(Osborn) Chapter 13: Learning Outcomes (Number and Title)

[Osborn] chapter 13
Learning Outcomes [Number and Title]

Learning Outcome 1
Discuss conceptual foundations that inform psychosocial nursing.
Learning Outcome 2
Define the characteristics of a therapeutic nursepatient relationship.
Learning Outcome 3
Utilize culturally competent principles of therapeutic communication for
the care of patients and significant others.
Learning Outcome 4
Apply the principles of teaching and learning to the care of patients and
significant others.
Learning Outcome 5
Identify the dimensions of crisis and the nursing actions that promote
adaptive coping.
Learning Outcome 6
Discuss the impact of illness and hospitalization on patients and
significant others.
Learning Outcome 7
Compare and contrast the psychodynamics of anxiety, frustration, anger,
depression, and loss and grief.
Learning Outcome8
Utilize the nursing process for patients experiencing loss and grief,
anxiety, depression, and anger.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. A patient tells the nurse that she needs help bathing even though she independently walks in the
room and accesses personal belongings without assistance. The nurse realizes this patient is
demonstrating which of the following ego defense mechanisms?
1.
2.
3.
4.
Regression
Projection
Sublimation
Compensation
Correct Answer: Regression

Rationale: Regression is a mechanism whereby a person returns to a time and level of less demanding
functioning. The patient, who is independent, is asking for help with the basic care task of bathing.
Projection occurs when individuals acknowledge their own shortcomings by blaming others or the
environment for their behavior. Sublimation describes a person who avoids acting in an unacceptable
way by substituting acceptable behavior. Compensation describes a person who overcomes a deficit by
overachieving in a more comfortable area.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Psychosocial Integrity
LO: 1
2. The daughter of an ill patient tells the nurse that her father would not be so sick if she had spent
more time with him over the years. The nurse realizes the daughter is exhibiting which of the
following cognitive distortions?
1.
2.
3.
4.
Personalization
Selective abstraction
Overgeneralization
Magnification
Correct Answer: Personalization

Rationale: Personalization is when external events are attributed to oneself without any evidence to
support the causal relationship. The daughter believes that visiting her father would have prevented the
illness. Selective abstraction is the conceptualization of a situation while ignoring contradictory
information. Overgeneralization is taking specific information and generalizing it broadly to unrelated
situations. Magnification is seeing something as far more important than it is.
LO: 1
3. A patient with a history of multiple childhood illnesses tells the nurse that she dislikes doctors and
hospitals because nothing good ever happens in a hospital. The nurses understanding of cognitive
concepts helps him realize this patients comment demonstrates:
1.
2.
3.
4.
A cognitive triad.
Selective abstraction.
Dichotomous thinking.
Minimization.
Correct Answer: Cognitive triad.

Rationale: The cognitive triad is a group of three negative recurring patterns of thought that influence
people to see themselves as inadequate, negatively misinterpret an experience, and view the future in a
negative way. The patient had many childhood illnesses and may have experienced at an early age that
hospitals and doctors mean illness, and therefore a bad experience. Selective abstraction occurs when a
situation is conceptualized while ignoring contradictory information. In dichotomous thinking,
experiences are categorized with all-or-nothing reasoning. Minimization is seeing something as far
less important than it is.
LO: 1
4. A student nurse is having difficulty establishing relationships with patients. Which of the following
should this student be counseled to do?
1.
2.
3.
4.
Develop self-awareness to focus on being helpful to patients.

Study cognitive theory.
Review the concepts of caring.
Focus on the purpose of a therapeutic alliance.
Correct Answer: Develop self-awareness to focus on being helpful to patients.

Rationale: One aspect of the nursepatient relationship is that of the nurses self-awareness. The nurse
needs to be responsible to expand insight into her own personality. The theorist Peplau explains that a
basic task of nursing education should be the development of each nurse as a person who wants to
nurse patients in a helpful way. The nurse should be encouraged to develop a helpful nature to her
personality. Cognitive theory does not assist with the development of the nursepatient relationship.
The concepts of caring might assist the nurse, but will not help with the nurses personality
development. A therapeutic alliance is when the nurse and patient work together to reach mutually
agreed-upon goals.
Nursing Process: Planning
LO: 2
5. While changing a patients abdominal dressing, the nurse talks about aspects of wound care, the
need to check the skin, and the protection of the wound from infection or injury. The nurse and patient
are currently in the _________ phase of the nursepatient relationship.
1.
2.
3.
4.
Working
Orientation
Termination
Caring
Correct Answer: Working

Rationale: The working phase of the nursepatient relationship describes the participation of the
patient and nurse in interventions to achieve mutually agreed-upon goals. Most patient education
occurs during this phase. The orientation phase is the first phase of the relationship in which
introductions occur and the trusting relationship begins to develop. The termination phase describes
the time during which the nurse and patient review what has occurred during the working phase and
the progress of goal achievement. There is not a caring phase within the nursepatient relationship.
Nursing Process: Implementation
LO: 2
6. A patient tells the nurse that he is happy to see her because she helps me and gets me what I
need when the other nurses do not. The nurse realizes the patient is describing the interpersonal
competence theme of:
1.
2.
3.
4.
Going the extra mile.

