The physician has just informed a patient that they have breast cancer and will require a mastectomy. The nurse finds that the patient is crying.
Which response by the nurse is most appropriate?
“This must be very difficult for you. I am here if you want to talk.”.
“Can you tell me why you are so upset?”
“I am sure everything will be alright. There is no need to cry.”.
“You will recover.”.
The Correct Answer is A
Choice A rationale
When a patient is informed about a serious diagnosis like breast cancer and the need for a mastectomy, it is common for them to experience a range of emotions, including sadness, fear, and anxiety. As a nurse, providing emotional support and creating a safe space for the patient to express their feelings is crucial. Offering to be there for the patient if they want to talk acknowledges their emotional distress and provides comfort.
Choice B rationale
Asking the patient why they are upset may come across as insensitive or dismissive. The patient has just received a life-changing diagnosis, and their emotional reaction is completely normal and expected. It’s important to provide support and empathy rather than questioning their feelings.
Choice C rationale
Telling the patient that everything will be alright and there is no need to cry may seem comforting, but it can actually invalidate the patient’s feelings. It’s important to acknowledge the patient’s emotions and allow them to express their feelings without judgment.
Choice D rationale
Telling the patient that they will recover may be seen as providing false reassurance. While it’s important to maintain hope, it’s also crucial to be honest and realistic with the patient about their diagnosis and treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Limiting intake to non-caloric containing liquids until the glucose is within normal limits is not the best advice for a patient with Type 1 diabetes reporting a blood glucose level of 210 mg/dL and symptoms of a sore throat, cough, and fever. While it’s important to stay hydrated, especially when sick, it’s also crucial to maintain a balanced diet to provide the body with necessary nutrients for recovery.
Choice B rationale
Decreasing intake of carbohydrates until blood glucose level is less than 100 mg/dL is not recommended. Carbohydrates are a primary source of energy, and reducing their intake could lead to low blood sugar or hypoglycemia, which can be dangerous.
Choice C rationale
Monitoring blood glucose levels every 4 hours and notifying the doctor if it continues to rise is the best advice. When a patient with diabetes is sick, their blood glucose levels can rise due to the stress the body is under. Regular monitoring allows for timely adjustments in insulin dosage and helps prevent diabetic ketoacidosis, a serious complication.
Choice D rationale
Administering only the morning prescribed dose of insulin is not advisable. Insulin requirements can increase when a person with diabetes is sick. Therefore, sticking to the regular insulin regimen without adjustments could lead to high blood sugar or hyperglycemia.
Correct Answer is A
Explanation
Choice A rationale
People with Type 1 diabetes have little or no insulin that can be released. This is because their pancreatic β-cells, which produce insulin, are destroyed by an autoimmune process. Without insulin, glucose cannot be taken up into cells to be used for energy. Oral antihyperglycemic agents work by increasing the release of insulin or increasing the body’s sensitivity to insulin, so they are not effective in Type 1 diabetes where there is an absolute insulin deficiency.
Choice B rationale
The cost of oral antihyperglycemic agents is not the primary reason they are not used in Type 1 diabetes. The main issue is the lack of insulin production, which these medications cannot address.
Choice C rationale
People with Type 1 diabetes do not typically have resistance to their endogenous insulin. Insulin resistance is more commonly associated with Type 2 diabetes.
Choice D rationale
While hypoglycemia can occur with the use of some antihyperglycemic agents, this is not the primary reason these medications are not used in Type 1 diabetes. The main issue is the absolute deficiency of insulin.
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