NCLEX Mental and Emotional Responses to Medical Illness Flashcards
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 don’t 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.
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
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. “Isn’t 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 nurse’s willingness to listen to the patient’s 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
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 don’t enjoy being with other people anymore.”
c. “I’d like to stop the voices I hear in my head.”
d. “I can’t 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.
A patient with HIV infection asks the nurse, “What do they mean by opportunistic infections?” The nurse’s 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.
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.
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.
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 patient’s need to maintain self-worth and self-esteem. The family is not the focus of the question.
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 patient’s 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.
While being bathed, a patient with AIDS asks the nurse, “Aren’t 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 patient’s feelings and encourages communication. The other options do not respond to the patient’s feelings.
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.
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; don’t 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.
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.
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 patient’s condition will deteriorate without the benefit of HAART. The remaining options are not likely to be seen as long as the patient uses denial.
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 patient’s 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.
