Managing Difficult Patients

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. After reading Case 1, select from below the correct statement:

a) Mrs. Hyman never once gave up on her husband's eventual recovery.
b) Dr. Hyman was a young, physically robust marine lieutenant.
c) Dr. Hyman's miraculous recovery can be attributed to a flexible care plan and a lot of plain old nursing persistence.
d) Dr. Hyman's stay in the burn center lasted over 6 months.

2. ICU psychosis is best described by one of the following statements:

a) Patient is unable to communicate with the physician or the nursing staff and is unable to respond to simple commands.
b) Patient's imagination completely takes over, fantasies become real, and the patient goes into a delirium.
c) Patient believes the nursing staff is actually trying to cause harm to him or her, even trying to kill.
d) Patient believes he or she is surrounded by enemies and the patient attacks the nursing staff.

3. Carol's most recent admission was precipitated by

a) Carol's psychiatric problems
b) preeclampsia
c) uncontrollable and assaultive behavior
d) botched-up abortion

4. Which of the following played an important role in the delivery of Carol's baby?

a) her mother's constant and reassuring presence
b) behavior modification progam
c) successful management of Carol's preeclampsia
d) patient's own determination and cooperation in seeing through a difficult pregnancy

5. Which of the following best describes Mrs. Hill's diagnosis?

a) myasthenia gravis
b) hypochondriasis
c) both of the above
d) none of the above

6. The technique described in Herbert Benson's book, The Relaxation Response, helped Mrs. Hill go off the ventilator within 24 hours.

a) True
b) False

7. What was the title Mrs. Hill ascribed to the author of this case study?

a) head nurse
b) respiratory therapist
c) motivator
d) pulmonary specialist
e) physical therapist

8. After reading Case No. 4, select the True statement:

a) The baby died in her parent's home.
b) The baby was born prematurely and weighed less than 2 lbs. at birth.
c) The father of the baby visited the baby only once and never could bring him- self to return.
d) Annie had great difficulty in participating in the baby's discharge planning.

9. Read Case No. 5. Select the correct statement from below:

a) Prior to his hospitalization, Cletus was living on the streets, dealing in crack and cocaine.
b) Cletus received little support, understanding or encouragement from his family or friends.
c) For a multi-problemed, irresponsible patient like Cletus, it is best to follow a well-prepared, precise nursing plan and not deviate from it.
d) When Cletus left, his burns were healed, he walked, fed himself and, most importantly, his irrational abusive behavior had been brought under control.

10. Leon was classified as "Treat As Blind" (TAB). In caring for such patients, certain procedures are followed. Select the incorrect statement from below:

a) To avoid spills and the possibility of patient hurting himself, patient is fed by an assistant.
b) Furniture and patient belongings are always placed in agreed-upon places.
c) All doors are left either completely open or shut.
d) Always say "Hello" when entering the room, "Goodbye" when leaving.
e) Before touching the patient, provide verbal cues.

11. The patient needed precise postoperative care, and to avoid medication errors and save time nurses used certain conventions and procedures. Which of the following statements is incorrect?

a) OD means right eye, OS left eye.
b) Right eye is always taken care of first.
c) On the medication box, OD was circled in black, OS in red.
d) Patient was told the name of the drug prior to administration.

12. After the vitrectomy, to prevent pressure build-up in the eye, the patient was forced to lie flat on his back for 3 days.

a) True
b) False

13. Leon's major strength lay in his family's cohesiveness, mutual love, and strong reli- gious faith.

a) True
b) False

14. In this case, the patient was stricken with Guillain-Barré syndrome. Select the incorrect statement about it from below:

a) Guillain-Barré syndrome is characterized by paralysis which occurs within 2 to 14 days of onset.
b) There's no cure for Guillain-Barré.
c) This is an autoimmune disease.
d) The prognosis for patients with Guillain-Barré syndrome is poor; the paralyis progressively gets worse and most patients die within 2 years.

