A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize?

Correct Answer: C

Rationale: The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen-carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life.

Correct Answer: D

Rationale: Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one's own unacceptable thoughts or feelings to another.

Correct Answer: D

Rationale: Compensation is an unconscious process that allows us to make up for deficits in one area by excelling in another area to raise self-esteem. Repression unconsciously puts an idea, event, or feeling out of awareness. Identification is an unconscious mechanism calling for imitation of mannerisms or behaviors of another. Devaluation occurs when the individual attributes negative qualities to self or others.

Correct Answer: C

Rationale: In this scenario, the correct completion to the etiological portion of the nursing diagnosis for a patient with obsessive-compulsive disorder is Option C: persistent thoughts about bacteria, germs, and dirt. This is the most appropriate choice because it directly relates to the core feature of OCD, which is the presence of obsessions (persistent, intrusive thoughts) and compulsions (repetitive behaviors aimed at reducing anxiety or preventing a feared outcome). Option A (feelings of responsibility for the health of family members) may be a common feature in individuals with high levels of anxiety, but it does not specifically address the nature of OCD symptoms seen in this patient. Option B (approval-seeking behavior from friends and family) is more characteristic of dependent personality traits rather than OCD. Option D (needs to avoid interactions with others) is more indicative of social anxiety disorder rather than OCD. Educationally, understanding the rationale behind selecting the correct etiological factor in a nursing diagnosis for a patient with OCD is crucial for providing effective care. By recognizing the key symptoms and triggers associated with OCD, nurses can tailor interventions to help patients manage their anxiety and compulsive behaviors effectively. This knowledge aids in promoting therapeutic relationships and fostering positive outcomes in psychiatric nursing practice.

Correct Answer: D

Rationale: The patient is expressing feelings related to the loss, and this is an expected and healthy behavior. This patient is at risk for a maladaptive response because of the history of a serious mental illness, but the nurse's priority intervention is to form a therapeutic alliance and support the patient's expression of feelings. Crying at 2 weeks after his death is expected and normal.