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Questions and Answers

Which nursing diagnosis has the highest priority for the patient running fearfully and crying, 'They're coming!'?

Self-care deficit

Risk for injury (correct)

Fear

Disturbed thought processes

The patient who checks and rechecks electrical cords due to obsession over a possible fire is demonstrating principles of what?

Flooding

Cognitive restructuring (correct)

Desensitization

Relaxation technique

Which defense mechanism is the patient using when claiming 'Nothing is wrong with me' despite clear signs of illness?

Displacement

Denial (correct)

Regression

Projection

What is the patient's level of anxiety based on their tremulous voice, rapid respirations, and elevated pulse before a biopsy?

Moderate Signup and view all the answers

What nursing intervention is most appropriate for a patient who has moderate anxiety and cannot understand preoperative information?

Present the information again in a calm manner using simple language. Signup and view all the answers

What is the rationale for encouraging a patient experiencing moderate anxiety to talk about their feelings?

Concerns stated aloud become less overwhelming and help problem solving begin. Signup and view all the answers

Which question is most appropriate for assessing a patient with a tentative diagnosis of generalized anxiety disorder?

"Do you find it difficult to control your worrying?" Signup and view all the answers

Where should a nurse place a patient showing disorganized behavior after a suggestion of a homosexual encounter?

An interview room furnished with a desk and two chairs Signup and view all the answers

What is the person's level of anxiety when experiencing nausea, dizziness, tachycardia, and hyperventilation after an auto accident?

Severe Signup and view all the answers

What defense mechanism is evident when a nurse not promoted says the nurse manager had a headache during the interview?

Projection Signup and view all the answers

The patient claiming that her best friend is perfect is demonstrating which mechanism?

Rationalization Signup and view all the answers

Which medication is appropriate for a patient experiencing a sudden episode of severe anxiety?

Lorazepam Signup and view all the answers

What describes the nurse's response when a non-promoted nurse supports the new manager after feelings of loss?

Altruism Signup and view all the answers

What coping mechanism is illustrated by a person who feels unattractive yet states, 'Although I'm not beautiful, I am smart.'?

Compensation Signup and view all the answers

What behavior is demonstrated by someone who speaks fondly of a rival while clearly feeling a strong negative emotion?

Reaction formation Signup and view all the answers

When an individual with sexual dysfunction blames their partner, which defense mechanism is used?

Rationalization Signup and view all the answers

What is the assessment of a student feeling alert and restless before a test?

Mild anxiety Signup and view all the answers

What intervention is most appropriate for a student who feels alert and restless before a test?

Explain that the symptoms result from mild anxiety and discuss the helpful aspects. Signup and view all the answers

Which comment best demonstrates a cruel person using rationalization?

"That person should not have provoked me." Signup and view all the answers

What is the best action for a patient experiencing panic and running while shouting?

Tell the patient, 'Stop running and take a deep breath. I will help you.' Signup and view all the answers

What is an appropriate nursing intervention for a person unable to leave home due to severe anxiety?

Teach the person to use positive self-talk techniques. Signup and view all the answers

Which statement by a person with possible obsessive-compulsive disorder indicates their condition?

"I check where my car keys are eight times." Signup and view all the answers

What health teaching should be included when alprazolam is prescribed for acute anxiety?

Avoid alcoholic beverages. Signup and view all the answers

Which statement is most likely if a patient with agoraphobia complains of loneliness and anxiety?

"Being afraid to go out seems ridiculous, but I can't go out the door." Signup and view all the answers

What phrase correctly completes the nursing diagnosis for a patient with OCD related to compulsive cleaning?

Persistent thoughts about bacteria, germs, and dirt Signup and view all the answers

What action should the nurse implement to help a patient with ritualistic handwashing develop more effective coping?

Encourage the patient to participate in social activities. Signup and view all the answers

Which nursing intervention should be implemented first for a patient experiencing panic?

Provide calm, brief, directive communication. Signup and view all the answers

What interventions should be suggested to foster parents of a child from an abusive background?

Use a calm manner and low voice. Signup and view all the answers

Which information should a nurse include in health teaching for a patient diagnosed with generalized anxiety disorder beginning a new prescription for lorazepam?

The importance of caffeine restriction Signup and view all the answers

Which assessment questions are most appropriate for a patient with possible obsessive-compulsive disorder?

"Do you do certain things over and over again?" Signup and view all the answers

What nursing diagnoses are likely for an adult who is socially withdrawn and hoards?

Risk for injury Signup and view all the answers

Which assessment data helps distinguish symptoms of conversion disorder from illness anxiety disorder?

Patient's style of presentation Signup and view all the answers

Which prescription medication would likely be prescribed for a patient diagnosed with a somatic symptom disorder?

