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Nure 231-29

The document discusses various nursing scenarios, including a client exhibiting signs of conversion disorder following a personal crisis, a client with delusions, and a client undergoing chemotherapy. It emphasizes the importance of establishing a trusting relationship with clients and provides specific responses and assessments related to different medical conditions. Additionally, it highlights the expected findings in cases such as Bell's palsy and open-angle glaucoma.

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George
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19 views1 page

Nure 231-29

The document discusses various nursing scenarios, including a client exhibiting signs of conversion disorder following a personal crisis, a client with delusions, and a client undergoing chemotherapy. It emphasizes the importance of establishing a trusting relationship with clients and provides specific responses and assessments related to different medical conditions. Additionally, it highlights the expected findings in cases such as Bell's palsy and open-angle glaucoma.

Uploaded by

George
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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A client arrives in the emergency department and tells the nurse that she is experiencing tingling in both

hands and is unable to move her fingers. The client states that she has been unable to work because of
the problem. During the psychosocial assessment, the client reports that 2 days earlier her husband told
her that he wanted a separation and that she would have to support herself financially. The nurse
concludes that this client is exhibiting signs compatible with:

Conversion disorder

Rationale: It is most important to establish a trusting relationship, which will indicate to the client that
the client is important. After a therapeutic relationship has been established, other interventions may
be carried out. The nurse would perform a physical assessment, but this would not be the first
intervention. The client should be informed of the nursing unit's rules, but, again, this is not the first
intervention. Telling the client that he or she will have to participate in self-care is inappropriate. The
client with bipolar disorder requiring hospitalization is likely to need assistance with care.

A client experiencing delusions says to the nurse, "I am the only one who can save the world from all of
the terrorists." What is the appropriate response by the nurse?

"I don't think anyone can save the world from the terrorists by himself."

A client who is scheduled to undergo chemotherapy asks the nurse, "Is my hair going to fall out?" The
nurse responds by telling the client that:

Her hair may fall out but will regrow after the chemotherapy is discontinued

A nurse has given a client with viral hepatitis instructions about home care. Which statement by the
client indicates to the nurse that the client needs further teaching?

"I need to eat three meals a day with foods high in protein, fat, and carbs."

A nurse provides home care instructions to a client who has undergone fluorescein angiography. The
nurse determines that the client needs further instruction if the client states that he must:

Contact the physician if the skin appears yellow

A nurse is measuring intraocular pressure by means of tonometry in a client who has just been found to
have open-angle glaucoma. Which tonometry reading would the nurse expect to note in this client?

28 mm Hg

An emergency department nurse assessing a client with Bell's palsy collects subjective and objective
data. Which finding does the nurse expect to note?

Complaints of inability to close the eye on the affected side

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