Deck 32: Psychological Needs of Patients With Medical Conditions

Question 1

An unconscious patient is brought to the emergency department by ambulance for trauma treatment. The patient is wearing a sweat-stained John Deere cap, a denim shirt worn out in the elbows, dirty bib overalls covered with patches, work boots worn thin, and ragged underclothes. Several staff laugh as they stabilize the patient, and one remarks, "Farmer John must have fallen off the tractor." The most appropriate action for the charge nurse is to say which of the following?

A) "So he's a farmer-get over it. Thank him for your food and move on."
B) "You are violating this man's right to be treated with respect, and it stops now."
C) "Grow up and do your jobs; I think you have all seen poor people before."
D) "Perhaps you could find an outlet for humour that's not at a patient's expense."

Answer 1

"You are violating this man's right to be treated with respect, and it stops now."

Question 2

A diabetic patient is to have a mid-thigh amputation of his left leg. He tells the nurse, "I guess I'll be called 'Gimpy' after the surgery. My life is really going to change when I can't carry out my exercise program anymore. It sure won't be the same." What do these comments suggest the patient is experiencing?

A) Loss and grief
B) Fear and denial
C) Depression
D) Spiritual distress

Answer 2

Loss and grief

Question 3

A nurse's brother mentions that he saw on the news that a man without any known illnesses died suddenly just after hearing that his ex-wife had committed suicide. He asks if this was coincidence or if an emotional shock can kill someone. The nurse should respond by noting that a number of serious medical conditions may be precipitated by emotional distress, including which of the following? Select all that apply.

A) Cancer
B) Lung disease
C) Hypertension
D) Certain headaches
E) Myocardial infarction
F) Cardiovascular disease
G) Peptic ulcer

Answer 3

Cancer
Hypertension
Certain headaches
Myocardial infarction
Cardiovascular disease
Peptic ulcer

Question 4

A patient hospitalized after an MI is restlessly moving about in bed. Her pulse, blood pressure, and respiratory rate are elevated. In a shaky voice, she tells the nurse, "I think I am going to die. The pain is gone, but it could come back anytime. Where is the doctor? Why isn't the doctor here with me?" The nurse should analyze this behaviour as suggesting which of the following nursing diagnoses?

A) Spiritual distress
B) Ineffective breathing pattern
C) Nonadherence
D) Anxiety

Question 5

A patient being treated for an MI has been transferred to a step-down unit from the intensive care unit. She uses the call bell as often as every 15 minutes. Each time a staff member responds, the patient complains about her care or makes a seemingly small request. Several staff tell the primary nurse that the patient is "obnoxious" and that they feel inadequate because they can never seem to satisfy her needs. The primary nurse can be most helpful by doing which of the following?

A) Explaining that the demanding behaviour is due to the patient's increasing anxiety
B) "Laying down the law" to the patient, limiting use of the call light to once per hour
C) Rotating caregivers to give each person a much-needed respite from the patient's complaints
D) Asking the patient's family to sit with her and help meet her need for attention

Question 6

A woman whose sister-in-law died of cancer is herself diagnosed with breast cancer after a mammogram. Her doctor has advised a lumpectomy followed by radiation and chemotherapy. The patient is awaiting surgery, oncology, and radiation consults and is scheduled for surgery the day after tomorrow. She tearfully tells the nurse, "I keep thinking about how there is something growing inside me that could kill me. It's like living with a bomb inside you, and you don't know if or when it's going to go off." Which nursing intervention is most likely to be helpful?

A) Interact frequently with the patient, and provide books and games to help her stay busy and distract her from her negative thinking.
B) Validate her feelings and, with her permission, have a member of a breast cancer survivors' support group visit her in her hospital room.
C) Provide support and validate her feelings, and then offer to have the hospital chaplain stop by to talk with her.
D) Sympathize with her concerns, but remind the patient that she has not even had the surgery yet, and the treatments may well rid her of cancer.

Question 7

A man was brought to the emergency room for treatment of minor injuries after an accident in which his life partner, a transvestite, was killed. He refuses care, paces, screams, "Why, why, why!" repeatedly, and scratches at his arms as if trying to tear the flesh. A nurse says, "Geez, he's going to hurt himself. We'd better admit him to psych." Which explanation for the nurse's response is most likely?

