Therapeutic Relationships
Of the three phases of the nurse patient relationship, which phase does laying expectations, setting parameters, and starting termination of the relationship.
Orientation
A nursing student who is frustrated after failing an exam goes to the gym to release their frustration through exercise rather than becoming angry with others. Identify the defense mechanism and its classification.
Sublimation — Healthy
A college student experiences significant emotional distress while adjusting to leaving home, beginning college, and establishing independence. What type of crisis is occurring?
What is a maturational/developmental crisis?
A nursing student feels overwhelmed by upcoming assignments and creates a study schedule to address the source of stress. What type of coping is being demonstrated?
What is problem-focused coping?
A patient reports feeling detached from their body, stating, "It feels like I am watching myself from outside my body." What symptom is the patient describing?
What is depersonalization?
Explain how using open-ended questions can enhance communication with the patient.
Using open-ended questions encourages the patient to express themselves more fully, facilitating a deeper conversation and allowing the nurse to understand the patient's concerns and emotions better.
A patient recently diagnosed with cancer states, "The doctor must have mixed up my test results. There is no way I have cancer." Identify the defense mechanism and its classification.
Denial — Immature
A patient experiences overwhelming anxiety and an inability to cope after unexpectedly losing their job. What type of crisis is occurring?
What is a situational crisis?
This hormone, released by the adrenal cortex, increases blood glucose and helps the body maintain its response to stress.
What is cortisol?
A patient states, "Everything around me feels unreal, almost like I am living in a dream," but recognizes that the environment has not actually changed. What symptom is the patient experiencing?
What is derealization?
Name three nontherapeutic communication techniques.
overhelping, controlling, narcissism, transference, counter transference, blurred boundaries, judging, shaming, dismissing, blocking, unavailability, inconsistency
A nurse who is angry with a supervisor goes home and yells at their spouse over a minor inconvenience. Identify the defense mechanism and its classification.
Displacement — Intermediate
A community experiences a devastating tornado that destroys homes and causes widespread displacement. What type of crisis is occurring?
What is an adventitious crisis?
A nursing student experiences increased heart rate, rapid breathing, dilated pupils, and sweating immediately before a difficult examination. Which stage of General Adaptation Syndrome is occurring?
What is the alarm stage?
A patient is unable to recall important autobiographical information following a traumatic event, and the memory loss cannot be explained by ordinary forgetting or a medical condition. What disorder should the nurse suspect?
What is dissociative amnesia?
A patient has just received distressing news about their diagnosis. They seem withdrawn and quiet.
Discuss the importance of nonverbal communication in this context.
Nonverbal communication is crucial as it can convey empathy and support; maintaining eye contact, nodding, and an open posture can help the patient feel more comfortable and understood.
A patient who is experiencing unacceptable feelings of hostility toward a family member begins accusing that family member of being hostile toward them. Identify the defense mechanism and its classification.
Projection — Immature
A patient with PTSD becomes visibly distressed during a physical examination and states, "Stop! Don't touch me!" What is the nurse's priority trauma-informed response?
What is stopping the examination, ensuring immediate safety, respecting the patient's boundaries, and offering choices about how to proceed?
A patient has been experiencing prolonged stress for several months and reports fatigue, frequent infections, headaches, and difficulty sleeping. Which stage of General Adaptation Syndrome is most consistent with these findings?
What is the exhaustion stage?
A patient demonstrates two or more distinct identity states accompanied by recurrent gaps in memory for everyday events and personal information. What disorder should the nurse recognize?
What is dissociative identity disorder (DID)?
You are caring for a bipolar who appears anxious and expresses feelings of fear and uncertainty about the future.
Describe two therapeutic communication techniques you would use to support this patient.
Active listening: This involves fully concentrating, understanding, responding, and remembering what the patient says.
Empathy: This involves recognizing the patient’s feelings and validating their emotions.
A patient experiencing significant anxiety about an upcoming surgery begins discussing surgical techniques, complication rates, and statistical outcomes while avoiding discussion of their feelings. Identify the defense mechanism and its classification.
Intellectualization — Intermediate
A patient in crisis states, "I cannot handle this anymore. Everyone would be better off without me." What is the nurse's priority response?
What is directly assessing suicidal thoughts, intent, plan, means, and immediate safety?
A nurse reports feeling emotionally exhausted, becoming increasingly cynical toward patients, and feeling ineffective at work. What occupational phenomenon should the nurse recognize?
What is burnout?
A patient experiencing depersonalization becomes increasingly anxious and states, "I don't feel real. I think I'm losing my mind." What nursing intervention is most appropriate?
What is using grounding techniques to help the patient reconnect with the present environment?