eBay:testbanks_and_xanax

ANS: D

When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse’s personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. “Why” questions are probing and nontherapeutic.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 9-47 (Table 9-2)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. A nurse is responsible for breaking silences. b. Patients withdraw if silences are prolonged. c. Silence can provide meaningful moments for reflection. d. Silence helps patients know that what they said was understood.

17. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

ANS: C

Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 9-11, 12, 47 (Table 9-2)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

18. A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice a. is rarely helpful. b. fosters independence. c. lifts the burden of personal decision making. d. helps the patient develop feelings of personal adequacy.

ANS: A

Giving advice fosters dependence on the nurse and interferes with a patient’s right to make personal decisions. It robs the patient of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it may contribute to a patient’s feelings of personal inadequacy. Giving advice also keeps the nurse in control and feeling powerful.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 9-20, 33, 54 (Table 9-3) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. “Just ignore them and they will leave you alone.” b. “You should make friends with other children.” c. “Call them names if they do that to you.” d. “Tell me more about how you feel.”

19. A school age child tells the school nurse, “Other kids call me mean names and will not sit with me at lunch. Nobody likes me.” Select the nurse’s most therapeutic response.

ANS: D

The correct response uses exploring, a therapeutic technique. The distracters give advice, a nontherapeutic technique.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 9-15, 47 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. “You sound very upset about this.” b. “God always forgives us for our sins.” c. “Why do you think you are being punished?” d. “If you feel this way, you should talk to your minister.”

20. A patient with acute depression states, “God is punishing me for my past sins.” What is the nurse’s most therapeutic response?

ANS: A

The nurse reflects the patient’s comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are nontherapeutic.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 9-10, 14, 15, 47 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A patient cries as the nurse explores the patient’s feelings about the death of a close friend. The patient sobs, “I shouldn’t be crying like this. It happened a long time ago.” Which responses by the nurse facilitate communication? (Select all that apply.)

a. “Why do you think you are so upset?” b. “I can see that you feel sad about this situation.” c. “The loss of a close friend is very painful for you.” d. “Crying is a way of expressing the hurt you are experiencing.” e. “Let’s talk about something else because this subject is upsetting you.”

ANS: B, C, D

Reflecting (“I can see that you feel sad,” “This is very painful for you”) and giving information (“Crying is a way of expressing hurt”) are therapeutic techniques. “Why” questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 9-14, 15, 47 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Cost savings for patients b. Maximize care management c. Access to services for patients in rural areas d. Prompt reimbursement by third-party payers e. Rapid development of trusting relationships with patients

2. Which benefits are most associated with use of telehealth technologies? (Select all that apply.)

ANS: A, B, C

Telehealth has shown that it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services; telehealth technologies can solve those problems. Although telehealth’s improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third-party payers. Telehealth technologies have not shown rapid development of trusting relationships.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 9-26, 27 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. “Why do you think these events have happened to you?” b. “There are people with problems much worse than yours.” c. “I’m glad you were able to tell me how you felt about your loss.” d. “I noticed your hands trembling when you told me about your accident.” e. “You look very nice today. I’m proud you took more time with your appearance.”

3. Which comments by a nurse demonstrate use of therapeutic communication techniques? (Select all that apply.)

ANS: C, D

The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are nontherapeutic techniques.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 9-47 (Table 9-2) | Page 9-54 (Table 9-3)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. “Tell me more about that situation.” b. “Let’s talk about something else.” c. “I notice you are pacing a lot.” d. “I’ll stay with you a while.” e. “Why did you do that?”

4. A nurse interacts with patients diagnosed with various mental illnesses. Which statements reflect use of therapeutic communication? (Select all that apply.)

ANS: A, C, D

The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate changing the subject and probing, which are nontherapeutic techniques.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 9-47 (Table 9-2) | Page 9-54 (Table 9-3)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Chapter 10: Stress Responses and Stress Management

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. The adult child of a patient diagnosed with major depressive disorder asks, “Do you think depression and physical illness are connected? Since my father’s death, my mother has had shingles and the flu, but she’s usually not one who gets sick.” Which answer by the nurse best reflects current knowledge?

a. “It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system.” b. “You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses.” c. “So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link.” d. “Negative emotions and prolonged stress interfere with the body’s ability to protect itself and can increase the likelihood of illness.”

