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50 Cards in this Set
- Front
- Back
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In considering what places a client with cancer at risk for emotional distress, which one of the following factors can be influenced by nursing interventions?
A. Disruption of age-specific developmental-like tasks B. Lack of prognostic certainty C. Knowledge of cancer diagnosis, treatment, and expected outcomes D. Previous life experiences and coping ability |
Answer: C. Knowledge of cancer diagnosis, treatment, and expected outcomes
Rationale: Client teaching will help with anxiety and fears. Client teaching is a nursing intervention |
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In caring for a client with a diagnosis of ineffective individual coping, which intervention will require the most participation on the part of the client?
A. Evaluation with the client on the effectiveness of current coping strategies B. Instruction in relaxation, imagery, and other holistic stress reduction techniques C. Providing referrals as needed to the psychiatric liaison nurse, psychologist, or social worker D. Strengthening the client's social support system |
Answer: D. Strengthening the client's social support system
Rationale: Although the nurse may help the client to identify the current social support system, only the client can determine the need to, or ways in which to, strengthen it. |
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Mrs. R. is a 76 year old retired banker who has done well for 2 years after pelvic exenteration. Recently she experienced a recurrence. She now has multiple draining fistulae and has been told that she is not a candidate for further treatmnet. Her son said that her response has been complete withdrawal. She has changed from a meticulous dresser and housekeeper to neglecting both. She refuses to eat and blames herself for not going for regular Pap smears. She refuses help from her son, saying he is "wasting his time, I deserve to die." Her responses reflect developmental, situational, and disease-related characteristics most suggestive of
A. Fear of death B. Low self-esteem C. Neurotic anxiety D. Role abandonment |
Answer: B. Low self-esteem
Rationale: Self-negation and self-blame are the defining characteristics that differentiate between low self-esteem and the other mood states |
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Mrs. R. was hospitalized for management of the fistulae. Once the drainage was managed effectively, Mrs. R. seemed to show more interest in her care. During this phase, the most therapeutic nursing approach to facilitate adaptive behavior would be to
A. Initiate referral for rehabilitative counseling B. Make no demands on Mrs. R. for her own care C. Positively reinforce Mrs. R.'s approaches to self care D. Transfer responsibility for Mrs. R.'s care to her family |
Answer: C. Positively reinforce Mrs. R.'s approaches to self care
Rationale: Option A is premature, based on the information given. Option B does not facilitate adaptive behavior. Option D fosters dependency. Option C is a behavioral approach that reinforces the desired behavior and is therefore the best response. |
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The nursing plan included a referral to a client support program to assist Mrs. R. in adapting to the life changes imposed by the progression of her cancer. Which of the following would provide this service?
A. I Can Cope B. National Cancer Institute (NCI) C. Reach to Recovery D. The Wellness Community |
Answer: D. The Wellness Community
Rationale: The Wellness Community is the only support program listed. I Can Cope is a group program only. Reach to Recovery is for mastectomy clients. The NCI is for research. |
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Mr. L. is admitted to an oncology unit, and assessment reveals flushed skin, sweating, jerky hand movements, and asking questions repeatedly. The most probably nursing diagnosis would be which of the following?