Antidepressant medications to treat co-morbid depression Signup and view all the answers

Patients diagnosed with somatic symptom disorder will probably be resistant to what?

Accepting psychiatric help Signup and view all the answers

For a patient with blindness related to conversion disorder, what psychological factor is most relevant?

The patient's anxiety is relieved through the physical symptom. Signup and view all the answers

What should a nurse do to help a patient with blindness related to conversion disorder eat?

Expect the patient to feed self after explaining arrangement of the food on the tray. Signup and view all the answers

Which nursing diagnosis is most relevant for a patient with chronic low self-esteem and blindness related to conversion disorder?

Chronic low self-esteem Signup and view all the answers

What is a high-priority nursing intervention for patients diagnosed with somatic symptom disorders?

Shift focus from somatic symptoms to feelings. Signup and view all the answers

A patient fears serious heart disease despite negative evaluations. What health problem is most likely?

Illness anxiety disorder (hypochondriasis) Signup and view all the answers

What observation is expected in a patient diagnosed with a somatic symptom disorder?

Has altered comfort and activity needs. Signup and view all the answers

To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms _____ .

serve as a coping mechanism Signup and view all the answers

A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to the patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to the patient. An appropriate outcome is that the patient will:

Demonstrate performance of former roles and tasks. Signup and view all the answers

Which comment by a patient who recently experienced a myocardial infarction indicates use of maladaptive, ineffective coping strategies?

My employer should have paid for a health club membership for me. Signup and view all the answers

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?

Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion. Signup and view all the answers

A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Which comment is most therapeutic from the nurse?

I'm wondering if you are feeling anxious about your illness and being left alone. Signup and view all the answers

A patient reports fears of having cervical cancer despite normal Pap smear results from multiple doctors. Which disorder would the nurse suspect?

Illness anxiety disorder (hypochondriasis) Signup and view all the answers

A patient diagnosed with a somatic symptom disorder expresses feeling like a burden to their family. It is important for the nurse to assess:

Secondary gains. Signup and view all the answers

What is an essential difference between somatic symptom disorders and factitious disorders?

Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization. Signup and view all the answers

A patient says, 'I know I have a brain tumor despite the results of the MRI. The radiologist is wrong.' Which response by the nurse fosters cognitive reframing?

Let's see if there are any other possible explanations for your vomiting. Signup and view all the answers

Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively?

Relaxation techniques Signup and view all the answers

Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder?

What are you unable to do now but were previously able to do? Signup and view all the answers

A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient states, 'Although I'm still having pain, I notice it less and am able to perform more activities.' The nurse should evaluate the treatment plan as:

Partially successful. Signup and view all the answers

A child has a history of multiple hospitalizations for recurrent systemic infections. Factitious disorder imposed on another is suspected. Which nursing interventions are appropriate? (Select all that apply.)

Keep careful, detailed records of visitation and untoward events. Signup and view all the answers

Which assessment findings suggest the possibility of a factitious disorder, imposed on self-type? (Select all that apply.)

History of multiple hospitalizations without findings of physical illness Signup and view all the answers

A patient diagnosed with a somatic symptom disorder expresses feelings of spiritual distress. Which nursing diagnoses apply to this patient? (Select all that apply.)

Spiritual distress Signup and view all the answers

A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings support the suspected diagnosis? (Select all that apply.)

Reports frequent syncope Signup and view all the answers

A nurse's neighbor asks about the potential for emotional shock to be fatal. Which serious medical conditions may be complicated by emotional stress? (Select all that apply)

Hypertension Signup and view all the answers

Which intervention should be included in the plan of care for a patient diagnosed with posttraumatic stress disorder (PTSD) who has frequent flashbacks?

Explain that the physical symptoms are related to the psychological state. Signup and view all the answers

Which behavior by the parents of four teenagers who died in an automobile accident most clearly demonstrates resilience?

Create a scholarship fund at their child's high school. Signup and view all the answers

What is the nurse's most therapeutic reply to a man grieving the sudden death of his wife, saying he can't live without her?

Her death is a terrible loss for you. Signup and view all the answers

How should the nurse analyze a woman's angry statement after her husband's death suggesting that the nurse's attention could have saved him?

Anger is an expected emotion in an adjustment disorder. Signup and view all the answers

What is the best intervention for a wife grieving her husband's heart failure?

I understand you are feeling upset. I will stay with you until your family comes. Signup and view all the answers

Which behavior indicates the parents of a child who drowned have adapted to their loss?

Throw flowers on the lake at each anniversary date of the accident. Signup and view all the answers

Which scenario demonstrates a dissociative fugue?

A man disappears after an extramarital affair and reappears without memory of what occurred. Signup and view all the answers

What assessment finding should the nurse prioritize for a patient with dissociative identity disorder?

