Crisis
The nurse is caring for a patient who states, "I did not handle that crisis very
well. I do not know what I was thinking at the time." Which best describes the
influence on the patient's self efficacy?
A) Emotional State
B) Social Persuasion
C) Vicarious experience
D) Mastery experience - correct answer ✔A) Emotional State
Rationale:
The nurse is caring for a patient who has experienced a crisis. Which
intervention should the nurse incorporate in to the plan of care to monitor the
patient for self-neglect?
A) Provide written instructions related to prescribed treatments
B) Contact a community resource to assist the patient in gaining
independence
C) Assess the patient's nutritional status
D) Assist the patient in identifying small tasks they can accomplish - correct
answer ✔C) Assess the patient's nutritional status
Rationale:
The intervention to monitor the patient for self-neglect is the assessment of
the patient's nutritional status. Signs of self-neglect include inadequate
nutrition, hydration, and hygiene. Contacting a community resource to assist
the patient in gaining independence and identifying small tasks the patient can
accomplish are interventions to promote effective coping. Providing written
instructions related to prescribed treatments can help decrease confusion that
may occur.
,The community nurse learns of a family who has moved into a homeless
shelter. Which referral should the nurse make first?
A) Mental health services
B) Clergyperson
C) Social Services
D) Primary healthcare provider - correct answer ✔C) Social Services
Rationale:
A social services referral is the most appropriate since social services are able
to assist with housing, employment, and other necessary basic services.
There is no indication of spiritual distress, mental health issues, or physical
illness.
The nurse is preparing to speak with a family regarding the loss of their father.
Which therapeutic statement should the nurse include after communicating
the loss?
A) "I've notified the chaplain to come speak with you."
B) "I'm here to assist you during this difficult time."
C) "Your father's healthcare provider has been notified."
D) "Would you like to tell me how you're feeling right now? - correct answer
✔B) "I'm here to assist you during this difficult time."
Rationale:
Offering assistance to the family after the loss conveys empathy and support.
The nurse should ask the family if they would like to speak to a chaplain
before making any arrangements. Asking the family to start discussing what
they are feeling does not give them time to process the information they have
just been given. Informing the family that the healthcare provider has been
notified is not a therapeutic statement.
, A patient who experienced an emotional trauma is being assessed for
stomach pain. Which question should the nurse ask first?
A) "On a scale of 1 to 10, how would you rate your pain?"
B) "Have you been seeing a counselor?"
C) "Do you want to talk about the trauma you experienced?"
D) "Are you currently taking any medications?" - correct answer ✔A) "On a
scale of 1-10, how would you rate your pain?"
Rationale:
Asking the patient to rate their pain is using a tool called scaling. It helps
assess the order of magnitude of an individual's experience and allows for
prioritization of care based on the person's input. Asking if the patient is
seeing a counselor would not be related to a pain assessment. Medical history
includes asking about any medication, but it does not directly assess the
patient's pain. A closed-ended or yes/no question would not assess the
patient's pain.
The nurse is caring for a patient who has learned that her unborn baby will
have Down Syndrome. Which nursing intervention should increase the
woman's ability to cope with the stressor?
A) Monitor the patient for suicide
B) Assess the patient for depression
C) Refer the patient to a social worker
D) Provide literature on caring for the child. - correct answer ✔D) Provide
literature on caring for the child
Rationale:
The nursing intervention that will best help the patient with coping is providing
literature on caring for the child. Increasing the knowledge of the patient
The nurse is caring for a patient who states, "I did not handle that crisis very
well. I do not know what I was thinking at the time." Which best describes the
influence on the patient's self efficacy?
A) Emotional State
B) Social Persuasion
C) Vicarious experience
D) Mastery experience - correct answer ✔A) Emotional State
Rationale:
The nurse is caring for a patient who has experienced a crisis. Which
intervention should the nurse incorporate in to the plan of care to monitor the
patient for self-neglect?
A) Provide written instructions related to prescribed treatments
B) Contact a community resource to assist the patient in gaining
independence
C) Assess the patient's nutritional status
D) Assist the patient in identifying small tasks they can accomplish - correct
answer ✔C) Assess the patient's nutritional status
Rationale:
The intervention to monitor the patient for self-neglect is the assessment of
the patient's nutritional status. Signs of self-neglect include inadequate
nutrition, hydration, and hygiene. Contacting a community resource to assist
the patient in gaining independence and identifying small tasks the patient can
accomplish are interventions to promote effective coping. Providing written
instructions related to prescribed treatments can help decrease confusion that
may occur.
,The community nurse learns of a family who has moved into a homeless
shelter. Which referral should the nurse make first?
A) Mental health services
B) Clergyperson
C) Social Services
D) Primary healthcare provider - correct answer ✔C) Social Services
Rationale:
A social services referral is the most appropriate since social services are able
to assist with housing, employment, and other necessary basic services.
There is no indication of spiritual distress, mental health issues, or physical
illness.
The nurse is preparing to speak with a family regarding the loss of their father.
Which therapeutic statement should the nurse include after communicating
the loss?
A) "I've notified the chaplain to come speak with you."
B) "I'm here to assist you during this difficult time."
C) "Your father's healthcare provider has been notified."
D) "Would you like to tell me how you're feeling right now? - correct answer
✔B) "I'm here to assist you during this difficult time."
Rationale:
Offering assistance to the family after the loss conveys empathy and support.
The nurse should ask the family if they would like to speak to a chaplain
before making any arrangements. Asking the family to start discussing what
they are feeling does not give them time to process the information they have
just been given. Informing the family that the healthcare provider has been
notified is not a therapeutic statement.
, A patient who experienced an emotional trauma is being assessed for
stomach pain. Which question should the nurse ask first?
A) "On a scale of 1 to 10, how would you rate your pain?"
B) "Have you been seeing a counselor?"
C) "Do you want to talk about the trauma you experienced?"
D) "Are you currently taking any medications?" - correct answer ✔A) "On a
scale of 1-10, how would you rate your pain?"
Rationale:
Asking the patient to rate their pain is using a tool called scaling. It helps
assess the order of magnitude of an individual's experience and allows for
prioritization of care based on the person's input. Asking if the patient is
seeing a counselor would not be related to a pain assessment. Medical history
includes asking about any medication, but it does not directly assess the
patient's pain. A closed-ended or yes/no question would not assess the
patient's pain.
The nurse is caring for a patient who has learned that her unborn baby will
have Down Syndrome. Which nursing intervention should increase the
woman's ability to cope with the stressor?
A) Monitor the patient for suicide
B) Assess the patient for depression
C) Refer the patient to a social worker
D) Provide literature on caring for the child. - correct answer ✔D) Provide
literature on caring for the child
Rationale:
The nursing intervention that will best help the patient with coping is providing
literature on caring for the child. Increasing the knowledge of the patient
