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Nursing 406 Unit 1 Nclex Questions and
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Start: Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation - ANS-✅Start: Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation A nurse is meeting with a young woman who has recently lost her job after moving with her husband to a new city. She describes herself as being anxious and pretty depressed. What principle of stress and adaptation should be integrated into the nurses plan of care for this patient? A) Adaptation often fails during stressful events and results in homeostasis. B) Stress is a part of all lives, and, eventually, this young woman will adapt. C) Acute anxiety and depression can be adaptations that alleviate stress in some individuals. D) An accumulation of stressors can disrupt homeostasis and result in disease. - ANS-✅Ans: D Feedback: Four conceptsconstancy, homeostasis, stress, and adaptationare key to the understanding of steady state. Homeostasis is maintained through emotional, neurologic, and hormonal measures; stressors create pressure for adaptation. Sometimes too many stressors disrupt homeostasis, and, if adaptation fails, the result is disease. If a person is overwhelmed by stress, he or she may never adapt. Acute anxiety and depression are frequently associated with stress. You are the nurse caring for an adult patient who has just received a diagnosis of prostate cancer. The patient states that he will never be able to cope with this situation. How should you best understand the concept of coping when attempting to meet this patients needs? A) Coping is a physiologic measure used to deal with change, and he will physically adapt. B) Coping is composed of the physiologic and psychological processes that people use to adapt to change. C) Coping is the human need for faith and hope, both of which create change. D) Coping is a social strategy that is used to deal with change and loss. - ANS-✅Ans: B Feedback: Indicators of stress and the stress response include both subjective and objective measures. They are psychological, physiologic, or behavioral and reflect social behaviors and thought processes. The physiologic and psychological processes that people use to adapt to stress are the essence of the coping process. Coping is both a physiologic and psychological process used to adapt to change. Coping is a personal process used to adapt to change. The nurse is with a patient who has learned that he has glioblastoma multiforme, a brain tumor associated with an exceptionally poor prognosis. His heart rate increases, his eyes dilate, and his blood pressure increases. The nurse recognizes these changes as being attributable to what response? A) Part of the limbic system response B) Sympathetic nervous response C) Hypothalamic-pituitary response D) Local adaptation syndrome - ANS-✅Ans: B Feedback: The sympathetic nervous system responds rapidly to stress; norepinephrine is released at nerve ending causing the organs to respond (i.e., heart rate increases, eyes dilate, and blood pressure increases). The limbic system is a mediator of emotions and behavior that are critical to survival during times of stress. The hypothalamic-pituitary response regulates the cortisol-induced metabolic effect that results in elevated blood sugars during stressful situations. Local adaptation syndrome is a tissue-specific inflammatory reaction.
You are the nurse caring for a 72-year-old woman who is recovering from a hemicolectomy on the postsurgical unit. The surgery was very stressful and prolonged, and you note on the chart that her blood sugars are elevated, yet diabetes does not appear in her previous medical history. To what do you attribute this elevation in blood sugars? A) It is a temporary result of increased secretion of antidiuretic hormone. B) She must have had diabetes prior to surgery that was undiagnosed. C) She has suffered pancreatic trauma during her abdominal surgery. D) The blood sugars are probably a result of the fight-or-flight reaction. - ANS-✅Ans: D Feedback: During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to glucose; the result is elevated blood sugars. Antidiuretic hormone is released during stressful situations and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Assuming the patient had diabetes prior to surgery demonstrates a lack of understanding of stress- induced hyperglycemia. No evidence presented in the question other than elevated blood sugars would support a diagnosis of diabetes. A patient tells the nurse that she does not like to go to the doctor and is feeling anxious about being in this place. When the nurse checks her blood pressure, it is elevated along with her heart rate. The nurse rechecks her blood pressure about 10 minutes later and it is normal. The patient asks the nurse if she should be concerned that she may have hypertension. What statement should guide the nurses response? A) She should not worry; it was stress related and her regular blood pressure is good. B) The first blood pressure was part of a simple stress response; our long-term blood pressure is controlled by negative feedback systems. C) Blood pressure is only one measure of hypertension; she should review this with the doctor and plan to recheck it on a regular basis. D) The respiratory infection is the probably the cause of the elevated