Risk for self-harm. Signup and view all the answers

The statement 'I feel detached and weird all the time' is most suggestive of which health problem?

Depersonalization disorder Signup and view all the answers

What is the best reply from the nurse when a UAP asks how to help a patient with amnesia?

Use short, simple sentences and keep the environment calm. Signup and view all the answers

Which intervention is most appropriate for a patient with depersonalization disorder who feels like they're going to float away?

Engage the patient in a physical activity. Signup and view all the answers

Which division of the autonomic nervous system is stimulated after a person runs from a crowded nightclub due to fire?

Sympathetic nervous system Signup and view all the answers

What assessment finding would the nurse expect after a car accident where the gas pedal became stuck?

Flashbacks Signup and view all the answers

What should the nurse's highest priority be when a soldier diagnosed with PTSD returns from active duty?

Depression Signup and view all the answers

Which comment by a soldier diagnosed with PTSD requires the nurse's immediate attention?

I saw my best friend get killed by a roadside bomb. Signup and view all the answers

What type of experience has a soldier described when they say, 'If there's a loud noise at night, I get under my bed because I think we're getting bombed'?

Flashback Signup and view all the answers

Which social event would be most disturbing for a soldier diagnosed with PTSD?

Fireworks display on July 4th Signup and view all the answers

Which comment by the parents best demonstrates support for the development of resilience in young children?

We spend daily family time talking about experiences and feelings. Signup and view all the answers

What phenomenon associated with PTSD is a soldier describing when they say, 'I keep seeing bits of flesh everywhere'?

Reexperiencing Signup and view all the answers

Which symptom associated with PTSD is described when a soldier's spouse says, 'He won’t even look at children'?

Avoidance Signup and view all the answers

What is the best response from the nurse when a spouse complains about their partner's behavior due to PTSD?

PTSD often strains relationships. Here are some community resources. Signup and view all the answers

Which assessment finding supports a diagnosis of dissociative fugue?

I cannot recall why I'm living in this town. Signup and view all the answers

What physiological response is expected for a patient after extensive wound care following surgery?

Vital signs return to normal. Signup and view all the answers

Why do relaxation techniques help patients who have experienced major traumas?

Engage the parasympathetic nervous system. Signup and view all the answers

Which etiology should complete the nursing diagnosis for a patient with dissociative identity disorder?

Cognitive distortions associated with unresolved childhood abuse issues. Signup and view all the answers

What disorders should the nurse suspect in a patient with a history of sexual abuse who feels numb in relationships?

Acute stress disorder Signup and view all the answers

What recommendations should the nurse make to foster parents of a traumatized child?

Explain and reinforce reality. Signup and view all the answers

What findings should the nurse be alert to in a patient with suspected PTSD?

Feels detached, estranged, or empty inside. Signup and view all the answers

Which experiences are most likely to precipitate PTSD?

Being in a bus that overturned. Signup and view all the answers

What action should a nurse take first when teaching coping strategies to a patient experiencing severe anxiety?

Lower the patient's current anxiety. Signup and view all the answers

Which health problem is likely when a woman is preoccupied with her feet being huge?

Body dysmorphic disorder Signup and view all the answers

What is an appropriate response for a nurse to a patient experiencing anxiety who says, 'I feel undone'?

I'm not sure I understand. Give me an example. Signup and view all the answers

What is the highest priority initial nursing intervention for a patient crying, 'They're coming!'?

Provide for the patient's safety. Signup and view all the answers

Study Notes

Interventions for PTSD

Educate patients that physical symptoms are linked to psychological states.
Encourage the discussion of trauma and its effects to promote coping strategies.

Resilience in Grief

Creating a scholarship fund following the loss of teenagers indicates resilience.
Returning to work after loss reflects coping, but may not demonstrate active resilience.

Therapeutic Responses in Grief

Expressing that the loss is significant validates the grieving individual's feelings.
Anger directed at caregivers can indicate normal grieving, especially in different cultures.

Grief Behavior in Parents

Throwing flowers on the lake every anniversary marks a healthy memorialization of a lost child.

Addressing Spousal Grief

Staying with a distressed spouse and offering comfort can provide immediate emotional support.

Characterization of Dissociative Fugue

Dissociative fugue is characterized by memory loss about one's identity or past events.

Patient Safety in Mental Health

Assessing risk for self-harm is the highest priority in patients with dissociative identity disorder.

Symptoms of Mental Disorders

Depersonalization disorder involves feeling detached from reality or oneself.
Flashbacks can occur after traumatic experiences, indicating unresolved trauma.

Anxiety and Coping Strategies

Physical activity serves as an intervention for patients experiencing feelings of detachment.
Engaging the parasympathetic nervous system helps patients who have undergone trauma.

Family discussions about experiences and feelings foster resilience among children.

