatment needs. Supportive counseling, family involvement, and support-group participation are important aspects of the treatment process, but they do not address the client's need for long-term treatment.
Which route of administration of medication is preferred in the most acute care situations?
Intravenous The intravenous route is the preferred parenteral route in most acute care situations because it is much more comfortable for the client and peak serum concentrations and pain relief occur more rapidly and reliably. Epidural administration is used to control postoperative and chronic pain. Subcutaneous administration results in slow absorption of medication. Medication administered intramuscularly is absorbed more slowly than intravenously administered medication.
The nurse is caring for a client who is seeking care after being raped. What is the primary reason the nurse does not leave the client alone during the emergency room stay?
Promotes the client's sense of safety The nurse's first responsibility is to provide the client a safe environment both physically and emotionally. Staying with the client will help promote a sense of safety. Although the other options may result from the nurse's presence, the primary goal is safety.
Which is not an area of focus within psychiatric rehabilitation?
Reduction in acute symptoms of psychosis Psychiatric rehabilitation is tertiary care that focuses on improving the client's level of functioning and self-governance for long-term self-care. Focusing on client strengths rather than the illness, hope, and collaboration achieve self-management. Reducing acute symptoms is a goal for the secondary level of care.
During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?
"Has something occurred that caused you to measure your thighs?" The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?
"It will enable the patient to remain home if that is what is desired." The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.
The parents of an adolescent with special needs express to the nurse that they feel guilty for considering respite care for a week to attend their older child's destination wedding. What would be the best response by the nurse?
"Let's explore several choices for care so you can feel comfortable and trust the care provider." The parents seeking respite care need to feel comfortable and trust the caregiver who will be caring for their adolescent. The nurse should assist the parents in exploring choices and not rush a decision. The nurse is hindering the parents by indicating they cannot handle the care of their adolescent, suggesting the wedding of the sibling be altered, and implying the care of their adolescent is undue stress. While the parents are living a different life from their peers with healthy children, parents of children with special needs rise to the challenge and are the experts/advocates for their child's care.
An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step?
Industry During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.
A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition?
Light therapy Phototherapy has proven effective for clients with symptoms of depression associated with a seasonal pattern. This condition, called seasonal affective disorder, may be related to lack of light and decreased melatonin production.
Children of parents who abused alcohol and substances are able to develop self-esteem and self-efficacy by developing which characteristics?
Resilience Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.
A 4-year-old is going to finger paint for the first time. What is the best action for the adult supervisor of this activity?
Support whatever the child paints. Preschoolers have a vivid imagination and need little direction for free-form play, such as finger painting. If a person draws a tree and tells the child to draw one, the child may no longer have fun, because the child believes that his or her tree will not look as good. The preschooler is not ready for competition and will drop out of the activity. Finger painting is a messy activity, so telling the child not to be messy takes the fun and the creative part out of the activity. The adult should provide aprons or clothing to protect the child's clothing and allow the painting in an area that can be cleaned easily.
A 39-year-old multigravida with diabetes presents at 32 weeks' gestation reporting she has not felt movement of her fetus. Assessment reveals the fetus has died. The nurse shares with the mother that the institution takes pictures after the birth and asks if she would like one. What is the best response if the mother angrily says no and starts crying?
Tell her that the hospital will keep the photos for her in case she changes her mind. Emotional care of the woman is complex, especially one who has suffered the loss of a child. The woman will need time to move through the stages of grief and the responses of grief vary from person to person. The mother may request the items later and they should be stored or kept for a year after the birth. There is no need to apologize to the client. It would be inappropriate to console her with the fact that she has other children. It negates her feelings and is not supportive of the woman at this time.
The nurse has been providing care to a client during a divorce. The client is now divorced from the spouse, effective 2 weeks ago. The nurse identified a nursing diagnosis of "Readiness for Enhanced Coping." What statement by the client would support this nursing diagnosis?
The client states, "I feel like I can finally get along with my life now that the divorce is final." The client's statement of being able to continue with life now that the divorce is final indicates that the client views the finality of the divorce as a relief. Because the client is eager to move on, the nurse would decide that "Readiness for Enhanced Coping" would be appropriate in this case. The client's statement of disbelief, alcohol use, and financial difficulties indicate difficulty in coping with the divorce and would not provide evidence or support for this diagnosis.
Avoiding which outcome is the primary reason for establishing professional boundaries with clients?
The loss of therapeutic effectiveness The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.
A woman is diagnosed with premenstrual dysphoric disorder. To address the woman's behavioral symptoms, which class of agents would the nurse anticipate needing to be addressed in the woman's teaching plan?
selective serotonin reuptake inhibitors (SSRIs) Although diuretics, NSAIDs, and vitamin supplements may be used as part of the treatment plan for premenstrual dysphoric disorder, SSRIs are commonly prescribed to address the behavioral and mood symptoms of this condition.
The most important tool of psychiatric nursing is the:
self The most important tool of psychiatric nursing is the self.