blood pressure, and, with treatment, her blood pressure should remain norm - ANS-✅Ans: B Feedback: A simple stress response will temporarily elevate a blood pressure and heart rate. Long-term blood pressure response is controlled by negative feedback systems. For a science teacher, this would be an appropriate level of teaching/learning and would serve to promote health. The nurse would be incorrect in assuming the patients blood pressure is good based on only two blood pressure readings. The stress of a respiratory infection could account for the elevated blood pressure, but assuring the patient that, with treatment, her blood pressure will return to normal may not be true. A patient presents to the health center and the nurse practitioners assessment reveals an enlarged thyroid. The nurse practitioner believes the thyroid cells may be undergoing hyperplasia. How would the nurse practitioner explain this condition to the patient? A) Hyperplasia is the abnormal decrease in cell and organ size and is a precursor to cancer. B) Hyperplasia is an abnormal increase in new cells and is reversible with the stimulus for cell growth removed. C) Hyperplasia is the change in appearance of the thyroid due to a chronic irritation and will reverse with the stimulus removed. D) Hyperplasia is a cancerous growth and will be removed surgically - ANS-✅Ans: B
patients ineffective individual coping has created a significant safety risk and is, therefore, the most appropriate nursing diagnosis. The nurse at the student health center is seeing a group of students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What will be included in the nurses intervention? A) The use of progressive tensing and relaxing of muscles to release tension in each muscle group B) Using a positive self-image to increase and intensify physical exercise, which decreases stress C) The mindful use of a word, phrase, or visual, which allows oneself to be distracted and temporarily escape from stressful situations D) The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations - ANS-✅Ans: C Feedback: Guided imagery is the mindful use of a word, phrase, or visual image to distract oneself from distressing situations or consciously taking time to relax or reenergize. Guided imagery does not involve muscle relaxation, positive self-image, or humor. The nurse is assessing a patient and finds two enlarged supraclavicular lymph nodes. The nurse asks the patient how long these nodes have noticeably enlarged. The patient states, I cant remember. A long time I think. Do I have cancer? Which of the following is an immediate physiologic response to stress the nurse would expect this patient to experience? A) Vasodilation of peripheral blood vessels B) Increased blood pressure C) Decrease in blood glucose levels D) Pupil constriction - ANS-✅Ans: B Feedback: An initial response to stress, as seen by the fight-or-flight response, is an increase in the patients heart rate and blood pressure. Vasoconstriction leads to the increase in blood pressure. Blood glucose levels increase, supplying more readily available energy, and pupils dilate. Your patient tells you that he has just been told that his computed tomography results were abnormal. You can expect that his sympathetic nervous system has stimulated his adrenal gland to release what? A) Endorphins B) Dopamine C) Epinephrine D) Testosterone - ANS-✅Ans: C Feedback: In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine. You walk into your patients room and find her sobbing uncontrollably. When you ask what the problem is, your patient responds, I am so scared. I have never known anyone who goes into a hospital and comes out alive. On this patients care plan you note a pre-existing nursing diagnosis of Ineffective Coping related to stress. What is the best outcome you can expect for this patient? A) Patient will adopt coping mechanisms to reduce stress. B) Patient will be stress free for the duration of treatment. C) Patient will avoid all stressful situations. D) Patient will be treated with an antianxiety agent - ANS-✅Ans: A Feedback: Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the patient needs to adopt coping mechanisms that are effective
for dealing with stress, such as relaxation techniques. The other options are incorrect because it is unrealistic to expect a patient to be stress free; avoiding stressful situations and starting an antianxiety agent are not the best answers as outcomes for ineffective coping. The nurse is assessing a patient and learns that the patient and his wife were married just 3 weeks earlier. Which of the following statements should underlie the nurses care planning for this patient? A) The patient and spouse should seek counseling to ease their transition. B) The patient will have better coping skills being in a stable relationship. C) Happy events do not normally cause stress. D) Marriage causes transition, which has the potential to cause stress. - ANS-✅Ans: D Feedback: Transition can contribute to stress, even if the transition is a positive change. The third group of stressors has been studied most extensively and concerns relatively infrequent situations that directly affect people. This category includes the influence of life events such as death, birth, marriage, divorce, and retirement. Counseling is not necessarily indicated. The nurse is assessing a newly admitted patient who is