A. Anxiety B. Fear C. Low self-esteem D. Phobias |
Answer: A. Anxiety
Rationale: Option A is correct, and these are classic signs of anxiety. The stimulus is diffuse, thereby ruling out fear and phobias. Self negation is not included, thus ruling out Option C (low self-esteem). |
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Mr. L. has started taking an antianxiety drug. He tells you that he feels much calmer but that his mouth is so uncomfortably dry that he is thinking about discontinuing the drug. The most therapeutic response would be to
A. Assure him that the dry mouth is not as bad as the anxiety B. Call the physician and request an order for another antianxiety drug C. Explain that the dryness generally diminishes increase fluid intake D. Support him in his decision and hold the daily dose |
Answer: C. Explain that the dryness generally diminishes increase fluid intake
Rationale: Option C represents knowledge of the reactions to the drug and a definitive strategy to alleviate the side effects. Option A negates the feelings of the client. Option B is premature or not indicated. Option D may lead to symptoms of withdrawal. |
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Mr. L. returns to the oncology outpatient clinic for his 1 year follow-up appointment. He states that he is having problems with sleeping, flashbacks of his initial treatment, and difficulty concentrating. You refer him for psychiatric evaluation, suspecting that he is experiencing
A. Bipolar disorder B. Generalized anxiety stress disorder C. Posttraumatic stress disorder D. Psychotic disorder |
Answer: C. Posttraumatic stress disorder
Rationale: Contact with reality is intact, so Option D is not true. No history of mood swings is given, thus eliminating Option A as a possibility. Although Option B may be present, the experience of flashbacks, with the other symptoms, may be indicative of Option C. |
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Antianxiety drugs are not discontinued abruptly because a possibly withdrawal effect is
A. Hypertensive episodes B. Narcolepsy C. Seizures D. Severe depression |
Answer: C. Seizures
Rationale: Withdrawal symptoms similar in character to those noted with barbiturates and alcohol, including seizures, have been reported after abrupt discontinuation of antianxiety drugs. |
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Mrs. S. is admitted to the hospital for the evaluation of metastatic disease related to her diagnosis of breast cancer. Her family is concerned about recent changes in her behavior such as crying, lack of interest in her appearance, and changes in sleeping and eating. In considering a referral for evaluation of depression in this client, it is most important to assess
A. Effect of behavior on family members B. Meaning of the illness to the client C. Meaning of appearance to patient and family D. Mental status as an indicator of delirium |
Answer: D. Mental status as an indicator of delirium
Rationale: It is important to assess for delirium with this client, who may be experiencing behavioral changes related to metastatic disease. Options A, B, and C are valid considerations, but organic causes of behavior must be ruled out first. |
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The nurse's assessment of treatment-related risk factors for depression in individuals with cancer should include
A. Chemotherapeutic agents being given B. Sleeping and eating patterns C. Symptom control, particularly pain D. Type of cancer |
Answer: A. Chemotherapeutic agents being given
Rationale: Although all of those factors are important to consider, only Option A reflects a treatment-related risk factor. |
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Which of the following risk factors for development of depressive symptoms is most amenable to direct nursing interventions?
A. Family developmental and situational crises B. Inadequate social support C. Inadequate symptom control D. Client history of suicidal thoughts |
Answer: C. Inadequate symptom control
Rationale: Crises and social support can be affected by interventions, but the nurse has limited control of these. Although a history of suicidal thoughts is important to consider, interventions to enhance symptom control particularly pain, may have a more direct effect on depressive symptoms. |
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Physical findings most descriptive of a depressed state include
A. Facial pallor, tense posturing, vocal tremors, and diaphoresis B. Flat affect, lack of spontaneity, minimal eye contact, and slumped posture C. Inappropriate affect, disheveled dress, sweaty hands, and tremors D. Labile emotions, hyperactivity, sighing respirations, and overtalkativeness |
Answer: B. Flat affect, lack of spontaneity, minimal eye contact, and slumped posture
Rationale: Questions require differentiation among depression (Option B), anxiety (Option A), psychosis (Option C), and panic (Option D). Depression is a state of feeling sad or discouraged. Anxiety is a state of feeling uneasy and apprehensive in response to a vague, nonspecific threat. Psychosis refers to disintegration of personality and loss of contact with reality. Panic is acute anxiety, terror, or fright. |
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Which of the following responses by the nurse would be most therapeutic in helping the client deal with the somatic complaints often associated with depression?
