A person who has been unable to leave home for more than a week because of severe anxiety says, 'I know it does not make sense, but I just can't bring myself to leave my apartment alone.' Which nursing intervention is appropriate?

Correct Answer: D

Rationale: In this scenario, option D is the most appropriate nursing intervention because teaching the person to use positive self-talk techniques can help them challenge and reframe their negative thoughts related to anxiety. By learning to replace self-defeating thoughts with positive affirmations, the individual can build self-confidence and reduce anxiety, ultimately empowering them to gradually overcome their fear of leaving the apartment. Option A, using online video calls, may provide temporary social interaction but does not address the underlying issue of anxiety. Option B, advising the person to accept the situation and use a companion, does not promote independence and may enable avoidance behavior. Option C, asking the person to explain the fear, while important for understanding their perspective, may not provide immediate coping strategies to manage the anxiety. Educationally, this question highlights the importance of cognitive-behavioral techniques in addressing anxiety disorders. Teaching individuals to reframe negative thoughts is a fundamental skill in mental health nursing practice. It emphasizes the role of nursing interventions in promoting self-management strategies for individuals experiencing anxiety, thus fostering empowerment and resilience in the face of mental health challenges.

Correct Answer: B

Rationale: The scenario depicts a frightening, traumatic, and stressful situation. Severe dissociation or "mind flight" may occur for those who have suffered significant trauma. The episodic failure of dissociation causes intrusive symptoms such as flashbacks. The problems identified in the distracters may or may not occur.

Correct Answer: A

Rationale: In response to trauma, the sympathetic arousal symptoms of rapid heart rate and rapid respiration prepare the person for flight or fight responses. Afterward, the dorsal vagal response damps down the sympathetic nervous system. This is a parasympathetic response with the heart rate and respiration slowing down and decreasing the blood pressure. Relaxation techniques promote activity of the parasympathetic nervous system.

Correct Answer: B

Rationale: The patient mentions that the symptoms make people more interested. This indicates that the patient feels uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in the scenario.

Correct Answer: D

Rationale: The correct answer is D) Factitious disorders are under voluntary control, whereas somatic symptom disorders involve the expression of psychological stress through somatization. This is because factitious disorders are characterized by intentional production or feigning of physical or psychological symptoms in order to assume the sick role, whereas somatic symptom disorders involve genuine physical symptoms that are linked to psychological distress. In factitious disorders, the individual consciously fabricates symptoms for various reasons such as gaining attention or sympathy, whereas in somatic symptom disorders, the physical symptoms are not intentionally produced but are a manifestation of underlying psychological distress. Option A is incorrect because both somatic symptom disorders and factitious disorders involve unconscious elements, but the key difference lies in the intentionality of symptom production. Option B is incorrect as it does not capture the essential distinction between intentional symptom fabrication in factitious disorders versus genuine symptom expression in somatic symptom disorders. Option C is incorrect as neither disorder is exclusively determined by childhood sexual abuse or solely culturally bound; they can have diverse etiologies and manifestations beyond these factors. In an educational context, understanding the differences between somatic symptom disorders and factitious disorders is crucial for nurses to accurately assess and provide care for patients presenting with complex health behaviors. By recognizing the underlying motivations and mechanisms behind these disorders, nurses can offer appropriate interventions and support tailored to the individual's needs.