A patient who is being counseled for somatoform pain disorder states he believes his pain is the result of an undiagnosed injury
He adds that he cannot adhere to his plan for care involving performing his own activities of daily living, walking 20 minutes daily, and using pain medication only at bedtime. He states he feels "like a baby" because his wife and children must provide so much care for him. The nurse understands that it is most important to assess: a. mood.
b. cognitive style.
c. secondary gains.
d. identity and memory.
C
Secondary gains reinforce maladaptive behavior and should be assessed in all cases where maladaptive behavior continues for an extended period of time despite efforts and opportunities to change. Here, the patient's dependency needs may be being met through care from his family, who do not realize that their caring for him is extending his somatic concerns. Mood is not suggested as an important element based on the data here, and although it should always be assessed in any psychiatric disorder, it is less likely to be contributing to his somatic focus than are secondary gains. The same is true of cognitive style, memory, and identity.
You might also like to view...
The nurse is planning care for the client whose nursing diagnosis is Death Anxiety. What should the nurse plan to discuss with the client first?
1. Advanced directive 2. The client's knowledge about the diagnosis and prognosis 3. Whether the client would like a lawyer to draw up a will 4. The stages of grief
A client who has an enlarged prostate gland tells the nurse he feels like his bladder is not completely empty after voiding, and his health care provider requests a check for residual urine. Which of these nursing actions is correct?
a. Catheterize him immediately after he voids, and record the amount obtained. b. Have him measure his voidings in sequentially numbered containers and record the amount and time of each voiding. c. Insert a retention catheter, and connect it to a bedside collection unit. d. Keep an accurate intake and output (I&O), and subtract and record the difference be-tween the intake and the output for each 8-hour shift.
What role do macrophages have in the neutrophilia that occurs in response to an acute bacterial infection?
A. Macrophages have no role in neutrophilia. B. When invasion occurs, macrophages mature into neutrophils, increasing their circulating numbers. C. At the onset of invasion, macrophages secrete a colony-stimulating factor that induces the bone marrow to increase the production and release of neutrophils. D. Inflammatory damage to macrophages allows release of proteolytic enzymes that enhance liver production of all white blood cell types, including mature, seg-mented neutrophils.
On examination of the client's external ears, a nurse observes reddened areas behind both ears. What should the nurse then ask the client?
A. "Do you wear eyeglasses?" B. "Do you have any allergies?" C. "How frequently do you wash behind your ears?" D. "Do you use bobby pins or other implements to clean your ears?"