15. Which ailment forced Numidia's transfer to the rehabilitation hospital?

a) upper respiratory infection
b) fungus infection
c) incontinence
d) urinary tract infection

16. The nursing staff felt that they had failed in one of the following areas of patient training:

a) bowel training
b) eating
c) ambulatory training
d) physical therapy

17. Numidia was originally from

a) Nigeria
b) Algeria
c) France
d) New York

18. Nursing care plan for aphasic patients has many standard approaches and yet must be tailored to the specific needs of a patient. Which of the following is the most important component of such a plan?

a) involve family members early on in the recovery
b) work with the patient on a one-to-one basis
c) repeat instructions as often as necessary
d) use body language to reinforce verbal communications
e) have a generous reservoir of patience

19. To ease Andy's pain during dressing changes and to obtain his cooperation, the nurse used several techniques. Which of the following worked like a miracle?

a) recite in minute detail everything the nurse was going to do
b) deep breathing _ inhale and exhale rhythmically
c) imagery _ picture yourself being somewhere else, doing something else
d) detachment _ the dressings being removed, the unbearable pain, etc. happening to someone else
e) prepare the patient gradually, give the patient ample time to create his own coping mechanism

20. Mrs. Johns' successful recovery can be attributed to the behavior modification program where the desirable behavior was rewarded (with a cigarette, for instance) and undesirable behavior punished (withholding of a cigarette).

a) True
b) False

21. The nursing care of 2-year-old Johnny required many ingenious techniques on the part of his mother. Which of the following was probably the most important?

a) game-playing
b) distraction
c) explain thoroughly to build trust
d) find practical solutions

22. In her book, Nursing Care of the Child with Long-Term Illness, Shirley Steel advo- cates a practice with which the author of this article _________.

a) agreed
b) disagreed

23. The 2-year-old boy underwent several different treatments for acute lymphoblastic leukemia, all of which had some severe side effects. Which one was the cause of infections and skin abscesses?

a) cobalt therapy
b) chemotherapy
c) L-asparaginase therapy
d) bone marrow injections

24. Out of exasperation, the author devised a way of dealing with Dorothy. Identify that from the following:

a) ignore Dorothy's constant complaining
b) pay her constant attention
c) submit to her demands
d) strictly enforce the rules no matter how much she complained

25. At the end, in Case No. 13, Dorothy came around, gave up her constant complaining, took her bath regularly and stopped calling the police.

a) True
b) False

26. During his difficult stay at the hospital, Sam and the nursing staff developed several coping mechanisms. Which of the following was the biggest source of strength for Sam?

a) commaraderie with other patients in the room
b) religion
c) his bear, Buggish
d) Sam's ability to manipulate the nursing staff
e) his wife and children

27. When Sam was admitted to the hospital his disease

a) was in the early stages.
b) had spread to lymph nodes.

28. In working with 92-year-old Rose, which of the following techniques yielded the desired results?

a) Be direct and firm.
b) Reward her for her good behavior.
c) Don't let her come out of her room until she cooperated.
d) Ignore her bad behavior.

29. In this case it was important to help Linda control her behavior and emotions, but equally important was to help her parents learn to cope with Linda's controlling behavior. Which technique helped the most?

a) play therapy
b) role-playing
c) tough love
d) involving other family members in Linda's recovery

30. Select the statement that describes the job a peripatologist does:

a) help a blind person relearn basic skills of daily living
b) teach a person to cope with his or her blindness mentally
c) teach blind people how to be mobile
d) combines the tasks of a mental health worker, social worker and nurse's aide

31. During Mrs. Stone's long rehabilitation which of the following persons may actually have impeded her progress?

a) peripatologist
b) Mrs. Stone's daughter
c) 85-year-old Italian widower
d) Jeb from the state association for the blind

32. Which of the following statements does not describe Ron?

a) homosexual
b) medical doctor
c) obsessive compulsive
d) intelligent
e) athletic

33. Mrs. Elliot's nursing plan evolved slowly during her stay at the hospital. Which of the following yielded the best results?

a) indulge her whims
b) encourage her to take part in her care
c) share among the nurses her care
d) move her to a semiprivate room

34. When caring for an overbearing patient like Mrs. Elliot, the author concludes the best nursing intervention is

a) set limits for her
b) ignore her incessant demands
c) swallow your own pride so that the patient can regain hers
d) ask the patient to hire a private nurse for herself

35. Mr. Gomez's demanding and manipulative behavior could be ascribed to:

a) As an amputee, Mr. Gomez felt he was losing control over his life when admitted to a hospital.
b) his racial minority status
c) pain medications
d) After his horrible accident, he felt he had to be on his guard all the time.
e) all of the above

36. After reading Case No. 21, select the incorrect statement:

a) Mr. MacDonald was a high-powered business executive.
b) Mr. MacDonald felt sorry for himself, helpless and dependent on the nursing staff.
c) The author felt that the most effective way of dealing with Mr. MacDonald was to make a "contract" with him about his treatment plan.
d) At the end of his rehabilitation, Mr. MacDonald was able to return home and live with minimal assistance.

