A nurse is contributing to the plan of care for a client who has severe depression following the loss of her spouse. When identifying client goals, which of the following goals should the nurse identify as the highest priority?

The client will identify positive qualities about herself.

The client will identify ways to achieve a reachable goal for the future.

The client will identify her position in the grief process.

The client will contact a staff member when she feels she might hurt herself.

Answer and Explanation

The Correct Answer is D

D. This goal addresses the immediate safety and well-being of the client. Depression, especially severe depression, can increase the risk of suicidal ideation and behaviors. It is crucial to ensure the client's safety and have measures in place for her to reach out for help if she feels overwhelmed or unsafe.

A. While this is an important goal for improving self-esteem and mood, it may not be the highest priority when the client's safety is at risk.

B. This goal focuses on future planning and motivation, which is important for recovery but may not be as urgent as ensuring immediate safety.

C. Understanding one's grief process is important for emotional healing, but it is not typically as critical as ensuring safety in the immediate term.

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Correct Answer is ["A","B"]

Explanation

A. Denial is a common initial reaction where individuals refuse to accept the reality of their illness. They may minimize symptoms, avoid medical advice, or believe that the diagnosis is incorrect. Denial can serve as a defense mechanism to protect individuals from the shock and emotional distress of a diagnosis.

B. Anger is another stage where individuals may experience frustration, resentment, or hostility towards themselves, others, or the situation. They might feel angry about their diagnosis, the impact it has on their life, or towards healthcare providers and caregivers.

C. Grief is a natural response to loss and can be experienced when individuals face the changes, limitations, or potential outcomes associated with their illness. Grief involves feelings of sadness, despair, and mourning for the life they had before the illness, as well as for potential losses in the future. However, it is not a typical stage of the illness experience.

D. Dependency refers to a stage where individuals may rely on others for physical, emotional, or practical support due to the challenges posed by their illness. This stage can involve seeking assistance with daily activities, relying on healthcare providers for treatment, or leaning on family and friends for emotional support. However, it is not a typical stage of the illness experience.

A. Anger B. Anxiety C. Withdrawal D. Denial

Correct Answer is D

Explanation

D. Denial is a defense mechanism where individuals refuse to acknowledge or accept a painful or distressing reality. In this case, despite objective medical evidence (biopsy results and MRI findings), the client persists in believing that the diagnosis of terminal cancer is incorrect. This refusal to accept the reality of the situation is characteristic of denial.

A. Anger typically involves feelings of frustration, resentment, or hostility towards others or the situation. While anger can be a reaction to receiving a terminal diagnosis, it is not reflective of refusing to accept the diagnosis itself.

B. Anxiety involves feelings of worry, fear, or unease about future events or uncertainties. While anxiety can accompany a terminal diagnosis, it does not manifest as outright refusal or disbelief in the diagnosis itself.

C. Withdrawal refers to a retreat or disengagement from social interactions or activities. It can be a coping mechanism in response to stress or difficult emotions. However, withdrawal does not specifically relate to refusing to accept a diagnosis like terminal cancer.

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A nurse is contributing to the plan of care for a client who has severe depression following the loss of her spouse. When identifying client goals, which of the following goals should the nurse identify as the highest priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following is a stage of the illness experience?

Correct Answer is ["A","B"]

Explanation

A hospitalized client is told that he has terminal cancer. The client adamantly believes that the physician is wrong despite biopsy results and MRI findings. This is an example of which of the following?

Correct Answer is D

Explanation

The client has recently started antidepressant drug therapy. He approaches the nurse complaining of a headache, palpitations, and stiffness in the neck. What is the nurse's priority action?

A male client who suffered a stroke completed his physical therapy and is returning to work. The client is in which stage of the illness experience?

A female client with anorexia nervosa and a cardiac condition was prescribed an antidepressant before she regained weight during her treatment course. The nurse should be aware of the possibility of which condition in this client?

Assessment of a client reveals severe and sudden mood swings from mania to depression. Which diagnosis should the nurse suspect?

A client has been given the diagnosis of bulimia. An appropriate medication used in the treatment of bulimia is which of the following?

A client continually reports physical symptoms in the absence of objective clinical findings. The nurse should suspect which of the following disorders?

A nurse is reinforcing teaching with a group of adolescents regarding identifying behavioral indicators of depression. Which of the following manifestations should the nurse include? (Select all that apply.)

The death rate from anorexia is higher than any other mental illness. Death usually results from which of the following? (Select all that apply.)