A client who experienced a myocardial infarction tells the nurse that he is fearful of dying.
Which statement by the nurse will help validate this client's feelings?
"It must be very frightening to be told that you've had a heart attack.”.
"Why are you afraid? Can you explain your fear of dying?"
"Please be assured that we're doing everything possible to prevent you from dying.”.
"Facing death would certainly be a frightening experience for me.”.
The Correct Answer is A
This scenario requires the application of therapeutic communication principles, specifically validation. Validating feelings involves acknowledging the client's emotional state without dismissing it. Nurses must distinguish between open-ended exploration, false reassurance, and self-disclosure to effectively support patients experiencing acute psychological distress.
Choice A rationale
Validation occurs when the nurse acknowledges the client's subjective experience. Myocardial infarction triggers significant anxiety regarding mortality. Acknowledging that the situation is frightening provides empathy and validates the client's feelings without being dismissive or providing false reassurance.
Choice B rationale
Asking why is often perceived as accusatory and may put the client on the defensive. It requires the client to analyze their emotions logically during a crisis, which can block further therapeutic communication and effective emotional expression.
Choice C rationale
This statement provides false reassurance. In a clinical setting, nurses cannot guarantee specific outcomes. This approach shuts down the client's expression of fear by shifting the focus to clinical actions rather than acknowledging the emotional reality.
Choice D rationale
This is an example of self-disclosure. By focusing on the nurse's own hypothetical feelings, the conversation shifts away from the client. Therapeutic communication must remain client-centered rather than focusing on the nurse's personal perspectives or reactions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Hyperkalemia management involves identifying medications that facilitate the removal of potassium from the body. Understanding the mechanism of action of various renal and GI medications is necessary. This prevents cardiac arrest by lowering potassium toward the 3.5 to 5.0 mEq/L range.
Choice A rationale
This medication is a cation exchange resin that works in the intestine. It exchanges sodium ions for potassium ions, allowing the potassium to be excreted through the feces. It is specifically indicated for treating high serum potassium levels.
Choice B rationale
Lactulose is an osmotic laxative primarily used to reduce serum ammonia levels in clients with hepatic encephalopathy. It promotes the excretion of ammonia through the stool but has no significant effect on lowering serum potassium levels.
Choice C rationale
This medication is an erythropoiesis stimulating agent used to treat anemia associated with chronic kidney disease. It stimulates red blood cell production in the bone marrow but does not influence electrolyte levels or treat acute hyperkalemia.
Choice D rationale
Sevelamer is a phosphate binder used to manage hyperphosphatemia in clients with chronic kidney disease. It prevents the absorption of dietary phosphorus in the gut but does not have a mechanism to lower serum potassium concentrations.
Correct Answer is C
Explanation
Evaluating pulmonary embolism in patients with renal impairment requires knowledge of contrast-induced nephropathy risks. One must apply understanding of different imaging modalities to select a test that provides diagnostic clarity without using nephrotoxic agents that would worsen kidney failure.
Choice A rationale
Pulmonary angiography is an invasive procedure requiring a large bolus of iodinated contrast. In a client with chronic kidney disease and recent nephropathy, this would likely cause further irreversible damage to the remaining renal function.
Choice B rationale
D-dimer is a screening tool with high sensitivity but low specificity. While it does not require contrast, it cannot definitively diagnose a PE. It is used to rule out PE in low-risk patients rather than confirm.
Choice C rationale
A ventilation-perfusion scan uses radioactive isotopes rather than iodinated contrast. It is the preferred diagnostic test for patients with renal failure because it avoids the risk of contrast-induced nephropathy while effectively assessing for V/Q mismatch.
Choice D rationale
A chest X-ray is useful for ruling out other causes of respiratory distress like pneumonia or pneumothorax, but it is not sensitive or specific enough to diagnose a pulmonary embolism. Most PE patients have normal X-rays..
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