an 84-year-old woman. The nurse learns that the patient has simultaneously experienced a hip fracture and the exacerbation of her chronic heart failure. What is an example of a bodily function that restores homeostasis by negative feedback when conditions shift out of normal range? A) Body temperature B) Pupil dilation C) Diuresis D) Blood clotting - ANS-✅Ans: A Feedback: Negative feedback mechanisms throughout the body monitor the internal environment and restore homeostasis when conditions shift out of normal range. Body temperature, blood pressure, and acid-base balances are examples of functions regulated by these compensatory mechanisms. Blood clotting in the body involves positive feedback mechanisms. Pupil dilation and diuresis are not modulated by negative feedback mechanisms. A patient who has a 40 pack-year history of smoking may have dysplasia of the epithelial cells in her bronchi. What would the nurse tell the patient about dysplastic cells in the bronchi? A) This is a benign process that occurs as lung tissue regenerates. B) Dysplastic cells have a high potential to become malignant. C) This process involves a rapid increase in number of cells. D) Dysplasia may cause uncontrolled growth of scar tissue - ANS-✅Ans: B Feedback: Dysplasia is bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same tissue type. Dysplastic cells have a tendency to become malignant; dysplasia is seen commonly in epithelial cells in the bronchi of people who smoke. This may not be a harmless condition and dysplasia does not cause scar tissue. Hyperplasia is an increase in the number of new cells. A teenage boy who was the victim of a near drowning has been admitted to the emergency department. The patient was submerged for several minutes and remains unconscious. What pathophysiological process has occurred as a result of the submersion? A) Atrophy of brain cells B) Cellular lysis C) Hypoxia to the brain D) Necrosis to the brain - ANS-✅Ans: C
A 44-year-old woman will undergo a bilateral mastectomy later today and the nurse in surgical admitting has begun the process of patient education. What positive outcome of providing the patient with information should the nurse expect? A) Increased concentration B) Decreased depression levels C) Sharing of personal details D) Building interdependent relationships - ANS-✅Ans: A Feedback: Giving patients information also reduces the emotional response so that they can concentrate and solve problems more effectively. Educating the patient does not decrease depression levels or build interpersonal relationships. Educating the patient does not mean sharing of personal details You are the nurse caring for a 51-year-old man who has just been told in a family meeting that he has stage IV colon cancer. You expect that the patient now has an increase in blood pressure, heart rate and respiratory rate. You spend time talking with this patient and his vital signs become closer to normal range. To what would you attribute this phenomenon? A) Cortisol levels are decreasing. B) Endocrine activity has increased. C) The patient is adapting to noxious stressors. D) The sympathetic response has been activated. - ANS-✅Ans: C Feedback: Selye developed a theory of adaptation to biologic stress that he named the general adaptation syndrome (GAS), which has three phases: alarm, resistance, and exhaustion. During the alarm phase, the sympathetic fight-or-flight response is activated with release of catecholamines and the onset of the adrenocorticotropic hormone (ACTH) adrenal cortical response. The alarm reaction is defensive and anti-inflammatory but self-limited. Because living in a continuous state of alarm would result in death, people move into the second stage, resistance. During the resistance stage, adaptation to the noxious stressor occurs, and cortisol activity is still increased. If exposure to the stressor is prolonged, the third stage, exhaustion, occurs. During the exhaustion stage, endocrine activity increases, and this has negative effects on the body systems (especially the circulatory, digestive, and immune systems) that can lead to death. While talking with the parents of conjoined twins who are medically unstable, you note that the father of the babies has an aggressive stance, is speaking in a loud voice, and makes several hostile statements such as, Id sure like to have words with that doctor who told us our babies would be okay. You know that this fathers cognitive appraisal has led to what? A) Harm/loss feelings B) Feelings of challenge C) A positive adjustment to the possible loss of his children D) The development of negative emotions - ANS-✅Ans: D Feedback: The appraisal process contributes to the development of an emotion. Negative emotions, such as fear and anger, accompany harm/loss appraisals, and positive emotions accompany challenge. Harm and challenge are not feelings, so the corresponding options are incorrect. There is nothing in the scenario that indicates that the father is making a positive adjustment to the possible loss of his children. The nurse is caring for a patient who was widowed 2 years prior to this current hospitalization, her fifth since the death of her husband. The woman says to the nurse, The doctor says my blood pressure is dangerously high. What is making my blood pressure so high? What does the nurse know about the probable cause of this patients hypertension?
