Chapter 29: Mental and Emotional Responses to Medical Illness My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 29: Mental and Emotional Responses to Medical Illness

Test Bank

MULTIPLE CHOICE

1. A teenaged patient hospitalized with the diagnosis of HIV places a No Visitors sign on the door, refuses phone calls, and states to the nurse, I know you dont want to be around me. Which of these nursing diagnoses is applicable to this situation?

a.

Fear of dying related to medical diagnosis

b.

Social isolation related to fear of rejection

c.

Deficient knowledge related to cognitive limitations

d.

Anger related to having to face death at such a young age

ANS: B

The patient has placed barriers between self and others. His statement referring to the nurse not wanting to be around him suggests use of projection as a means of defending against anxiety. Data given in the scenario do not support the diagnosis of fear. Neither lack of knowledge nor cognitive limitation is suggested in the scenario. Anger is not a NANDA-accepted diagnosis.

DIF: Cognitive Level: Application REF: Page 670 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

2. Which factor should be the primary consideration when assessing the advisability of prescribing psychotropic medications for a patient with AIDS?

a.

Nutritional status of the patient

b.

Tolerance for oral medications

c.

Characteristics of emotional distress

d.

Length of time since the diagnosis was made

ANS: C

The severity of symptoms present will determine the type and dosage of medication that should be prescribed (e.g., antidepressants would be used for symptoms of depression, anxiolytics for acute anxiety, and psychotropics for symptoms of acute psychosis such as delusions or hallucinations). The other factors are not as relevant to the prescription of medications.

DIF: Cognitive Level: Application REF: Page 673

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. A patient diagnosed with AIDS is observed attempting to hide an article on the subject of lethal injections. Which response by the nurse would be most appropriate?

a.

Please let me have the journal. An article like that will only upset you.

b.

I noticed what you are reading. Why are you trying to hide it?

c.

Tell me what you think of the article you were reading.

d.

Isnt that a pretty grim article?

ANS: C

Suicide thoughts are common in the patient with AIDS. The correct option accepts this fact and indicates the nurses willingness to listen to the patients thoughts about the article and his situation. This intervention can address feelings of hopelessness and powerlessness. The remaining options imply the patient was doing something wrong or is passing judgment on the article.

DIF: Cognitive Level: Application REF: Page 672

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

4. Which statement made by a patient with AIDS indicates that the patient is exhibiting symptoms associated with acute psychotic-type dementia?

a.

I move more slowly than I used to.

b.

I dont enjoy being with other people anymore.

c.

Id like to stop the voices I hear in my head.

d.

I cant always remember where I put things.

ANS: C

Hallucinations, dementia, psychomotor agitation, and other psychotic behaviors are part of acute psychotic presentation of dementia associated with AIDS. The other options are more consistent with dementia chiefly characterized by mild depression.

DIF: Cognitive Level: Analysis REF: Page 667

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5. A patient with HIV infection asks the nurse, What do they mean by opportunistic infections? The nurses best response would be, They are:

a.

Infections transmitted by sexual contact.

b.

Rare illnesses that occur only in homosexual men.

c.

Infectious diseases from tropical or subtropical countries.

d.

Infections that develop when the immune system is suppressed.

ANS: D

Opportunistic infections occur when the immune system is suppressed. Under ordinary circumstances with an active immune system, these infectious organisms would not cause illness. Opportunistic infections are not sexually transmitted diseases. Both homosexual and heterosexual men, as well as women who are HIV-positive, may develop opportunistic infections. Opportunistic infections are not limited to tropical diseases.

DIF: Cognitive Level: Application REF: Page 665

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. The plan of care for a patient who is HIV-positive calls for the nurse to observe the patient for symptoms of AIDS dementia. Which symptoms support that diagnosis?

a.

Fever, night sweats, and nausea

b.

Elevated pulse, respirations, and blood pressure

c.

Inability to concentrate, forgetfulness, and apathy

d.

Increased appetite and specific food and drink cravings

ANS: C

Behavioral and cognitive symptoms of AIDS dementia are poor concentration, inability to problem solve, apathy, social withdrawal, forgetfulness, slowness of thinking, and motor deficits. None of the other options would suggest the presence of AIDS dementia because they are not related to cognitive function.

DIF: Cognitive Level: Application REF: Page 667

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

7. A teen is concerned that she may have been exposed to the HIV virus by her sexual partner but has resisted being tested. The nurse can hypothesize that the primary reason she has not been tested is because she:

a.

Distrusts the confidentiality of the health care system

b.

Is concerned about possibly losing her current partner

c.

Is waiting to see whether symptoms would develop

d.

Fears she might test seropositive

ANS: D

Fear of testing seropositive is a strong deterrent to being tested. As long as one has no concrete evidence, denial can be protective. Distrust may be a factor for some patients, but this is probably secondary to the fear of learning that one is HIV-positive. The remaining options are rarely seen as primary reasons.

DIF: Cognitive Level: Application REF: Page 668

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

8. A patient with AIDS is feeling threatened by his inability to work and take care of the yard and garden he loves. Which patient outcome is appropriate at this time? The patient will:

a.

Explain his declining state of health to the family.

b.

Realign goals to achieve a positive emotional state.

c.

Enlist others to help him carry out his former tasks.

d.

Accept the fact he will not be able to assume previous roles.

ANS: B

Goal realignment is necessary because it is not possible for the patient to carry out former roles. Acceptance is not stated in behavioral terms. Asking for help does not address the patients need to maintain self-worth and self-esteem. The family is not the focus of the question.

DIF: Cognitive Level: Application REF: Page 670

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

9. A patient has been hospitalized with problems related to AIDS and is experiencing profound dementia. Which intervention will be most helpful in assisting the family to adjust and plan for the patients future?

a.

Provide information on available support groups.

b.

Encourage placement of the patient in an adult care home.

c.

Explain the importance of engaging in social activities with friends.

d.

Advise the family to focus on present rather than possible future problems.

ANS: A

Associating with others who are experiencing similar problems is most helpful. The family will receive needed information and support. An adult care home would not be a suitable placement. Social involvement with others is not as high a priority as receiving support and information. This is not appropriate, because a plan for care that considers future deterioration must evolve.

DIF: Cognitive Level: Application REF: Page 671

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10. While being bathed, a patient with AIDS asks the nurse, Arent you afraid of getting this disease from me? Which response would be most therapeutic?

a.

You sound surprised that I want to spend time with you.

b.

No; I always use universal precautions to manage the risk.

c.

Statistics show that few nurses get AIDS from their patients.

d.

I have always firmly believed that whatever will be, will be.

ANS: A

This response reflects the patients feelings and encourages communication. The other options do not respond to the patients feelings.

DIF: Cognitive Level: Application REF: Page 672

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

11. The nurse manager is interviewing staff to work on the AIDS unit and asks the applicants this question: How do you feel about working with patients who have AIDS? The best candidate for the position would be the applicant who responds:

a.

I firmly believe there will soon be a cure for AIDS.

b.

I believe that everyone is worthy of the best care I can provide.

c.

I have done extensive research on AIDS and understand the disease.

d.

I know I will have to be more careful, especially with injections and IVs.

ANS: B

This response shows a belief in the worth and dignity of each patient. It suggests that the nurse will be able to be accepting and nonjudgmental. One option shows a lack of understanding of universal precautions. The other options do not answer the question or sidesteps the issue.

DIF: Cognitive Level: Application REF: Page 672

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. At an educational session for patients with HIV infection and their support persons, the nurse is asked, If the incidence of AIDS has declined, why is it that its prevalence has increased? The nurse can explain this by responding:

a.

This is a statistical aberration; dont let it confuse you.

b.

More people are living longer with both HIV infection and AIDS.

c.

Delays in diagnosis and treatment contribute to the increased death rate.

d.

Transmission to vulnerable populations has affected AIDS surveillance data.

ANS: B

The incidence of AIDS began to decline only recently; however, HAART has prolonged the interval between HIV infection and development of AIDS and has reduced deaths from AIDS. Consequently, the number of people living with AIDS has increased. This situation is not an aberration. Discussing diagnosis delays has no bearing on the issue. The comment about surveillance data is unsupported by evidence.

DIF: Cognitive Level: Application REF: Page 665

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

13. When planning care for a patient newly diagnosed with AIDS, the nurse takes into consideration that the patient should be closely monitored for covert symptoms associated with:

a.

Fluid and electrolyte imbalance

b.

Imbalanced nutrition

c.

Adjustment disorder

d.

Schizophrenia

ANS: C

Adjustment disorder commonly occurs related to overwhelming feelings associated with having a fatal disease or being overwhelmed by feelings engendered by living with HIV. Untreated negative feelings severely affect both the physical and psychologic well-being of the patient. AIDS patients are not at high risk for schizophrenia. The remaining options would be evidenced by overt symptoms.

DIF: Cognitive Level: Application REF: Page 669 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

14. A patient with AIDS persistently uses denial with respect to the seriousness of the condition. The nurse will need to be alert for the presence of defining characteristics for the nursing diagnosis of:

a.

Anxiety

b.

Hopelessness

c.

Noncompliance

d.

Powerlessness

ANS: C

Denial of his illness may lead to noncompliance with the medical regimen. The nurse needs to intervene quickly if noncompliance occurs, since the patients condition will deteriorate without the benefit of HAART. The remaining options are not likely to be seen as long as the patient uses denial.

DIF: Cognitive Level: Application REF: Page 670 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

15. A patient who is HIV-seropositive continues to use heroin on a daily basis but has agreed that his behavior endangers others and promises not to share needles. What can the nurse give as a realistic estimate for success in attaining this outcome?

a.

Low potential for achievement

b.

High potential for achievement

c.

Moderate potential for achievement

d.

Ultra-high potential for achievement

ANS: A

Despite the patients good intentions not to share needles, he may not care who uses his needle when the heroin takes effect. The other options are unrealistically optimistic. High-risk behaviors are difficult to change. They are hard to discuss and harder still to achieve when they are drug-related, because substance use alters judgment.

DIF: Cognitive Level: Application REF: Page 669 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

16. A patient with AIDS tells the nurse, My recent life has been a series of losses. Ive lost my job and my income, as well as my identity as a prominent business leader. Whats next? What can the nurse offer that will facilitate adaptive coping?

a.

I can see that youre feeling discouraged and hopeless.

b.

I will help you plan to live as normally as possible in the months ahead.

c.

Perhaps it would be wise to restrict your contacts to those who know of your illness.

d.

If you wish, I can help you investigate to see if you have been the victim of discrimination.

ANS: B

Nurses who engage in problem solving with patients help minimize the patients burden of adapting to the disease. With this remark, the nurse is assisting the patient to make plans to maintain the highest level of functioning possible. Achieving the goal of living as normally as possible will enhance self-esteem. Focusing on negative feelings does not help the patient move ahead. To suggest severing relationships at a time when social networking is important is inappropriate. Discussing discrimination does not move the patient into the future.

DIF: Cognitive Level: Application REF: Page 671

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

17. Which remark by a patient would suggest that the treatment plan for a patient with AIDS has been successful in promoting decisional control?

a.

I recognize that what Ive lost, I will never be able to regain.

b.

Ive learned enough about my disease to be able to make informed decisions.

c.

Ill be happy when my suffering comes to an end and I can join my partner.

d.

I see no advantage in antiviral therapy. The side effects are worse than the symptoms of AIDS.

ANS: B

This response reflects the patients satisfaction with his knowledge of the disease and his ability to make informed decisions. Suggesting limitations has a sense of powerlessness. Discussing what happens after death shows resignation to impending death. Discussing side effects reflects a poor quality of life.

DIF: Cognitive Level: Application REF: Page 672 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

18. The nurse is preparing to teach a patient who is newly diagnosed with diabetes about medications and blood testing. As the teaching occurs, the nurse knows that effective coping will depend to a great degree on the patients:

a.

Perceived self-efficacy

b.

External locus of control

c.

Religious belief systems

d.

Number of significant others

ANS: A

Research has shown that, especially with chronic diseases, perceived self-efficacy (internal locus of control) increases the likelihood of managing difficult situations. External locus of control is associated with uncontrollable factors. A particular religion has not been associated with effective coping and the number of significant others have not been influential.

DIF: Cognitive Level: Application REF: Page 663

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

19. A patient newly diagnosed with diabetes has also been diagnosed with depression. The nurse knows to be alert for:

a.

Increased low blood glucose results

b.

Increased high blood glucose results

c.

Failure to follow treatment plans consistently

d.

Anger and potential of violence against significant others

ANS: C

Depression is frequently associated with fatigue and hopelessness, leading to erratic treatment compliance. Research has not shown depression to have a direct impact on blood sugar. There are not enough data to support the outcomes related to anger and violence.

DIF: Cognitive Level: Application REF: Page 664

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. A patient diagnosed with HIV has moved back to her small hometown to be close to family. The major impact on the health management of this patient will include:

a.

Emotional toll on families

b.

The lack of supportive services

c.

Financial burden of care on families

d.

Distance from emergency acute care facilities

ANS: B

This migration has raised concern about the adequacy of health care and supportive services in regions where many do not understand HIV/AIDS and where specialists are typically not available. Although the other options are impactful, they do not have the same impact on the basic lack of needed services.

DIF: Cognitive Level: Application REF: Page 666

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. Which intervention addresses a strategy identified by the federal government to achieve an HIV-free generation?

a.

Nutritional programs that deliver meals

b.

Free medications for the uninsured patient

c.

Screening programs directed towards women

d.

Home health personnel available to deliver care

ANS: C

The Presidential Advisory Council on HIV/AIDS in February 2010 recommended several strategies to assist with the achievement of an HIV-free generation. Strategies and policies include early screenings addressing at-risk women. Although useful, the remaining options do not directly address the stated strategies.

DIF: Cognitive Level: Application REF: Page 666

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

1. A patient who received a diagnosis of HIV infection a week ago, reports to the clinic nurse symptoms that are seen in acute anxiety. Which behaviors are supportive of that diagnosis? Select all that apply.

a.

Incapable of staying physically relaxed

b.

Difficulty with focusing thoughts

c.

Muscular tension

d.

Bradycardia

e.

Insomnia

ANS: A, B, C, E

The symptoms described are consistent with anxiety with the exception of bradycardia; typically tachycardia is seen in such patients.

DIF: Cognitive Level: Application REF: Page 665

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. A patient recently diagnosed with HIV infection reports symptoms that support a diagnosis of adjustment disorder. These symptoms include telling the nurse, I feel so sad every time I think of my diagnosis. I cry a lot, and I dont go out as much as I did before. It just doesnt seem right to laugh. I dont have a good appetite, but I force myself to eat something at every meal, so I havent lost weight. From this description, the nurse would determine that the patients symptoms most closely correspond to those of (select all that apply):

a.

Sadness

b.

Anorexia

c.

Aggression

d.

Frequent crying

e.

Delusional beliefs

ANS: A, B, D

The selected symptoms most closely resemble those of adjustment disorder with depressive features. Aggression is more impulsive in nature and delusions are related to psychotic conditions.

DIF: Cognitive Level: Application REF: Page 669

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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