Psychosociocultural Nursing Care
4. Emotionally charged topics should be approached with respectful, sincere
interactions that are accepting and nonjudgmental, which will promote further verbalizations.
36. 1. This response encourages the patient to explore concerns. Verbalization of concerns, validation of feelings, and patient teaching may help reduce anxiety.
2. This intervention bypasses data collection.
In addition, ice chips are composed of water, which is contraindicated before and initially after a bronchoscopy because of the risk for aspiration.
3. This response ignores both of the patient’s concerns and addresses a completely different issue.
4. Fluid and food are not permitted after a bronchoscopy until the gag reflex returns.
37. 1. The patient is the primary source of information. When nonverbal commu- nication reinforces the verbal message, the message reflects the true feelings of the patient because nonverbal be- havior is under less conscious control than verbal statements.
2. This abdicates the nurse’s responsibility to
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includes providing feedback and encouragement.
4. This statement reflects the orientation phase of a therapeutic relationship. The nurse and patient make a verbal agreement to work together to assist the patient to achieve a goal.
5. This statement reflects the termination phase of a therapeutic relationship. It focuses on summarizing what has transpired and been accomplished and looks to the future.
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Psychological Support
KEYWORDS
The following words include nursing/medical terminology, concepts, principles, and information relevant to content specifically addressed in the chapter or associated with topics presented in it.
English dictionaries, nursing textbooks, and medical dictionaries, such as Taber’s Cyclopedic Med- ical Dictionary, are resources that can be used to expand your knowledge and understanding of these words and related information.
Anxiety:
Mild Moderate Severe
Panic, panic attack Behavior modification Beliefs
Bereavement Body image Confusion
Conscious, unconscious, subconscious Coping
Crisis:
Adventitious/unpredictable events Developmental/maturational Situational
Crisis intervention Defense mechanisms:
Compensation Conversion Denial
Depersonalization Dissociation Identification Intellectualization Introjection Minimization Projection Rationalization Reaction formation Regression Repression Sublimation Substitution Suppression Delirium Delusions Dementia Dependence Depression
Egocentric (self-absorbed) Empathy, empathetic, empathic Freudian terms:
Ego Id Superego Grieving:
Anticipatory Dysfunctional
Stages of Grieving (Kübler-Ross):
Denial Anger Bargaining Depression Acceptance Guided imagery Hallucinations Hopelessness Meditation Memory Midlife crisis Personal identity Positive mental attitude Powerlessness
Progressive relaxation Psychodynamic
Psychosocial development Psychotherapy
Role:
Role ambiguity Role conflict Role strain Self-concept Self-esteem Social isolation
Spirituality, Spiritual distress Suicide, Suicidal
Sympathy
Transference/Countertransference Trust
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QUESTIONS
1. A patient with a terminal illness tells the nurse, “I have lived a long life. I am ready to go.” What is the nurse’s best response?
1. Sit quietly by the bedside 2. Offer the patient a back rub
3. Tell the family about the patient’s statement
4. Initiate a discussion of how dying is part of the life cycle
2. Which word reflects a concept that is nonessential for the nurse to establish a therapeutic relationship?
1. Trust 2. Caring 3. Control 4. Empathy
3. A man with a heart condition continues to perform strenuous sports against medical advice. Which defense mechanism does the nurse identify the patient is using?
1. Denial 2. Repression 3. Introjection 4. Dissociation
4. The nurse is caring for a patient with a comprehension deficit. What should the nurse do to best support this patient?
1. Ask that unclear words be repeated 2. Speak directly in front of the patient 3. Make a referral for a hearing evaluation 4. Establish structured activities of daily living
5. What is an important concept to consider about anxiety to provide appropriate nursing care?
1. Panic attacks generally have a slow onset that can be prevented if identified early 2. One can conceptualize anxiety as being similar to the health-illness continuum 3. People who lead healthy lifestyles rarely experience anxiety
4. Anxiety is an abnormal reaction to realistic danger
6. Which word reflects the ability of a person to perceive another person’s emotions accurately?
1. Trust 2. Empathy 3. Sympathy 4. Autonomy
7. Which patient response identified by the nurse is unrelated to clinically depressed older adults?
1. Fatigue
2. Disturbed sleep 3. Stress incontinence 4. Activity intolerance
8. When considering the concepts regarding the defense mechanism of projection, the nurse identifies that the person who fears being taken advantage of usually is:
1. In denial 2. An opportunist 3. Depersonalizing 4. Eager to please others
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9. What is the consequence when the nurse denies a patient the use of a defense mechanism?