A) Prolonged or unrelenting suffering can cause physical illness. B) Physical illness is always caused by prolonged stress. C) The elderly are at increased risk for hypertension due to stress. D) Stress always exacerbates the physiologic processes of the elderly - ANS-✅Ans: A Feedback: When a person endures prolonged or unrelenting suffering, the outcome is frequently the development of a stress-related illness. Physical illness is not always caused by prolonged stress. The elderly population is not the only population at increased risk for hypertension due to stress. Stress does not always exacerbate the physiologic processes of the elderly. This is an absolute statement, and true absolutes are rare. You are the psychiatric-mental health nurse caring for a young, recently married woman, whose sister and niece were recently killed in a motor vehicle accident. This young woman is making arrangements for the funerals, and you know that your patient has insight into her current stressors. What do you know is occurring with this young woman? A) The mediating process is occurring. B) The patient is experiencing an expected level of denial. C) The patients awareness of her stress makes it more acute. D) The patient is emotionally overwhelmed. - ANS-✅Ans: A Feedback: After recognizing a stressor, a person consciously or unconsciously reacts to manage the situation. This is termed the mediating process. Nothing in the scenario indicates the patient is either in denial or feeling overwhelmed. Awareness of stress does not necessarily exacerbate it. As an occupational health nurse at a large industrial plant, you are planning the return to work of an employee who was exposed to a chemical spill. To what type of stressor has this patient been exposed? A) Physiologic B) Psychosocial C) Physical D) Psychiatric - ANS-✅Ans: C Feedback: Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. A chemical spill is neither a psychiatric nor a psychosocial phenomenon. You are caring for a patient in the urgent care center who presented with complaints of lethargy, malaise, aching, weakness, and loss of appetite. During the assessment, you note an area on the patients right posterior calf that is warm to touch, edematous, and tender to touch. You know the most probable cause of this patients symptoms is what? A) Local inflammatory response B) Systemic shock response C) Local infectious response D) Systemic inflammatory response - ANS-✅Ans: D Feedback: The inflammatory response is often confined to the site, causing only local signs and symptoms. However, systemic responses can also occur. During this process, general, nonspecific symptoms develop, including malaise, loss of appetite, aching, and weakness. The fact that the patient is experiencing systemic effects such as lethargy, malaise, aching, weakness, and loss of appetite suggests that inflammation is not limited to one specific site. You are discharging a 4-year-old boy from the emergency department. The boy was seen for an insect bite that became swollen and reddened and warm and painful to touch. The patients vital signs are all
Feedback: The longest-acting phase of the physiologic response, which is more likely to occur in persistent stress, involves the hypothalamic-pituitary pathway, not the sympathetic-adrenal-medullary pathway. Selyes general adaptation syndrome (GAS) is a theory of adaption to biologic stress. Selye compared the GAS with the life process: childhood, adulthood, and later years. What would occur during adulthood in the GAS? A) Stressful events occur and resistance or adaption occurs. B) Successful avoidance of stressful life events leaves the body vulnerable. C) The accumulation of lifes stressors causes resistance to fall. D) Vulnerability leads to eventual death. - ANS-✅Ans: A Feedback: Selye compared the general adaptation syndrome with the life process. During childhood, too few encounters with stress occur to promote the development of adaptive functioning, and children are vulnerable. During adulthood, a number of stressful events occur, and people develop resistance or adaptation. During the later years, the accumulation of lifes stressors and wear and tear on the organism again decrease peoples ability to adapt, so resistance falls, and, eventually, death occurs. Based on this comparison, options B, C, and D are incorrect. You are auditing the electronic health record of a 33-year-old patient who was treated for a postpartum hemorrhage. When reviewing the patients records, you can see various demonstrations of negative feedback loops. Which of the following constitute negative feedback loops? Select all that apply. A) Serum glucose levels B) Acid-base balance C) Temperature D) Blood clotting E) Labor onset - ANS-✅Ans: A, B, C Feedback: These mechanisms work by sensing deviations from a predetermined set point or range of adaptability and triggering a response aimed at offsetting the deviation. Blood pressure, acidbase balance, blood glucose level, body temperature, and fluid and electrolyte balance are examples of functions regulated through such compensatory mechanisms. Coagulation and labor onset are results of positive feedback loops. A group of nurses are planning the care of an older adult who is being rehabilitated following a stroke. A nurse notes that hypertension and cardiovascular disease could have occurred over time if the patient previously experienced a state of chronic arousal. In a state of chronic arousal, what can happen within the body? A) Blood pressure decreases. B) Serum glucose levels drop. C) Arteriosclerosis may develop. D) Tissue necrosis may occur. - ANS-✅Ans: C Feedback: If the sympathetic-adrenal-medullary response is prolonged or excessive, a state of chronic arousal develops that may lead to high (not low) blood pressure, arteriosclerotic changes, and cardiovascular disease. If the production of ACTH is prolonged or excessive, behavior patterns of withdrawal and depression are seen. In addition, the immune response is decreased, and infections and tumors may develop. A group of nurses are attending an educational inservice on adaptive and maladaptive responses to stress. When talking about the assessment of coping strategies in patients, the nurses discuss the use of
drugs and alcohol to reduce stress. What is most important for the nurses to know about these coping behaviors? A) They are effective, but alternative, coping behaviors. B) They do not directly influence stress in the body. C) They are adaptive behaviors. D) They increase the risk of illness. - ANS-✅Ans: D Feedback: Coping processes that include the use of alcohol or drugs to reduce stress increase the risk of illness. The use of drugs and alcohol as a means to reduce stress are not effective coping behaviors. They are maladaptive behaviors, even though they have a short-term effect on stress. You are assessing an older adult patient post-myocardial infarction. You attempt to identify your patients health patterns and to assess if these health patterns are achieving the patients goals. How should you best respond if it is found that the patients health patterns are not achieving their goals? A) Seek ways to promote balance in the patient. B) Refer the patient to social work. C) Identify alternative models of health care. D) Provide insight into the patients physiological failings. - ANS-✅Ans: A Feedback: The nurse has a significant role and responsibility in identifying the health patterns of the patient receiving care. If those patterns are not achieving physiologic, psychological, and social balance, the nurse is obligated, with the assistance and agreement of the patient, to seek ways to promote balance. The nurse is not obligated to refer to social work, identify alternative forms of care, or provide insight into the physiologic failings of the system if the patients health patterns are not achieving their goals. A patient is experiencing intense stress during his current hospital admission for the exacerbation of chronic obstructive pulmonary disease (COPD). Which of the patients actions best demonstrates adaptively coping? A) Becoming controlling B) Reprioritizing needs and roles C) Using benzodiazepines as ordered D) Withdrawing - ANS-✅Ans: B Feedback: Adaptive ways of coping included seeking information, reprioritizing needs and roles, lowering expectations, making compromises, comparing oneself to others, planning activities to conserve energy, taking things one step at a time, listening to ones body, and using self-talk for encouragement. Becoming controlling or withdrawing are not ways to cope adaptively. Benzodiazepines are sometimes indicated, but these are not considered to be an adaptive coping behavior. The nurse is performing discharge planning for a patient who has numerous chronic health problems. The nurse recognizes that lifestyle changes would likely benefit the patients health status. Which factor would the nurse identify as most important in determining health status? A) Gender B) Ethnicity C) Social class D) Interfamilial relationships - ANS-✅Ans: C
A medical-surgical nurse is teaching a patient about the health implications of her recently diagnosed type 2 diabetes. The nurse should teach the patient to be proactive with her glycemic control in order to reduce her risk of what health problem? A) Arthritis B) Renal failure C) Pancreatic cancer D) Asthma - ANS-✅Ans: B Feedback: One chronic disease can lead to the development of other chronic conditions. Diabetes, for example, can eventually lead to neurologic and vascular changes that may result in visual, cardiac, and kidney disease and erectile dysfunction. Diabetes is not often linked to cancer, arthritis, or asthma. A patient who undergoes hemodialysis three times weekly is on a fluid restriction of 1000 mL/day. The nurse sees the patient drinking a 355-mL (12 ounce) soft drink after the patient has already reached the maximum intake of fluid for the day. What action should the nurse take? A) Take the soft drink away from the patient and inform the dialysis nurse to remove extra fluid from the patient during the next dialysis treatment B) Document the patients behavior as noncompliant and notify the physician C) Further restrict the patients fluid for the following day and communicate this information to the charge nurse D) Reinforce the importance of the fluid restriction and document the teaching and the intake of extra fluid - ANS-✅Ans: D Feedback: Management of chronic conditions includes learning to live with symptoms or disabilities and coming to terms with identity changes resulting from having a chronic condition. It also consists of carrying out the lifestyle changes and regimens designed to control symptoms and to prevent complications. Although it may be difficult for nurses and other health care providers to stand by while patients make unwise decisions about their health, they must accept the fact that the patient has the right to make his or her own choices and decisions about lifestyle and health care A patient with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the patient and her family to establish goals for care. What is likely to be a first priority in goal setting for the patient? A) Maintenance of activities of daily living B) Pain control C) Social interaction D) Promotion of spirituality - ANS-✅Ans: B Feedback: Once the phase of illness has been identified for a specific patient, along with the specific medical problems and related social and psychological problems, the nurse helps prioritize problems and establish the goals of care. Identification of goals must be a collaborative effort, with the patient, family, and nurse working together, and the goals must be consistent with the abilities, desires, motivations, and resources of those involved. Pain control is essential for patients who have a terminal illness. If pain control is not achieved, all activities of daily living are unattainable. This is thus a priority in planning care over the other listed goals. An international nurse has noted that a trend in developing countries is a decrease in mortality from some acute conditions. This has corresponded with an increase in the incidence and prevalence of chronic diseases. What has contributed to this decrease in mortality from some acute conditions?
A) Improved nutrition B) Integration of alternative health practices C) Stronger international security measures D) Decrease in obesity - ANS-✅Ans: A Feedback: In developing countries, chronic conditions have become the major cause of health-related problems due to improved nutrition, immunizations, and prompt and aggressive management of acute conditions. The integration of alternative health practices has not contributed to a decrease in mortality. Stronger international security measures have not contributed to a decrease in mortality. Obesity has not decreased, even in developing countries. A 37-year-old woman with multiple sclerosis is married and has three children. The nurse has worked extensively with the woman and her family to plan appropriate care. What is the nurses most important role with this patient? A) Ensure the patient adheres to all treatments B) Provide the patient with advice on alternative treatment options C) Provide a detailed plan of activities of daily living (ADLs) for the patient D) Help the patient develop strategies to implement treatment regimens - ANS-✅Ans: D Feedback: The most important role of the nurse working with patients with chronic illness is to help patients develop the strategies needed to implement their treatment regimens and carry out activities of daily living. The nurse cannot ensure the patient adheres to all treatments. Providing information of treatment options is not the nurses most important role. The nurse does not provide the patient with a detailed plan of ADLs, though promotion of ADLs is a priority. A patient has recently been diagnosed with type 2 diabetes. The patient is clinically obese and has a sedentary lifestyle. How can the nurse best begin to help the patient increase his activity level? A) Set up appointment times at a local fitness center for the patient to attend. B) Have a family member ensure the patient follows a suggested exercise plan. C) Construct an exercise program and have the patient follow it. D) Identify barriers with the patient that inhibit his lifestyle change. - ANS-✅Ans: D Feedback: Nurses cannot expect that sedentary patients are going to develop a sudden passion for exercise and that they will easily rearrange their day to accommodate time-consuming exercise plans. The patient may not be ready or willing to accept this lifestyle change. This is why it is important that the nurse and patient identify barriers to change. A home care nurse is making an initial visit to a 68-year-old man. The nurse finds the man tearful and emotionally withdrawn. Even though the man lives alone and has no family, he has been managing well at home until now. What would be the most appropriate action for the nurse to take? A) Reassess the patients psychosocial status and make the necessary referrals B) Have the patient volunteer in the community for social contact C) Arrange for the patient to be reassessed by his social worker D) Encourage the patient to focus on the positive aspects of his life - ANS-✅Ans: A Feedback: The patient is exhibiting signs of depression and should be reassessed and a referral made as necessary. Patients with chronic illness are at an increased risk of depression. It would be simplistic to arrange for him to volunteer or focus on the positive. Social work may or may not be needed; assessment should precede such a referral.
C) The schizophrenic patient D) The schizophrenic client - ANS-✅Ans: B Feedback: Using people-first language means referring to the person first: the patient with diabetes rather than the diabetic, the diabetic patient, or the diabetic client. A 19-year-old patient with a diagnosis of Down syndrome is being admitted to your unit for the treatment of community-acquired pneumonia. When planning this patients care, the nurse recognizes that this patients disability is categorized as what? A) A sensory disability B) A developmental disability C) An acquired disability D) An age-associated disability - ANS-✅Ans: B Feedback: Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy. Acquired disabilities may occur as a result of an acute and sudden injury, acute nontraumatic disorders, or progression of a chronic disorder. Age-related disabilities are those that occur in the elderly population and are thought to be due to the aging process. A sensory disability is a type of a disability and not a category. The nurse is reviewing the importance of preventative health care with a patient who has a disability. The patient states that she will not have the money to pay for her annual gynecologic exams or mammograms due to the cost of this hospitalization. What information would be appropriate for the nurse to share with the patient? A) Limited finances are a common problem for patients with a disability. Since you were hospitalized this year, you can likely forego the gynecologic exam and mammogram. B) These are very important health preventative measures, so you will need to borrow the money to pay for the exam and mammogram. C) Ill look into federal assistance programs that provide financial assistance for health-related expenses for people with disabling conditions. D) These preventative measures should likely be tax deductible, so you should consult with your accountant and then make your appointments. - ANS-✅Ans: C Feedback: Several federal assistance programs provide financial assistance for health-related expenses for people with some chronic illnesses, acquired disabling acute and chronic diseases, and diseases from childhood. Lack of financial resources, including health insurance, is an important barrier to health care for people with disabilities. Each of the other responses is inappropriate and inaccurate. You are the case manager who oversees the multidisciplinary care of several patients living with chronic conditions. Two of your patients are living with spina bifida. You recognize that the center of care for these two patients typically exists where? A) In the hospital B) In the physicians office C) In the home D) In the rehabilitation facility - ANS-✅Ans: C Feedback: The day-to-day management of illness is largely the responsibility of people with chronic disorders and their families. As a result, the home, rather than the hospital, is the center of care in chronic conditions. Hospitals, rehabilitation facilities, clinics, physicians offices, nursing homes, nursing
centers, and community agencies are considered adjuncts or back-up services to daily home management. The nurse is caring for a patient diagnosed with cancer of the liver who has chosen to remain in his home as long as he is able. The nurse reviews the care plan for the patient and notes that it focuses on palliative measures. The nurse also notes that over the last 3 weeks, the patients condition has continued to deteriorate. What is the nurses best response to this clinical information? A) Recognize that death will most likely occur in the next week. B) Recognize that the patient is in the trajectory phase of chronic illness and should be kept pain-free. C) Recognize that the patient is in the downward phase of chronic illness and should be reassessed. D) Recognize that the patient should immediately be admitted into the hospita - ANS-✅Ans: C Feedback: The downward phase occurs when symptoms of chronic illness worsen despite attempts to control the course through proper regimen management. A downward turn does not necessarily lead to death. A downward trend can be arrested and the trajectory reestablished at any point, depending on the condition and the treatment. A patient who is palliative may not desire hospitalization and aggressive treatment. A nurse is planning the care of a patient who has been diagnosed with renal failure, which the nurse recognizes as being a chronic condition. Which of the following descriptors apply to chronic conditions? Select all that apply. A) Diseases that resolve slowly B) Diseases where complete cures are rare C) Diseases that have a short, unpredictable course D) Diseases that do not resolve spontaneously E) Diseases that have a prolonged course - ANS-✅Ans: B, D, E Feedback: Chronic conditions can also be defined as illnesses or diseases that have a prolonged course, that do not resolve spontaneously, and for which complete cures are unlikely or rare. Research has corroborated an experienced nurses observation that the incidence and prevalence of chronic conditions is increasing in the United States. What health promotion initiative most directly addresses the factor that has been shown to contribute to this increase? A) A program to link residents with primary care providers B) A community-based weight-loss program C) A stress management workshop D) A cancer screening campaign - ANS-✅Ans: B Feedback: Lifestyle factors, such as smoking, chronic stress, and sedentary lifestyle, that increase the risk of chronic health problems such as respiratory disease, hypertension, cardiovascular disease, and obesity are all thought to be factors for the increasing incidence of chronic conditions. Obesity is paramount among these, exceeding the significance of lack of access to primary care, inadequate cancer screening, and inadequate stress management. A patient who has recently been diagnosed with chronic heart failure is being taught by the nurse how to live successfully with her chronic condition. Her ability to meet this goal will primarily depend on her ability to do which of the following? A) Lower her expectations for quality of life and level of function. B) Access community services to eventually cure her disease. C) Adapt her lifestyle to accommodate her symptoms.
