Your patient Vicky just received a diagnosis of terminal cancer. You plan to speak to her about her response to the diagnosis.. When you reach her room, you find Vicky on the phone. As youre standing in the doorway, she starts laughing. You are startled when she states, Why are you looking so sad? Obviously the tests were wrong. I am not that sick. The patient is displaying:

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Denial. Vicky's response of laughing and stating that the tests were wrong, and she is not that sick, indicates a classic example of denial. Denial is a defense mechanism where individuals refuse to acknowledge a painful reality to protect themselves from the emotional impact of the situation. Option A) Transference involves redirecting feelings from one person to another and is not demonstrated in this scenario. Option B) Regression refers to reverting to an earlier stage of development in the face of stress, which is not evident in Vicky's response. Option D) Isolation involves separating conflicting thoughts or feelings, which is also not displayed by the patient. Educationally, understanding defense mechanisms like denial is crucial in behavioral health nursing. By recognizing and interpreting these mechanisms, nurses can better assess and support patients coping with difficult diagnoses and situations. It is essential for nurses to approach patients with empathy, understanding, and therapeutic communication skills to help them navigate their emotions and responses effectively.

Correct Answer: B

Rationale: In the field of Behavioral Health Nursing, understanding the essential components of palliative care is crucial for providing holistic and compassionate care to patients and their families facing life-limiting illnesses. Option B, "Effective communication, terminal care, bereavement planning," is the correct choice for several reasons. Effective communication is fundamental in palliative care as it allows healthcare providers to understand and address the physical, emotional, and spiritual needs of patients and their families. Terminal care focuses on managing symptoms, alleviating pain, and improving quality of life for patients approaching the end of their lives. Bereavement planning involves providing support to the family both during the patient's illness and after their passing, ensuring they receive the necessary resources and counseling to cope with their loss. Option A, "Rehabilitation, continuity of care, treatment," is incorrect because while continuity of care is important in palliative care, rehabilitation and treatment focus more on curative measures rather than comfort and quality of life at the end of life. Option C, "Terminal care, symptom control, rehabilitation," is partly correct but lacks the crucial component of effective communication and bereavement planning. Option D, "Education, research grief planning," is incorrect as it does not encompass the core elements of palliative care such as symptom management and terminal care. Educationally, understanding the components of palliative care is essential for nurses to deliver patient-centered care, promote dignity, and respect individual preferences at the end of life. By choosing the correct answer, nurses can enhance their communication skills, provide holistic care, and support both patients and families through the challenging journey of serious illness and loss.

Correct Answer: C

Rationale: The most appropriate nursing action when a postoperative client suddenly becomes cyanotic in the recovery room is to reposition the head and determine the patency of the airway (Option C). This action is crucial as cyanosis indicates a lack of oxygen reaching the tissues, which can be caused by airway obstruction. Repositioning the head helps to open the airway and ensure that the client can breathe effectively. Starting the administration of oxygen through a nasal cannula (Option A) may be necessary, but ensuring airway patency takes precedence in this situation. Calling for assistance (Option B) is important but should be done after addressing the immediate concern of airway obstruction. Inserting an oral airway and suctioning the nasopharynx (Option D) is an invasive procedure that should only be done if other non-invasive interventions are ineffective. In the context of behavioral health nursing, it is essential to understand the physiological responses to stress and potential complications postoperatively. Proper airway management is a fundamental nursing skill that can be life-saving in emergency situations. This scenario highlights the importance of quick assessment and intervention to ensure patient safety and well-being.

Correct Answer: C

Rationale: In this scenario, option C is the correct answer. The client stating, "I cannot have anything to drink or eat after midnight on the night before the surgery," indicates a lack of knowledge. The current practice is to allow clear fluids up to 2 hours before surgery to prevent dehydration and hypoglycemia. Option A is correct because wearing a pneumatic compression device postoperatively is a common practice to prevent deep vein thrombosis. Option B is also correct as the skin prep area does need to be larger to reduce the risk of infection. Educationally, it is important for nurses to ensure that clients have accurate information regarding their surgical procedures to promote positive outcomes and reduce anxiety. Providing clear, concise preoperative education empowers clients to be active participants in their care and aids in their recovery process. It is crucial for nurses to correct any misconceptions or misinformation to enhance patient safety and satisfaction.

Correct Answer: B

Rationale: In a manic episode, neurotransmitters play a crucial role in the manifestation of symptoms. The correct answer is B) norepinephrine and dopamine. Norepinephrine and dopamine are known to be elevated during manic episodes, contributing to increased energy, elevated mood, impulsivity, and other manic symptoms. Option A) acetylcholine and serotonin are not typically elevated in manic episodes. Acetylcholine is more associated with attention, learning, and memory processes, while serotonin is linked to mood regulation and is often implicated in depression rather than mania. Understanding the neurotransmitter imbalances in mental health conditions like manic episodes is vital for nurses working in behavioral health settings. Recognizing the role of norepinephrine and dopamine can help nurses in assessing, planning, and implementing appropriate interventions to manage manic symptoms effectively. Educating nursing students and professionals about these neurotransmitter imbalances enhances their ability to provide holistic care for individuals experiencing behavioral health challenges.