PSYCH LAB QUIZ BEE.pptx
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This document contains a quiz on therapeutic communication techniques for nurses. It includes 10 multiple choice questions about appropriate nurse responses in various patient situations. The questions cover topics like responding to suicidal statements, minimizing a patient's feelings, using open-ended questions with a psychotic patient, and reflecting back a patient's underlying feelings. For each question, answer choices are provided and the correct answer is revealed. The quiz aims to teach nurses effective communication strategies.
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The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.
The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977).
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Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
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Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
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The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.
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1. What, if anything, did the nurse do wrong?
2. Had she moved beyond her scope of practice?
3. Could the nurse's conduct be justified under the patient advocate portion of her role?
4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?
Support your responses with evidence and cite your sources.
Length 4 pages not counting the case. At least 4 references; scholarly sources
COURSE MATERIAL INFORMATION
: Ethical Principles and Dilemmas of Confidentiality, Veracity, and Fidelity
Health care .
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
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- 3. 01 A DEPRESSED CLIENT IN AN INPATIENT UNIT SAYS TO THE NURSE, “MY FAMILY WOULD BE BETTER OFF WITHOUT ME.” WHICH IS THE NURSE’S BEST RESPONSE?
- 4. A. “HAVE YOU TALKED TO YOUR FAMILY ABOUT THIS?” B. “EVERYONE FEELS THIS WAY WHEN THEY ARE DEPRESSED.” C. “YOU WILL FEEL BETTER ONCE YOUR MEDICATION BEGINS TO WORK.” D. “YOU SOUND VERY UPSET. ARE YOU THINKING OF HURTING YOURSELF?” CHOICES
- 6. 02 STAN IS A NEW NURSE. HE IS VERY CONCERNED ABOUT GETTING HIS TASKS DONE. HE WALKS IN ON HIS PT, WHO IS LOOKING OUT THE WINDOW. STAN ASKS, "WHAT'S WRONG?" THE PT ANSWERS, "I'M OLD, AND MY BODY IS WEARING OUT." STAN REPLIES, "OH COME ON, YOU AREN'T THAT OLD, AND YOU JUST HAVE A KIDNEY INFECTION." WHAT HAS STAN DONE?
- 7. A. MINIMIZING FEELINGS B. FALSE REASSURANCE C. SHARING HUMOR D. CONFRONTATION CHOICES
- 9. 03 THE PATIENT STATES, “I DON'T BELIEVE I HAVE CANCER, IT'S JUST SOMETHING THE DOCTOR MADE UP SO HE CAN EARN MONEY FROM ME” What kind of defense mechanism does the patient exhibit?
- 10. A. REGRESSION B. PROJECTIO N CHOICES B. PROJECTION C. DENIAL D. REJECTION
- 12. 04 THIS TYPE OF COMMUNICATION REQUIRES THE NURSE TO SELECT WORDS AND PHRASES CAREFULLY IN ORDER TO ESTABLISH A DIALOGUE AND TRUST WITH THE PATIENT.
- 13. A. ACTIVE LISTENING B. THERAPEUTIC USE OF SELF C. THERAPEUTIC COMMUNICATION D. CONSTRUCTIVE COMMUNICATION CHOICES
- 15. 05 A PATIENT WITH DISTURBED THOUGHT PROCESSES SUSPECTS THAT HIS FOOD HAS BEEN POISONED. WHICH COMMUNICATION TECHNIQUE SHOULD THE NURSE USE to encourage the patient to eat?
- 16. A. USING OPEN- ENDED QUESTIONS AND SILENCE B. SHARING PERSONAL PREFERENCES REGARDING FOOD CHOICES C. DOCUMENTING REASONS WHY THE PATIENT DOES NOT WANT TO EAT D. OFFERING OPINIONS ABOUT THE NECESSITY OF ADEQUATE NUTRITION CHOICES
- 18. 06 DURING A NURSE-CLIENT INTERACTION, WHICH NURSING STATEMENT MAY BELITTLE THE CLIENT'S FEELINGS AND CONCERNS?
- 19. A. "DON'T WORRY. EVERYTHING WILL BE ALRIGHT." B. "YOU APPEAR UPTIGHT." C. "I NOTICE YOU HAVE BITTEN YOUR NAILS TO THE QUICK." D. "YOU ARE JUMPING TO CONCLUSIONS." CHOICES
- 21. 07 CLIENT: "WHEN I AM ANXIOUS, THE ONLY THING THAT CALMS ME DOWN IS ALCOHOL." NURSE: "OTHER THAN DRINKING, WHAT ALTERNATIVES HAVE YOU EXPLORED TO DECREASE ANXIETY?"
- 22. A. REFLECTING B. MAKING OBSERVATIONS C. FORMULATING A PLAN OF ACTION D. GIVING RECOGNITION CHOICES
- 24. 08 WHAT TECHNIQUE OF THERAPEUTIC COMMUNICATION DO THESE STATEMENTS BELONG TO? “GO ON.” “AND THEN?” “ TELL ME ABOUT IT.”
- 25. A. REFLECTING B. OFFERING GENERAL LEADS C.CLARIFYING D. ACCEPTING CHOICES
- 27. 09 A NEWLY ADMITTED CLIENT DIAGNOSED WITH OBSESSIVE- COMPULSIVE DISORDER (OCD) WASHES HANDS CONTINUALLY. THIS BEHAVIOR PREVENTS UNIT ACTIVITY ATTENDANCE. WHICH NURSING STATEMENT BEST ADDRESSES THIS SITUATION?
- 28. A. “EVERYONE DIAGNOSED WITH OCD NEEDS TO CONTROL THEIR RITUALISTIC BEHAVIORS.” B. “IT IS IMPORTANT FOR YOU TO DISCONTINUE THESE RITUALISTIC BEHAVIORS.” C. “WHY ARE YOU ASKING FOR HELP IF YOU WON’T PARTICIPATE IN UNIT THERAPY?” D. “LET’S FIGURE OUT A WAY FOR YOU TO ATTEND UNIT ACTIVITIES AND STILL WASH YOUR HANDS.” CHOICES
- 30. 10 THIS THERAPEUTIC COMMUNICATION TECHNIQUE MIRRORS WHAT THE NURSE BELIEVES THAT THE CLIENT’S FEELINGS TO BE UNDERNEATH THE WORDS.
- 31. A.RESTATING B. PARAPHRASING C. REFLECTION D. SUMMARIZING CHOICES
- 33. THANK YOU