A) The nurse's experience tells her that the patient is developing a psychotic reaction to the stress of the accident and death.
B) She is stigmatizing the patient due to his sexuality, dramatic grief response, and connection to a transvestite person.
C) The nurse is unsure how to handle a person presenting in this manner, is anxious as a result, and copes by wanting to shift the patient to another unit.
D) Medical nurses usually have less skill in managing emotional problems, and psychiatric staff are more appropriate to deal with people who are grieving.

Question 8

A patient who has been diagnosed with breast cancer has many questions related to surgery, radiation therapy, and chemotherapy. The nurse provides education about the disease and treatments but perceives that the patient has further questions about coping with day-to-day situations. Which of the following actions would be of greatest benefit to the patient?

A) Suggesting cognitive-behavioural therapy with a counsellor
B) Teaching her to monitor her stress level while at home
C) Suggesting she enroll in a pain-management program
D) Referring her to a support group for people with breast cancer

Question 9

A staff nurse tells the clinical nurse leader, "I am at a total loss as to how to deal with this patient. He has so many physical needs since his head and neck surgery! Those needs have to be my primary focus, but sometimes it seems he's crying and in emotional pain, too, and I don't know how to help with that." Which resource would likely be the best choice to help this nurse?

A) Psychiatric consultation liaison nurse
B) On-call psychiatrist
C) Unit social worker
D) Hospital chaplain

Question 10

A patient has just learned that all possible treatments for his disease have been exhausted, and it will likely claim his life within the next month. He is alert, has full control of his motor abilities, and is comfortable. He tells the nurse he cannot bear to leave his 11- and 13-year-old children when they are so young, that they seem so upset by his condition they change the topic when he brings it up, that he does not know how to talk with them, and yet he has so many things he has to say to them while there is still time. Which option would be most helpful for the nurse to endorse?

A) Writing down his feelings and thoughts in a journal
B) Talking with a minister, priest, or hospice social worker
C) Telling the children that there is no time, they must face this
D) Praying for guidance and strength to deal with this challenge

Question 11

A college student is a patient is on a medical unit for treatment of Guillain-Barré syndrome, a rare disorder that produces ascending paralysis and can be fatal if respiratory function is compromised. She is very anxious and frequently calls for staff. Staff direct her to try to calm down and explain that her sensation of being short of breath is due to her anxiety causing her to hyperventilate. Her family becomes increasingly concerned as the patient moves from being anxious to panic-stricken, saying she cannot breathe. Her resident doctor is called and reinforces the need for the patient to slow and deepen her breathing to control anxiety. Away from the patient, staff talk about how histrionic and whiny she is. Soon afterwards, the patient goes into respiratory arrest. She is left in a permanent vegetative state from hypoxia. Which of the following is the primary cause of this tragic outcome?

A) The paralysis had impaired respiration.
B) Her disorder was not adequately treated.
C) Staff stigmatized the patient as a whiner.
D) Her doctor was negligent in his response.

Question 12

A patient has a disorder that causes progressive, severe muscle pain and weakness, and she has curtailed physical and social activities to accommodate her condition. She tells the nurse "I cannot do anything. I have to depend on other people to help me. I do not enjoy much of anything anymore; even food does not taste good. I cannot see that my situation will change, so I feel pretty hopeless." Which of the following is the priority action the nurse should take?

A) Point out that there is always room for hope
B) Discuss the importance of physical exercise
C) Inquire about her support system and coping plans
D) Assess for signs of depression

Question 13

Which comment by the patient indicates use of a maladaptive or ineffective coping strategy?

A) "That heart attack was no fun, but at least it woke me up to my need for a better diet and more exercise."
B) "My family and God will see me through this. It won't be easy, but I'll never be alone."
C) "I definitely have cancer. Now I need to look at the effects of treatment and decide whether I will be able to work daily."
D) "I wouldn't be in this position if the company had better health benefits. If they paid for health club memberships, maybe I wouldn't be here now."

Question 14

A 32-year-old patient experiences an intestinal perforation and requires emergency surgery. The surgeon first meets the patient just before anesthesia is to be given and explains that peritonitis and intestinal inflammation may make a colostomy necessary. The patient is still quite groggy when stepped down to a postoperative unit and does not yet know that he does have a colostomy. Which initial response(s) should his nurse anticipate when the patient discovers that this procedure has been necessary? Select all that apply.