37. Mr. J. J. Sylvester was a real con artist when it came to getting the things he wanted during his stay at the hospital. Which of the following works the best in managing a patient like Mr. J. J. Sylvester?

a) Confront the patient with his con game and shame him into not trying such tactics again.
b) Team communication among the nursing staff and doctors.
c) Every time a patient is caught with his con game take away some privilege.
d) Ignore the patient's con games, stick to the nursing plan originally formulated.

38. Mrs. Sylvester had little to do in helping her husband's discharge from the hospital to live independently at home.

a) True
b) False

39. After reading Case No. 23, select the correct statement from the following:

a) Mr. Bowen was transferred to the general patient unit after spending 2 months in the burn unit.
b) Mr. Bowen's family played an important role in his recovery.
c) Mr. Bowen never responded to the nurse's entreaties and attention.
d) Mr. Bowen finally succumbed to his illness at the hospital.

40. In her path to recovery from colostomy, 20-year-old Patty was helped the most by

a) herself
b) her husband
c) her mother
d) Barbara from Ostomy Club

41. Most patients with anorexia nervosa share certain traits. Dr. Evans was different in one respect:

a) Dr. Evans was a 45-year-old professional man trained in dentistry.
b) Dr. Evans was manipulative and devious.
c) Dr. Evans was in severe denial about his eating disorder.
d) Dr. Evans would steal and hoard food and exercise for hours on end.

42. As a last resort measure, which of the following nursing interventions yielded some positive results?

a) restrict Dr. Evans' fluid intake
b) make sure Dr. Evans did not exercise excessively
c) assign two nursing assistants to watch over Dr. Evans during mealtimes
d) present Dr. Evans with a contract

43. What was the one thing that made a major contribution in the rehabilitation process of Cal?

a) Make sure that Cal drank sufficient fluids during the day.
b) Help him learn self-catheterization and regain his dignity.
c) Allow him to take care of himself; let him take responsibility for his own rehabilitation.
d) His transfer to an acute care hospital for excision of a kidney abscess _ the source of urinary tract infections.

44. Laura stayed in the unit for 5 weeks during which time she made notable progress. Which of the following actions or events does the author consider most responsible for her progress?

a) When Laura stopped manipulating the nurses she was on her way to recovery. b) Channeling her energies into constructive projects, such as baking, cooking, cleaning, etc., made a great improvement in her outlook.
b) Being elected chairperson of the patient government meeting was a big step forward for Laura.
c) Laura had turned the corner when she accepted responsibility for her actions.

45. Which of the following statements accurately describes Katie's state of mind?

a) Katie felt hopeless about her prognosis from AVM with nothing to look forward to in life.
b) Katie's expectations were unrealistically high from the beginning.

46. Which of the following was the most pressing problem Emma presented to the nurses?

a) Emma's condition was terminal due to invasive vulvar cancer.
b) Emma was into deep denial.
c) Emma had no family support.
d) Emma was rude, demanding and manipulative.

47. All of the following characteristics describe Mark except one:

a) Mark was cooperative;
b) liked to talk about his family and personal feelings;
c) uncomplaining;
d) was a successful businessman.

48. Select the response that describes Billy's diagnosis:

a) Tourette's syndrome
b) mixed specific developmental disorder with infantile autism, residual state
c) affective disorder, bipolar, mixed
d) sensory integration problem
e) all but (a)

49. Which of the following conclusions can be drawn from this case?

a) Nurses made the mistake of treating the illness, but ignoring the patient.
b) Mrs. Ladley showed no interest in her husband's recovery, paid nary a visit.
c) Nurses realized that Mr. Ladley could never be discharged back home without the help of Mrs. Ladley.
d) Sometimes it's better to banish family members from the care of patient in order to make the patient independent.