PTSD Diagnostic Features

Avoidance of reminders and re-experiencing the trauma are core symptoms of PTSD.
Community resources can support relationships strained by PTSD-related challenges.

Treatment of Anxiety

Reducing a patient's anxiety before teaching coping strategies is essential for effectiveness.
Body dysmorphic disorder involves significant distress over perceived body flaws.

Safety Concerns in Nursing

Patient safety is paramount when managing acute anxiety or panic responses.
Assessment of anxiety levels helps direct appropriate interventions based on severity.

Understanding Defense Mechanisms

Denial manifests as refusal to acknowledge significant health concerns.
Cognitive restructuring addresses negative thought patterns through therapy.

Intervention Techniques for Anxiety

Presenting information in clear, simple terms aids understanding in anxious patients.
Offering open communication encourages patients to express feelings and clarify understanding.### Anxiety and Defense Mechanisms
Moderate anxiety can be alleviated by discussing feelings, as expressing concerns allows for effective problem-solving.
In assessing generalized anxiety disorder, a pertinent question involves difficulty in controlling worrying.
Severe anxiety is indicated by physical symptoms such as tachycardia and hyperventilation.

Behavioral Responses and Interventions

In cases of disorganized behavior due to anxiety, placing the patient in a calm interview room is ideal.
Appropriate nursing responses can help patients cope with panic, including providing calm communication and teaching relaxation techniques.

Managing Compulsive Behaviors

To help patients with obsessive-compulsive disorder, focus should shift from compulsions to participation in social activities.
Common indicators of obsessive-compulsive disorder include repetitive behaviors, such as checking items multiple times.

Health Education and Medication

Instructions for anxiolytic medications like lorazepam should emphasize the avoidance of alcohol.
For patients with anxiety disorders, understanding symptoms is crucial for effective coping strategies.

Symptoms and Care Planning

Patients with somatic symptom disorders may resist psychiatric help despite the need for mental health support.
Secondary gains relate to patients’ reluctance to abandon their physical symptoms as those symptoms may provide emotional relief.

Recognizing Illness Anxiety

Illness anxiety disorder manifests as excessive fear of diseases despite negative medical evaluations, exemplified by having repeated normal test results but still fearing illness.
Therapeutic communication should address underlying anxieties and encourage open dialogue about symptoms.

Patient Support Strategies

In dealing with social withdrawal and hoarding symptoms in patients, nursing diagnoses should include chronic low self-esteem and ineffective home maintenance.
Supporting children from abusive backgrounds involves providing a simple environment and maintaining a calm approach to reduce anxiety.

Therapeutic Comments and Interventions

Therapeutic communication should express empathy and concern for a patient’s anxiety, especially when they exhibit maladaptive coping strategies.
Identifying and validating patients’ feelings can be instrumental in supporting their transition in care.

Understanding Functional Disorders

Functional neurological disorders may present with symptoms like blindness without concern for the underlying issue, leading to complex nursing care challenges.
Recognizing the distinct characteristics of somatic symptoms vs. factitious disorders is crucial for accurate diagnosis and treatment planning.### Somatic Symptom Disorders vs. Factitious Disorders
Somatic symptom disorders involve voluntary control, while factitious disorders are unconscious and automatic.
Factitious disorders are influenced by psychological factors; somatic symptom disorders stem from stress.
Childhood sexual abuse is linked to factitious disorders; somatic symptom disorders can be culture-bound.
Expression of psychological stress occurs through somatization in somatic symptom disorders.

Cognitive Reframing Response

Effective response to a patient expressing belief in illness despite contrary evidence involves exploring other explanations.

Treatment Modalities

Relaxation techniques are recommended for patients diagnosed with somatic symptom disorders to enhance coping skills.

Identifying Secondary Gains

Assessment of what activities a patient can no longer do helps identify potential secondary gains related to somatic symptom disorders.

Evaluation of Treatment Success

Noticing reduced pain perception and increased activity suggests partial success in the treatment of somatic symptom disorders.

Nursing Interventions in Factitious Disorder

Careful documentation of visitation and unusual events is critical in cases suspected of factitious disorder imposed on another.
Encourage group visits for family members and maintain frequent interactions with the patient during visitation hours.

Indications of Factitious Disorder

Multiple hospitalizations without physical illness findings and numerous medical procedures could indicate a factitious disorder.

Nursing Diagnoses for Patients

Patients expressing feelings of divine punishment and familial burden may exhibit spiritual distress and ineffective role performance.

Assessment Findings for Somatic Symptom Disorder

Female gender, frequent syncope reports, and insomnia linked to pain may support a diagnosis of somatic symptom disorder.

Emotional Stress and Physical Health

Serious medical conditions that can be aggravated by emotional stress include cancer, hypertension, immune disorders, and cardiovascular disease.

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