1. Damages the Id 2. Causes more anxiety 3. Facilitates effective coping 4. Encourages emotional growth
10. Which nursing intervention best supports a patient’s sense of self?
1. Referring to counseling services 2. Exploring maladaptive responses 3. Verbalizing realistic expectations 4. Maintaining respectful interactions
11. Which defense mechanism is being used when a patient who has just been diagnosed with terminal cancer calmly says to the nurse, “I’ll have to get on the Internet to assess my options?”
1. Intellectualization 2. Introjection 3. Depression 4. Denial
12. A person addicted to alcohol says to the nurse, “I just drink a little to help me relax after a hard day at work.” Which defense mechanism is the patient using?
1. Substitution 2. Suppression 3. Rationalization 4. Intellectualization
13. A patient is told that surgery is necessary and the patient begins to experience elevations in pulse, respirations, and blood pressure. What stage of anxiety is indicated by these nursing assessments?
1. Mild 2. Moderate 3. Severe 4. Panic
14. The nurse identifies which defense mechanism is being used when an adolescent who is a poor student excels in sports?
1. Projection 2. Sublimation 3. Displacement 4. Compensation
15. Which nursing action best demonstrates support of human dignity in the practice of nursing?
1. Maintaining confidentiality of information about clients 2. Supporting the rights of others to refuse treatment 3. Obtaining sufficient data to make inferences 4. Staying at the scene of an accident
16. The nurse identifies that a patient who has diabetes continues to eat foods with a high glycemic index. What defense mechanism is being used by the patient?
1. Intellectualization 2. Introjection 3. Regression 4. Denial
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17. To provide the most effective psychosocial support, which data are the most helpful to the nurse?
1. Progress notes 2. Medical history 3. Patient concerns 4. Family contributions
18. A preoperative patient is anxious about pending elective surgery. Which is the best way for the nurse to help the patient reduce the anxiety?
1. Involve significant others 2. Use distraction techniques 3. Foster verbalization of feelings
4. Use progressive desensitization strategies
19. The nurse concludes that a woman is remembering only the good times after the death of her husband. What defense mechanism is the woman using?
1. Compensation 2. Minimization 3. Repression 4. Regression
20. A patient strongly states the desire to go to the hospital coffee shop for lunch regardless of hospital policy. What does the nurse conclude that this behavior most likely reflects?
1. The need to regain some measure of control 2. Anger with the policies of the hospital 3. Disappointment with hospital food 4. A desire for a change of scenery
21. The nurse is teaching a patient about the positive effects of exercise to reduce anxiety. The nurse evaluates that the information is understood when the patient says, “Exercise reduces anxiety by:
1. Interfering with the ability to concentrate.”
2. Stimulating the production of endorphins.”
3. Reducing the metabolism of adrenaline.”
4. Decreasing the acidity of blood.”
22. The physician informs a patient that the diagnosis is inoperable cancer and the prognosis is poor. After the physician leaves the room, the patient begins to cry.
What should the nurse do?
1. Touch the patient’s hand to provide support 2. Leave the room to give the patient privacy to cry
3. Telephone the patient’s family to inform them of the diagnosis 4. Ask the patient questions to encourage a ventilation of feelings
23. Which might a patient be at risk for in the psychosocial domain when the nursing assessment indicates that the patient is almost completely paralyzed?
1. Infection 2. Self-harm 3. Constipation 4. Powerlessness
24. The nurse determines that the situation that stimulates the greatest anxiety for most people is:
1. Accepting assistance from nonfamily members 2. Arranging for home care before discharge 3. Carrying out self-care activities when ill 4. Managing uncertainty about an illness
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25. The nurse is caring for a patient who is scheduled for intravenous chemotherapy for cancer. Which defense mechanism is being used when the patient says to the daughter, “Be brave”?
1. Rationalization 2. Minimization 3. Substitution 4. Projection
26. Which is the most appropriate inference made by the nurse when a patient says, “I’m the same age as my father when he died. Am I going to die of my cancer?” What is the patient experiencing?
1. Grieving associated with perceived impending death 2. Fear associated with perceived threat to biological integrity 3. Powerlessness associated with feelings of being out of control 4. Impaired coping associated with inadequate psychological resources
27. A patient who is withdrawn says, “When I have the opportunity, I am going to commit suicide.” What is the best response by the nurse?
1. “You have a lovely family. They need you.”
2. “You must feel overwhelmed to want to kill yourself.”
3. “Let’s explore the reasons you have for wanting to live.”
4. “Suicide does not solve problems. Tell me what is wrong.”
28. A dying patient is withdrawn and depressed. Which nursing action is most therapeutic?
1. Assisting the patient to focus on positive thoughts daily 2. Explaining that the patient still can accomplish goals 3. Accepting the patient’s behavioral adaptation 4. Offering the patient advice when appropriate
29. After being hospitalized for a surgical procedure, a patient who was impressed with the care received from the nurses decides to change careers and become a nurse.
What is this an example of?
1. Fantasy 2. Projection 3. Identification 4. Intellectualization
30. The nurse is caring for several patients with emotional needs. What is the most common cause of anxiety that the nurse should consider when collecting information from these patients?
1. Identifiable fears 2. Unexpected events 3. Threats to ego integrity 4. Anticipated dependence
31. Which situation identified by the nurse reflects the defense mechanism of displacement?
1. A woman is very nice to her mother-in-law whom she secretly dislikes 2. A man says that he is not so bad, so don’t believe what they say about him 3. An adolescent puts a poor grade on a test out of her mind when at her
after-school job
4. An older man gets angry with friends after family members attempt to talk with him about his illness
32. Which is the best way for the nurse to support patients’ self-esteem needs across the life span?
1. Employing a positive mental attitude
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33. The nurse identifies that a patient is mildly anxious. The nurse understands that when a patient is mildly anxious the patient may appear:
1. Alert 2. Fearful 3. Forgetful 4. Preoccupied
34. What is the underlying basis of all the defense mechanisms?
1. Compensation 2. Suppression 3. Regression 4. Repression
35. The nurse is assessing a patient who is fearful. Fear is most commonly experienced when the precipitating cause is:
1. Life-threatening 2. Unexpected 3. Recurrent 4. Unknown
36. A patient expresses a sense of hopelessness. Which concern identified by the nurse is the priority?
1. Risk for self-harm 2. Inability to cope 3. Powerlessness 4. Fatigue
37. When assessing a patient for anxiety, the nurse determines that anxiety is a:
1. Reaction triggered by a known stressor 2. Response that is avoidable
3. Universal experience 4. Threat to the id
38. A woman with diabetes does not follow her prescribed diet and states, “Everyone with diabetes cheats on their diet.” Which defense mechanism does the nurse identify this patient has used?
1. Rationalization 2. Sublimation 3. Undoing 4. Denial
39. When the nurse analyzes a patient’s statements, which statements best reflect the dimensions of self-esteem? Select all that apply.
1. _____ “I really like the me that I see.”
2. _____ “What do I want to achieve?”
3. _____ “How do I appear to others?”
4. _____ “I like to do things my way.”
5. _____ “I’m OK, you’re OK.”
40. Anxiety can progress through levels of severity from mild to panic. The patient’s level of anxiety will influence how the nurse approaches the patient situation. Place these patient statements in order as anxiety progresses from mild, to moderate, to severe, and finally to panic.
1. “I want to know more about the surgery I am having tomorrow.”
2. “I don’t think I am going to make it through the surgery tomorrow.”
3. “I can’t concentrate and all I think about is the pain I may have tomorrow.”
4. “I get butterflies in my stomach when I think about the surgery tomorrow.”
Answer: _______________________
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ANSWERS AND RATIONALES
4. 1. It is the patient who is having difficulty with comprehension who may need words repeated, not the nurse.
2. This action does not facilitate comprehen- sion. It helps a patient with a hearing deficit recognize that someone is speaking, and it facilitates lip reading if the patient has the ability to read lips.
3. The patient’s problem is a decreased ability to process and understand information, not a hearing loss.
4. New experiences require a person to