A. Advising the clients to minimize these symptoms, thus conserving energy to fight the disease B. Explaining that the symptoms are not "real" and therefore need no treatment C. Listening nonjudgmentally and trying diversional techniques as a possible method of alleviation D. Validating that symptoms do or do not have a physiologic basis |
Answer: C. Listening nonjudgmentally and trying diversional techniques as a possible method of alleviation
Rationale: When there is no physiologic basis for the symptoms, "treatment" of somatic aspects of depression is contraindicated, because such actions reinforce these maladaptive behaviors and symptoms. To ask the client to "buck up" is asking the impossible and instilling guilt. The symptoms are "real" to the client, and diversion may help. |
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In teaching management of the side effects of antidepressant medication, which of the following would be most important for an elderly client?
A. Change from a lying to a standing position slowly B. Monitor changes in visual acuity C. Increase fluid intake D. Take medication at bedtime |
Answer: A. Change from a lying to a standing position slowly
Rationale: Risk for falls is a primary concern with an older client. Option B may or may not be necessary. Option C is recommended for dry mouth associated with most antidepressants. Option D depends on the specific drug being taken. |
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The most serious potential outcome of depression in cancer clients is
A. Interference with social roles B. Lack of compliance with medical treatment C. Severe physchologic regression with loss of function D. Suicidal ideation and/or attempt |
Answer: D. Suicidal ideation and/or attempt
Rationale: At one time, it was thought that clients with cancer did not attempt suicide. However, with cancer now being a chronic disease, suicidal thoughts and/or attempts are more common. Therefore, Option D is the most serious potential outcome of depression in clients with cancer. |
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Mr. G. returns to the oncology clinic for treatment of recurrent lymphoma after bone marrow transplant. He tells you that it is hard to believe that there is a purpose to his experience, tearfully stating, ."I'm really angry and I don't trust anything anymore." The most probably nursing diagnosis would be
A. Anxiety B. Ineffective coping C. Self-esteem disturbance D. Spiritual distress |
Answer: D. Spiritual distress
Rationale: Loss of purpose, beliefs, and trust is indicative of spiritual distress. Anxiety symptoms are not present, ineffective coping is not specific enough, and the client is not exhibiting any self-negating behavior indicative of self-negating behavior indicative of self esteem problems. |
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Spiritual distress is often misdiagnosed as
A. Cognitive problems B. Lack of social support C. Noncompliance D. Psychologic distress |
Answer: D. Psychologic distress
Rationale: Cognitive problems would be indicated by other symptoms. no information is given that would lead to the conclusion that Options B or C exist. Spiritual distress is often confused with psychologic distress because of symptom similarity and comfort with attributing these symptoms to psychologic, rather than spiritual, difficulties. |
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From your past contact with Mr. G., you know him to be a deeply spiritual person, attending church and using prayer to manage the demands of his illness and treatment. Today he angrily refuses when you volunteer to call his pastor for him. Your best response to this would be:
A. Getting angry with God isn't going to help B. Perhaps you'd like to tell me more about what you're feeling right now C. Sounds like you'd like some privacy, I'll be back soon D. Would you like me to pray with you? |
Answer: B. Perhaps you'd like to tell me more about what you're feeling right now
Rationale: B is a therapeutic response and acknowledges the client's discomfort. Option A denies his feelings. Option C indicates the nurse's discomfort. Option D is imposing the nurse's beliefs. |
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In considering barriers that influence a client's ability to continue his or her spiritual beliefs and practices, the most significant one is
A. Activity and dietary restrictions B. Ignorance of health care providers C. Lack of privacy D. Treatment regimen requirements |
Answer: B. Ignorance of health care providers
Rationale: The nurse's lack of knowledge can be the most significant barrier. once we understand beliefs and practices, we can then, it is hoped, consider and explain Options A, C, and D. |
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Mr. G.'s family can best enhance his spiritual well-being by
A. Avoiding discussion of his spiritual concerns with him B. Discussing their opposition to his spiritual beliefs C. Participating in his spiritual practices with him D. Sharing their perceptions of his spiritual distress |
Answer: C. Participating in his spiritual practices with him
Rationale: Avoiding or challenging spiritual concerns will not provide support and enhancement of spiritual well-being. Although sharing perceptions may be helpful, there is not enough information given to know how supportive this may be. Option C represents a concrete way to enhance spiritual well-being. |