ANS: D

The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to illness. Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother’s baseline.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 10-7, 8 TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Engaging in activity without using any supplemental oxygen b. Sleeping comfortably and soundly, without respiratory distress c. Feeling relaxed and taking regular deep breaths when leaving home d. Having a younger, healthier body that knows no exercise limitations

2. A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize?

ANS: C

The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen–carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 10-16, 40 (Box 10-3) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

3. A nurse leads a psychoeducational group for patients experiencing depression. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors. b. prevents damage from overstimulation of the sympathetic nervous system. c. detoxifies the body by removing metabolic wastes and other toxins. d. improves mood stability for patients with bipolar disorders.

ANS: A

-Endorphins produced during exercise result in improvement in mood and lowered anxiety. The other options are not accurate.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 10-12, 19, 37 (Box 10-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Motor restlessness b. Somatic complaints c. Memory deficiencies d. Sensory perceptual alterations

4. A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, “The immigration to America has been very difficult.” Considering cultural background, which expression of stress by this patient would the nurse expect?

ANS: B

Honduras is in Central America. Many people from Central American cultures express distress in somatic terms. The other options are not specific to this patient’s cultural background and are less likely to be observed in persons from Central America.

PTS: 1

DIF: Cognitive Level: Understand (Comprehension)

REF: Page 10-11 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Advise the patient, “Go to sleep 30 to 60 minutes earlier each night to increase rest.” b. Direct the patient in slow and deep breathing using abdominal muscles. c. Suggest the patient consider that a new job might be better than the present one. d. Tell the patient, “Relax by spending more time playing with your pet.”

5. A patient nervously says, “Financial problems are stressing my marriage. I’ve heard rumors about cutbacks at work; I am afraid I might get laid off.” The patient’s pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement?

ANS: B

The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident by elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system will counter the sympathetic nervous system’s arousal, normalizing these vital sign changes and reducing the physiological demands stress is placing on his body. Other options do not address his physiological response pattern as directly or immediately.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 10-3, 4, 15, 16, 39 (Box 10-2)

TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity a. A person who has been assigned more responsibility at work b. A parent whose job required relocation to a different city c. A person returning to college after an employer ceased operations d. A man who recently separated from his wife because of marital problems

6. According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a person’s stress status and coping abilities?

ANS: C

A person returning to college after losing a job is dealing with two significant stressors simultaneously. Together, these stressors total more life change units than any of the single stressors cited in the other options.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 10-12, 13, 31 (Table 10-3) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. “Religion does not usually affect health, but you were younger and stronger then.” b. “Contact with supportive people at a church might help, but religion itself is not especially helpful.” c. “Studies show that spiritual practices can enhance immune system function and coping abilities.” d. “Going to church would expose you to many potential infections. Let’s think about some other options.”

7. A patient newly diagnosed as HIV-positive seeks the nurse’s advice on how to reduce the risk of infections. The patient says, “I went to church years ago and I was in my best health then. Maybe I should start going to church again.” Which response will the nurse offer?

ANS: C

Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being. The other options wrongly suggest that spiritual practices have little effect on the immune system or reject the patient’s preferences regarding health management.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 10-11, 12 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax a. Advise the patient that being so particular about potential friends reduces social contact. b. Suggest using the Internet as a way to find supportive others with similar values. c. Encourage the patient to begin dating again, perhaps with members of the church. d. Discuss how divorce support groups could increase coping and social support.

8. When a nurse asks a newly admitted patient to describe social supports, the patient says, “My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I don’t have many friends because most people my age just want to go out drinking.” Which action will the nurse apply?

ANS: D

High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships affect a person’s coping negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than helping her cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable persons.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 10-10, 11

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. “It could be that prayer is your only hope.” b. “You may find prayer gives comfort and lowers your stress.” c. “I can help you feel calmer by teaching you meditation exercises.” d. “We do not have evidence that prayer helps, but it wouldn’t hurt.”

9. A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse, “Do you think saying a prayer would help?” Select the nurse’s best answer.

ANS: B

Many patients find that spiritual measures, including prayer, are helpful in mediating stress. Studies have shown that spiritual practices can enhance the sense of well-being. When a patient suggests a viable means of reducing stress, it should be supported by the nurse. Indicating that prayer is the patient’s only hope is pessimistic and would cause further distress. Suggesting meditation or other alternatives to prayer implies that the nurse does not think prayer would be effective.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 10-11, 12

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation