Quiz 30 :
Psychological Needs of Patients With Medical Conditions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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