U2: COPING, STRESS QUIZ
A primary healthcare provider tells a client about the diagnosis of inoperable cancer and that the client does not have long to live. After the primary healthcare provider leaves, the client says to the nurse, "I feel fine. I probably only have the flu." The nurse determines that the client is in the denial stage of grief. What should the nurse do to help meet the client's emotional needs?
Allow the denial and be available to discuss the situation with the client. Allowing the denial and being available to discuss the situation with the client does not remove the client's only way of coping, and it permits future movement through the grieving process when the client is ready. Reassuring the client that everything will be alright is false reassurance. The client must not be abandoned; the nurse's presence is a form of emotional support. The client's denial should be neither encouraged nor removed; encouraging denial is a form of false reassurance.
A preterm newborn is admitted to the neonatal intensive care unit (NICU). Which concern is most commonly expressed by NICU parents?
Fear of handling the infant Because these infants are so tiny and frail, parents most commonly fear handling or touching them; they should be encouraged to do so by the NICU staff. The primary concern is the infant's fragility, not bonding; however, bonding should be encouraged. Although there may be concerns about a long hospital stay, they are not commonly expressed by mothers. The primary concern is the infant's fragility, not breast-feeding. Breasts may be pumped and breast milk given in gavage feedings.
A client comes to the crisis center because her spouse has stated that he wants a divorce. The client states that she is angry and feels rejected. What should the nurse encourage the client to do to cope with this emotional trauma?
Learn to constructively vent her anger. Coping mechanisms, such as venting anger, may help the client address the feelings of rejection. Defense mechanisms are usually subconscious and not under a person's control; specific coping approaches should be explored. Avoidance is a defense mechanism that may reduce anxiety, but it will not assist in problem-solving. Dating should not be encouraged until the client has worked through the current crisis.
A client with recurrent episodes of depression comes to the mental health clinic for a routine follow-up visit. The nurse suspects that the client is at increased risk for suicide. What is a contributing factor to the client's risk for suicide?
OVERWHELMING FEELINGS OF GUILT Overwhelming feelings of guilt contribute to the client's risk for suicide. The client may ruminate over past or current failings, and extreme guilt can assume psychotic proportions. Psychomotor retardation and decreased physical activity are clinical findings associated with depression and usually do not lead to suicide because the client does not have the energy for self-harm. Impulsive behaviors, not deliberate thoughtful behaviors, contribute to the client's risk for suicide.
A 6-year-old child has been wetting the bed at night since the birth of a baby brother. What defense mechanism is the child using to cope with the stress of accepting a new family member?
REGRESSION Regression is the return to an earlier and more comfortable developmental level. Repression is the unconscious and involuntary forgetting of painful ideas, events, or conflicts. Dissociation is the unconscious separation of painful feelings and emotions from an unacceptable idea, situation, or object. Displacement is discharging pent-up feelings to a less threatening object or person.
A client confides to the nurse, "I've been thinking about suicide lately." What conclusion should the nurse make about the client?
The client is fearful of the impulses and is seeking protection from them. Clients frequently report suicidal feelings so the staff will have the chance to stop them. They are really asking, "Do you care enough to stop me?" It may be true that the client feels safe and can share feelings with the nurse, but, more importantly, the client is seeking help and protection. It may be true that the client wants to frighten the nurse or wants attention from the staff, but these are unlikely motivations for the behavior.
A nurse is assessing a client who has been emotionally immobilized since her husband requested a divorce and moved out of their home. What should be determined first by the nurse in the crisis intervention center?
What the divorce means to the client Determining the significance of the divorce to the client is a method of identifying the client's perception of the event; it is critical to adequate assessment and appropriate intervention. The client's relationship with her husband is secondary in importance and may divert attention from the client's perception of the problem and the significance of the divorce to the client. Receptivity to suggestions should be explored later in therapy (i.e., in the planning stage). Although financial concerns are important, they should not be the first topic addressed.