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Mr. J., a 48 year old businessman, has recently been given the diagnosis of lung cancer. His family states that since his diagnosis, he has refused to participate in decision making regarding his treatment, is ignoring post-biopsy instructions, and has become more withdrawn. The most accurate nursing diagnosis would be
A. Anxiety B. Ineffective coping C. Powerlessness D. Spiritual distress |
Answer: C. Powerlessness
Rationale: Symptoms presented are indicative of powerlessness. Options A and D are not represented by these symptoms. Option B is not specific enough. |
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An individual's response to the loss of personal control depends primarily on which of the following:
A. Duration of time since diagnosis B. Individual patterns of coping C. Meaning of the loss D. Response of family and friends |
Answer: B. Individual patterns of coping
Rationale: Loss of personal control is just that, personal; therefore Option B is the primary influencing factor. Options A and D may be influences. Assessment of Option C is not present. |
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Mr. J. states, "I don't feel like I have any control over what is happening to me." Which of the following is an appropriate statement for the nurse to make?
A. "Ask your doctor about your care, and he will answer your questions." B. "Ask your wife to let you do more things for yourself." C. "Let's spend some time talking about your feelings." D. "We will develop a routine schedule for your care so you will know what to expect." |
Answer: C. "Let's spend some time talking about your feelings."
Rationale: Use an open-ended statement to elicit individual perceptions of the perceptions of the response without jumping to conclusions of a diagnosis of loss of personal control. |
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The most basic nursing intervention designed to facilitate Mr. J.'s sense of personal control would be
A. Asking family to make decisions regarding burdensome areas of treatment and care B. Discussing with him his feelings regarding personal control C. Encouraging identification of areas over which control can be maintained D. Providing successful management of symptoms |
Answer: D. Providing successful management of symptoms
Rationale: Management of symptoms is a basic nursing intervention in facilitating a client's sense of personal control. Options B and C would be additional interventions once symptom control is accomplished. Option A would not be therapeutic for the client. |
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Before discharge, the most important nursing intervention for facilitation of a sense of control for both Mr. J. and his family would be:
A. Make a referral to an appropriate home care agency B. Organize a health team meeting to plan his care C. Provide specific care instructions for family members D. Seek client's and family's opinions and suggestions about his care at home |
Answer: D. Seek client's and family's opinions and suggestions about his care at home
Rationale: Seeking the opinions of both client and family about his care is most facilitation of his sense of control. Options A, B, and C, although important, represent doing something for the client, not facilitating his sense of control. |
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A behavior that would indicate a need for immediate professional assistance (mental health professional) with Mr. J. is
A. Inability to perform activities of daily living B. Noncompliance with treatment regimen C. Refusal to discuss personal feelings D. Verbalization of self-harm intentions |
Answer: D. Verbalization of self-harm intentions
Rationale; Statements of suicidal intentions require immediate response for further assessment by a mental health professional. Option A or B requires problem solving by care providers, and Option C may be the client's choice. |
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Grief is defined as changes in thinking, feeling, and behaving that occur in response to
A. Death of a significant other B. Disease with an uncertain prognosis C. Losses related to the aging process D. Loss of a valued object or person |
Answer: D. Loss of a valued object or person
Rationale: All of the situations given may precipitate the grief process, but the best definition of grief is Option D. |
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In addition to the developmental and situational factors that most people experience, individuals with cancer may also experience
A. Changes in body structure/function B. Changes in employment, including retirement C. Multiple losses and unanticipated losses D. Symbolic losses, including independence |
Answer: A. Changes in body structure/function
Rationale: Options B, C, and D are factors that all people may experience. Changes in body structure and function are more specific to the experiences of cancer diagnosis and treatment. |
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In discussing the process of grief with clients or family members, the most basic point to emphasize is:
A. One's grief response will be influenced by past experiences with loss and grief B. Each family member will grieve in their own fashion C. Somatic symptoms of grief often occur D. Specific stages of grief exist |
Answer: A. One's grief response will be influenced by past experiences with loss and grief
Rationale: One's past experiences are basic to one's grief responses throughout life; therefore Option A is the most basic point. Options B, C, and D are also applicable. |
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Resolution of the grief process may be facilitated by which of the following interventions?
