The spouse of a patient with terminal cancer visits daily and cheerfully talks with the patient about wedding anniversary plans for the next year. When the nurse asks about any concerns, the spouse says, "I'm busy at work, but otherwise things are fine."
Which nursing diagnosis is most appropriate?
a. Ineffective coping related to lack of grieving
b. Anxiety related to complicated grieving process
c. Caregiver role strain related to feeling overwhelmed
d. Hopelessness related to knowledge deficit about cancer
ANS: A
The spouse's behavior and statements indicate the absence of anticipatory grieving, which may lead to impaired adjustment as the patient progresses toward death. The spouse does not appear to feel overwhelmed, hopeless, or anxious.
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An anxious client is to complete the Minnesota Multiphasic Personality Inventory-2 as part of the psychological testing. The client is worried about not having enough time to prepare for the test
To decrease anxiety, the nurse reviews the purpose of the test and explains that the client will: 1. Just need to complete a series of sentences. 2. Interpret ink blots. 3. Only have to copy geometric designs. 4. Be answering true or false questions.
When auscultating a patient's heart sounds, the nurse hears a louder S2 when listening at the 2nd intercostal space right sternal border. The nurse determines that this finding is consistent with the closure of which heart valves?
A) Aortic and pulmonic B) Tricuspid and mitral C) Pulmonic and tricuspid D) Mitral and aortic
A patient is brought to the emergency department by friends, who state that the patient was in a bar fight and got stabbed in the leg about 15 minutes ago. The nurse would anticipate that the body would respond by a(n)
a. increase in serum glucose. b. decrease in serum glucose. c. heart rate of 72/minute. d. respirations of 16/minute.
It is all right for patients to place objects down the cast to scratch.
Answer the following statement true (T) or false (F)