50. Turning point in Case No. 33 came at one of the following junctures:

a) when little Tommy was weaned off the respirator
b) when the author wrote the letter _ "written" by Tommy to his patients
c) when Mr. and Mrs. Sutton agreed on sharing the care details for their son
d) when Tommy left the hospital

51. Which of the following occurrences could be considered a turning point in Sam's recovery?

a) Sam realized he wasn't as disfigured as he had feared;
b) Sam started to tolerate debridement sessions on a regular basis;
c) family realized his condition was temporary and he was going to make steady progress;
d) Sam was taken out of the isolation chamber.

52. Sarah wanted to die at home, but eventually she died in the hospital.

a) True
b) False

53. Jamey's behavior _ the rhythmic poking at the eyes, thumb-sucking, and masturbation _ was typical of a deaf-blind child.

a) True
b) False

54. Which of the following statements represented the fact in this case?

a) Mrs. Mellon suffered a stroke after an "insulin coma."
b) From the start, Mr. Mellon's methodical and intellectual caring for his wife endeared him to the nurses.
c) Mrs. Mellon finally regained bladder control and was able to walk with only standby help.
d) In the final analysis, Mr. Mellon hindered, rather than helped, the small progress made by Mrs. Mellon.

55. Which of the following statements is not factual?

a) Sammy finally succumbed to his terminal illness.
b) Sammy's illness brought Sally and Mr. Questin together as a family.
c) The one thing this family had in common, despite all their problems, was their love for the boy.
d) Sammy's ordeal made Sally a stronger, more assertive person.

56. Which of the following statements most accurately describes the problem faced by the nurses in this case?

a) Mr. Heller's physical problems _ diabetes, cerebral atherosclerosis, bilateral neuropathy of both legs, etc. _ were overwhelming.
b) Lottie was afraid of letting go of her husband, not wanting him to become ` independent of her.
c) Mr. Heller had given up on his recovery, he did not want to participate in his daily routine.
d) There was a fundamental disagreement between the nurses and the patient and his wife on the care and planning for Mr. Heller.

57. Case No. 40 is about communication. The communication problem existed between

a) Robbie and the nursing staff
b) Robbie and his mother

58. The student nurse had to write an effective nursing care plan for her patient, Betty. Can you identify the most obvious problem the nurse tackled?

a) trying to keep her (Betty's) clothes on
b) incontinence
c) obesity
d) schizophrenia

59. In Case No. 42 what would you consider was the main problem?

a) The patient, being a nurse herself, was very demanding.
b) Her requests were rather impossible.
c) The patient had threatened to sue the hospital for malpractice, prompting the staff to avoid her as much as possible.
d) There was lack of communication between the staff and the patient, and among members of the nursing staff.

60. The difficulty described with the patient in Case No. 43 related to

a) demanding patient
b) inadequate diagnosis
c) communication
d) interference from family members

61. Which of the following therapies turned the corner for the patient in Case No. 44?

a) thiothixene hydrochloride (Navane)
b) amobarbital (Amytal)
c) electroconvulsive therapy (ECT)
d) group therapy

62. Case No. 45 describes the patient who had undergone surgery for a hip arthroplasy.

a) True
b) False

63. Which of the following is not a True statement of facts?

a) Mrs. Savage was diagnosed with Guillain-Barré syndrome.
b) Since Mrs. Savage couldn't see or speak, communication with her was limited to brass bells fastened to her feet.
c) Her husband came every day and read her books and talked about the latest neighborhood gossip.
d) After her discharge from the hospital Mrs. Savage invited all the ICU nurses to her home to show her appreciation.

64. Toward the end of her stay in the hospital, Carrie came to accept her death.

a) True
b) False

65. In Case No. 48 what was the biggest challenge facing the nurse?

a) get the patient to accept the fact that he was suffering from chronic, incurable disease;
b) get the patient to take part in his rehabilitation plan;
c) improve communication between the patient and his family;
d) provide the intensive nursing care that the patient needed.

66. What was the thing that Cyrus wanted the most while in the hospital?

a) He wanted to be able to eat by mouth.
b) He wanted his wife and children to be near him all the time.
c) He needed to feel that he was in charge.
d) He wanted to be off the ventilator.

67. In Case No. 50, the nurse was able to make a big difference in the rehabilitation of Michael because she refused to go strictly by the book.

a) True
b) False

68. The rule taught in nursing schools, when you're caring for a delusional patient, never agree with or get involved in his delusion, worked very well with Sergeant Caulder.

a) True
b) False