A. Encouraging discussion of the feelings related to the loss B. Discouraging expression of negative feelings, such as anger C. Providing sedation as suggested by others D. Restricting visitors to family members only |
Answer: A. Encouraging discussion of the feelings related to the loss
Rationale: Responses other than Option A represent strategies that block grief work and resolution of loss. |
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Which of the following client responses is most representative of a dysfunctional grief response?
A. A 76 year old man who cared for his wife during the terminal phases of colon cancer reports frequent vivid dreams about his wife and himself B. A mother who cries continuously and keeps saying, "No, he can't die," as she attends her 21 year old son who is dying of leukemia C. A 35 year old woman who, at 6 weeks after a mastectomy, avoids hugs and physical contact with family and friends and has not allowed her husband to look at the surgical site D. A 35 year old widower who prides himself on keeping all of his wife's possessions and visiting her grave daily for 5 years since her death while neglecting his other responsibilities |
Answer: D. A 35 year old widower who prides himself on keeping all of his wife's possessions and visiting her grave daily for 5 years since her death while neglecting his other responsibilities
Rationale: Options A, B, and C represent normal grief responses. Options D is the best answer because of the evidence of a prolonged and unresolved grief process. |
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Of the following grief responses, which is indicative of the need for mental health intervention?
A. Crying, angry outbursts B. Preoccupation with lost object/person C. Somatic symptoms D. Withdrawal or social isolation |
Answer: D. Withdrawal or social isolation
Rationale: Withdrawal or social isolation could be a symptom of clinical depression and deserves further evaluation. Options A, B, and C represent normal grief responses. |
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Ms. P., an 18 year old with a recent diagnosis of leukemia, comes to the clinic for evaluation of determination of treatment. In your assessment of Ms. P., you determine that she has lived on her own this past year and has a conflictual relationship with her parents. As you continue your assessment, which additional finding might be indicative of a potential for social dysfunction?
A. Admits she has a temper and has "gotten in trouble before." B. Has two roommates who accompany her to the clinic C. Lives in a community with ethnic and cultural characteristics similar to her own D. Seems knowledgeable about her illness and its treatment |
Answer: A. Admits she has a temper and has "gotten in trouble before."
Rationale: A history of violence and possible legal difficulties may place her at risk. Other data indicate social functioning. |
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Ms. P. is admitted to the hospital for induction chemotherapy. Her parents come to visit regularly, and often their visits end with angry shouting matches. As Ms. P.'s nurse, you schedule a meeting with the family. Given the above, your initial interventions are directed at
A. Assisting family members to discuss their thoughts and feeling about Ms. P.'s illness B. Establishing limits on problematic behavior C. Instruction regarding the disease and treatment regimen D. Referral of family to appropriate resources |
Answer: A. Assisting family members to discuss their thoughts and feeling about Ms. P.'s illness
Rationale: Although limit setting (Option B) is appropriate, the first goal would be to better understand this family's emotional issues. Other interventions, although appropriate, do not address the identified problems. |
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The most basic psychologic requirement of social functioning is
A. Ability to problem solve B. Effective interaction with others C. Effective reality testing D. Intact family structure |
Answer: C. Effective reality testing
Rationale: Options A and B would not be possible if the more basic requirement of effective reality testing were not present. Option D is not a requirement of social functioning. |
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Ms. P. will be discharged soon and will need to move home with her parents for a period of time. In preparing Ms. P. and her parents for discharge, it is most important to
A. Encourage Ms. P. to participate in self-care B. Encourage her parents to limit social contacts C. Plan for ongoing evaluation of effects of caring on caregivers D. Provide the client and family with skills required for day-to-day care |
Answer: D. Provide the client and family with skills required for day-to-day care
Rationale: Providing both client and family with care skills is important to the client's participation and successful self-care (Options A and C). Option B is nontherapeutic intervention. |
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Mr. O., a 30 year old unemployed factory worker, is admitted to your unit with a diagnosis of colon cancer. A nursing assessment reveals that he is a recent immigrant who has been living with a cousin since losing his job. Which factor places Mr. O. at most risk for social dysfunction?
