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.
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.
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.
a) Carol's psychiatric problems b) preeclampsia c) uncontrollable and assaultive behavior d) botched-up abortion
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
a) myasthenia gravis b) hypochondriasis c) both of the above d) none of the above
a) True b) False
a) head nurse b) respiratory therapist c) motivator d) pulmonary specialist e) physical therapist
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.
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.
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.
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.
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.
a) upper respiratory infection b) fungus infection c) incontinence d) urinary tract infection
a) bowel training b) eating c) ambulatory training d) physical therapy
a) Nigeria b) Algeria c) France d) New York
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
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
a) game-playing b) distraction c) explain thoroughly to build trust d) find practical solutions
a) agreed b) disagreed
a) cobalt therapy b) chemotherapy c) L-asparaginase therapy d) bone marrow injections
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
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
a) was in the early stages. b) had spread to lymph nodes.
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.
a) play therapy b) role-playing c) tough love d) involving other family members in Linda's recovery
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
a) peripatologist b) Mrs. Stone's daughter c) 85-year-old Italian widower d) Jeb from the state association for the blind
a) homosexual b) medical doctor c) obsessive compulsive d) intelligent e) athletic
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
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
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
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.
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.
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.
a) herself b) her husband c) her mother d) Barbara from Ostomy Club
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.
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
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.
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.
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.
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.
a) Mark was cooperative; b) liked to talk about his family and personal feelings; c) uncomplaining; d) was a successful businessman.
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)
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.
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
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.
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.
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.
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.
a) Robbie and the nursing staff b) Robbie and his mother
a) trying to keep her (Betty's) clothes on b) incontinence c) obesity d) schizophrenia
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.
a) demanding patient b) inadequate diagnosis c) communication d) interference from family members
a) thiothixene hydrochloride (Navane) b) amobarbital (Amytal) c) electroconvulsive therapy (ECT) d) group therapy
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.
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.
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.