D) Pediatric units - ANS-✅Ans: C Feedback: Patients with preexisting disabilities due to conditions that have been present from birth or due to illnesses or injuries experienced as an adolescent or young adult often require health care and nursing care in medical-surgical settings. Step-down units provide care between the ICU setting and the regular units. Pediatric units provide care for patients aged 19 and younger. Adult day care may or may not be appropriate. You are caring for a young woman who has Down syndrome and who has just been diagnosed with type 2 diabetes. What consideration should you prioritize when planning this patients nursing care? A) How her new diagnosis affects her health attitudes B) How her diabetes affects the course of her Down syndrome C) How her chromosomal disorder affects her glucose metabolism D) How her developmental disability influences her health management - ANS-✅Ans: D Feedback: It is important to consider the interaction between existing disabilities and new diagnoses. Cognitive and motor deficits would greatly affect diabetes management. Diabetes would not likely affect her attitude or the course of her Down syndrome. Chromosomal disorders such as Down syndrome do not affect glucose metabolism. You are the nurse caring for a young mother who has a longstanding diagnosis of multiple sclerosis (MS). She was admitted to your unit with a postpartum infection 3 days ago. You are planning to discharge her home when she has finished 5 days of IV antibiotic therapy. With what information would it be most important for you to provide this patient? A) A succinct overview of postpartum infections B) How the response to infection differs in patients with multiple sclerosis C) The same information you would provide to a patient without a chronic condition D) Information on effective management of multiple sclerosis in the home setting - ANS-✅Ans: C Feedback: In general, patients with disabilities are in need of the same information as other patients. Information on home management of MS has likely been already provided to the patient. The immune response does not greatly differ in this patient. You have admitted a new patient to your unit with a diagnosis of stage IV breast cancer. This woman has a comorbidity of myasthenia gravis. While you are doing the initial assessment, the patient tells you that she felt the lump in her breast about 9 months ago. You ask the patient why she did not see her health care provider when she first found the lump in her breast. What would be a factor that is known to influence the patient in seeking health care services? A) Lack of insight due to the success of self-managing a chronic condition B) Lack of knowledge about treatment options C) Overly sensitive patient reactions to health care services D) Unfavorable interactions with health care providers - ANS-✅Ans: D Feedback: Because of unfavorable interactions with health care providers, including negative attitudes, insensitivity, and lack of knowledge, people with disabilities may avoid seeking medical intervention. The population of people who are disabled is not overly sensitive to the reactions of those providing health care services. This is more likely than lack of insight or knowledge on the part of the patient. The community nurse is caring for a patient who has paraplegia following a farm accident when he was an adolescent. This patient is now 64 years old and has just been diagnosed with congestive heart failure. The patient states, Im so afraid about what is going to happen to me. What would be the best nursing intervention for this patient?
A) Assist the patient in making suitable plans for his care. B) Take him to visit appropriate long-term care facilities. C) Give him pamphlets about available community resources. D) Have him visit with other patients who have congestive heart failure. - ANS-✅Ans: A Feedback: The nurse should recognize the concerns of people with disabilities about their future and encourage them to make suitable plans, which may relieve some of their fears and concerns about what will happen to them as they age. Taking him to visit long-term care facilities may only make him more afraid, especially if he is not ready and/or willing to look at long-term care facilities. Giving him pamphlets about community resources or having him visit with other patients who have congestive heart failure may not do anything to relieve his fears. An initiative has been launched in a large hospital to promote the use of people-first language in formal and informal communication. What is the significance to the patient when the nurse uses people-first language? A) The nurse knows more clearly who the patient is. B) The person is of more importance to the nurse than the disability. C) The patients disability is the defining characteristic of the patients life. D) The nurse knows that the patients disability is a curable condition. - ANS-✅Ans: B Feedback: This simple use of language conveys the message that the person, rather than the illness or disability, is of greater importance to the nurse. The other answers are incorrect because no matter what language the nurse uses, the nurse knows who the patient is, that the patients disability is not most important in the patients life, and that the patients disability most likely will never be cured. A patient who is recovering from a stroke expresses frustration about his care to the nurse, stating, It seems like everyone sees me as just a problem that needs fixing. This patients statement is suggestive of what model of disability? A) Biopsychosocial model B) Social model C) Rehabilitation model D) Interface model - ANS-✅Ans: C Feedback: The rehabilitation model regards disability as a deficiency that requires a rehabilitation specialist or other helping professional to fix the problem. This is not characteristic of the biopsychosocial, social, or interface models. The interface model of disability is being used to plan the care of a patient who is living with the effects of a stroke. Why should the nurse prioritize this model? A) It fosters dependency and rapport between the caregiver and the patient. B) It encourages the provision of care that is based specifically on the disability. C) It promotes interactions with patients focused on the root cause of the disability. D) It promotes the idea that patients are capable and responsible - ANS-✅Ans: D Feedback: The interface model promotes the view that people with disabilities are capable, responsible people who are able to function effectively despite having a disability. It does not foster dependency, does not encourage giving care based on the patients disability, and does not encourage or promote interactions with patients that are focused on the cause of the disability.