A) Distress that he has been disfigured and will be repugnant to others
B) Thankfulness that the surgery was successful and that he will live
C) Concerns about how he will do all the things he is used to doing
D) Anger that this has happened to him and that it has ruined his life
E) Depression related to changes in body image and perceived losses

Question 15

A patient being treated for an MI has been transferred from the intensive care unit to a step-down unit. She uses the call bell as often as every 15 minutes. She makes a seemingly small request or complains each time a staff member is summoned. Several staff tell the primary nurse that the patient is "obnoxious" and that they feel inadequate because they can never seem to satisfy her needs. The primary nurse decides to intervene directly with the patient. Which response would be most therapeutic?

A) "I'm wondering if you are feeling anxious about your illness and being left alone."
B) "The staff are concerned that you are not satisfied with the care you are receiving."
C) "Let's talk about why you use your call light so frequently; it's a bit of a problem."
D) "You are frustrating the staff by calling them so often; any idea why you do that?"

Question 16

A woman whose sister-in-law died of cancer is herself diagnosed with breast cancer after a mammogram. Her doctor has advised a lumpectomy followed by radiation and chemotherapy. The patient is awaiting surgery, oncology, and radiation consults and is scheduled for surgery the day after tomorrow. She tearfully tells the nurse, "I keep thinking about how there is something growing inside me that could kill me. It's like living with a bomb inside you, and you don't know if or when it's going to go off." Which observation noted in the patient's chart would most suggest that nursing interventions had been helpful?

A) "Less tearful today, denies having questions or concerns, pain rating = 0, up ad lib."
B) "Reading and talking with visitors, smiles readily, says she feels better since talking."
C) "States she is less worried after looking at her glass as half full instead of half empty."
D) "Met with oncologist, reports she is not going to think about it until they know more."

Question 17

Which modality would be helpful to include in the standard plan of care for patients who are being treated for severe, chronic low back pain? Select all that apply.

A) Biofeedback to promote muscular relaxation relief of tension that aggravates pain
B) Guided imagery to deepen relaxation and desensitize the patient to pain
C) Hypnosis for a state of restful alertness and blocking out painful sensations
D) Acupuncture and transcendental meditation for relaxation and direct pain relief
E) Psychotherapy to address emotional issues that can aggravate tension and pain

Question 18

A patient is recovering from a severe myocardial infarction. He tells his nurse, to whom he is very close, "I will be fine once I get home. All that 'watch your cholesterol, watch your calories, watch your stress' stuff is bull; if your time is up, your time is up." Which response would be most therapeutic?

A) "You've had a very serious heart attack and are lucky to be getting a second chance that many don't get; what you do with it is up to you."
B) "It sounds as if you would be just as happy with dying sooner as later. I wonder if those cute grandkids would feel the same way."
C) "Well, when you are home you can do as you wish, but until then you are on a low-sodium, low-fat diet and will be walking 30 minutes per shift."
D) "Research has shown that diet changes and stress control can at least double how long a person lives after a heart attack like yours."

Question 19

A patient being treated for an MI has been transferred from the intensive care unit to a step-down unit. She is anxious and uses the call bell as often as every 15 minutes, complaining or making a seemingly small request each time the staff member enters the room. Which indicator should staff focus on to monitor for the outcome of "anxiety self-control"?

A) Patient monitors duration of anxiety episodes
B) Patient sleeps 7 or more hours each night
C) Patient has stopped using the call button
D) Uses call button not more than once per hour

Question 20

A patient hospitalized after an MI is restlessly moving about in bed. Her pulse, blood pressure, and respiratory rate are elevated. In a shaky voice, she tells the nurse, "I think I am going to die. The pain is gone, but it could come back anytime. Where is the doctor? Why isn't the doctor here with me?" Place the nursing interventions in the order that would make them most therapeutic.

A) "I want you to breathe slowly with me, counting to 3 as you breathe in and again as you breathe out. I think this will help, but if not, I'll call your doctor."
B) "You seem very anxious, which is understandable. Your vital signs are up a bit because you are anxious, not because there is a problem with your heart."
C) "We are watching you very closely via the monitors and will be here in moments if there is a problem, so you can rest easy now, knowing we are watching over you."
D) "A heart attack can be a very frightening experience. Would you like to talk about it with me for a while?"