A. Language or cultural differences B. Living situation C. Poor social and interpersonal skills D. Prolonged hospitalization |
Answer: A. Language or cultural differences
Rationale: Language and cultural difference place individuals at risk for social dysfunction. The nursing assessment does not indicate Options B, C, or D. |
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Mr. O. has surgery for his colon cancer and is scheduled for outpatient chemotherapy treatment. In preparing him for the beginning of this treatment, it is most important to assess his
A. Extent of social support in the community B. Problem-solving and decision-making skills C. Psychiatric history of antisocial personality D. Need for financial assistance |
Answer: B. Problem-solving and decision-making skills
Rationale: Basic to the success of outpatient treatment are the client's problem-solving and decision-making skills. Options A and D are also important factors to consider. No indication of a psychiatric assessment is present. |
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A history of poorly developed social and interpersonal skills, social isolation, and prolonged cancer treatment hospitalization may place a person at risk for the nursing diagnosis:
A. Ineffective coping B. Powerlessness C. Impaired social interaction D. Spiritual distress |
Answer: C. Impaired social interaction
Rationale: Factors identified are indicative of the potential for impaired social interaction. Option A is not specific enough. Options B and C are not indicated by factors presented. |
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In preparing Mr. O. for discharge, the most important nursing intervention would be
A. Assessing his understanding of his illness and its treatment B. Contacting immigration services for support information C. Providing him with social and financial services information D. Supporting his enrollment in English as a Second Language course |
Answer: A. Assessing his understanding of his illness and its treatment
Rationale: Option A is basic to the success of the client's future care. Options B and C are not the responsibility of the nurse, and Option C, although important, would be based on a further assessment of need. |
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Emotional Distress
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a pattern of expected changes in thinking, feelings, and behaviors that occur in response to the diagnosis, prognosis, treatment, and events that occur in the clinical course of cancer.
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Anxiety
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a state of feeling uneasy and apprehensive in response to a vague, nonspecific, or unidentifiable threat
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Depression
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a state of feeling sad, discouraged, hopeless, and worthless, which may vary from transient emotional distress to a major psychiatric illness with possible suicidal ideation
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What are the primary symptoms for depression?
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depressed mood
loss of interest or pleasure |
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Spiritual distress
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state of experiencing a disturbance in one's belief or value system that provides strength, hope and meaning in life
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Loss of personal control
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perception that one's own actions will not significantly affect an outcome; a perceived lack of control over certain events or situations that affect outlook, goals, and lifestyle
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Loss
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an experience in which an individual relinquishes a connection to a valued person, object, relationship, or situation.
loss can occur without death any loss can result in grief and mourning |
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Grief
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the emotional response to loss; grief work is the adaptive process of mourning. Grief work is a process.
Expressed as changes in thoughts, feelings, and behaviors experienced as a natural human response to an actual or perceived loss of a loved person, relationship, object, function, status, or identity |
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Social dysfunction (client and family)
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a state of being unable to interact effectively with one's social environment - family, work or school, and community.
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