Translating.
Getting to know you.
Establishing trust.
Correct Answer: Going the extra mile.

Rationale: The patient is comparing the current nurse with others who do not get him what he needs.
This is a description of the nurse going the extra mile. Translating describes the nurse being able to
understand what a patient is describing or needing. In the getting to know you phase, the nurse takes
the time to communicate with patients in an effort to understand their needs and goals. Trust is
established when the nurse portrays nonjudgmental behavior and accepts the patient as a unique
individual.
Nursing Process: Evaluation
LO: 2
7. Prior to assessing a patient from a different culture, which of the following should the nurse do to
ensure cultural competence?
1.
2.
3.
4.
Review the patients culture to ensure cultural awareness.

Find another nurse who knows the patients native language.
Conduct the assessment as any other assessment would be done.
Leave the assessment to be done by another nurse.
Correct Answer: Review the patients culture to ensure cultural awareness.

Rationale: To provide the best care for the patient, the nurse should review information about the
patients culture to ensure awareness. As nurses enter into therapeutic relationships, they do so with
persons of diverse beliefs and values. These beliefs and values are born from cultural and subcultural
socialization. Nurses are expected to be culturally sensitive and competent, continually striving to
provide culturally appropriate care to patients and families. The nurse should not seek another nurse to
do the assessment or negate the fact that the patient is from another culture. The nurse should not leave
the assessment for another nurse to complete.
Cognitive Level: Applying
LO: 3
8. While conducting an assessment, the nurse asks the patient to explain more about the type of pain
she is experiencing. The nurse is utilizing which of the following therapeutic communication
techniques?
1.
2.
3.
4.
Exploring
Focusing
Accepting
Offering self
Correct Answer: Exploring

Rationale: The nurse uses the exploring technique to delve deeper into a subject, as when the nurse
asks the patient to explain more about the type of pain. Focusing is a technique that helps when a
patient moves quickly between topics. Accepting is when the nurse conveys an attitude of reception
and regard that is characterized by head nodding and eye contact. Offering self describes the nurse
making herself available to the patient by either sitting or staying with the patient.
LO: 3
9. A patient tells the nurse that he thinks he has cancer because every other male family member was
diagnosed with cancer at the same age. The nurse tells the patient that everything will be all right.
the nurses response exemplifies the nontherapeutic technique of:
1.
2.
3.
4.
Giving reassurance.
Agreeing.
Giving advice.
Probing.
Correct Answer: Giving reassurance

Rationale: The nurse provided the nontherapeutic technique of giving reassurance, which indicates to
the patient that there is no cause for anxiety, and devalues the patients feelings. It would have been
better for the nurse to ask the patient to discuss that a bit further. The nurse is not agreeing with the
patients idea, is not giving the patient advice, nor is the nurse probing for more information.
LO: 3
10. The nurse is planning to instruct a patient on the anatomy of the heart so that he will understand what
type of surgery he needs. The best teaching strategy for the nurse to use would be:
1.
2.
3.
4.
Discussion with printed materials.

Role modeling.
Demonstration.
Self-discovery.
Correct Answer: Discussion with printed materials.

Rationale: The patient is in need of cognitive knowledge about the anatomy of the heart. The teaching
strategy that supports cognitive learning is discussion with printed materials. Role modeling is a
strategy for affective learning. Demonstration and self-discovery are strategies to support psychomotor
learning.
Nursing Process: Learning
LO: 4
11. A patient tells the nurse that he will not learn how to give himself insulin injections because he
gave his father insulin injections and he died anyway. To facilitate this patients learning, the nurses
best action would be to:
1. Talk with the patient about his fathers illness and how the insulin injections will help him
control his own illness.
2. Ask the patient if he prefers to read about how to provide the injections.
3. Leave a needleless syringe at the patients bedside for him to practice with.
4. Provide a diagram of body areas where insulin injections should be given.
Correct Answer: Talk with the patient about his fathers illness and how the insulin injections will help
him control his own illness.
Rationale: The nurse should talk with the patient about his fathers illness and how the injections will
help with the control of his own illness. The patient has experience with providing injections but has
an attitude or belief about insulin and the role it plays in diabetes management. The patient needs
affective learning, or learning that involves changing an attitude, value, or feeling. The nurse should
not ignore the patients statement by asking if he prefers written instructions on how to provide
injections. Leaving a needleless syringe at the bedside for the patient to practice or providing a
diagram of body areas where insulin injections should be given would not support the patients need
for affective learning.
LO: 4
12. The nurse has instructed a patient on the home use of a machine to treat sleep apnea. Which of the
following would indicate that the patient understands the instructions?
1.
2.
3.
4.
Patient demonstrates the use of the machine and the application of the mask.
Patient points to the instructions.
Patient says, I know how to do it.
Patient looks to her husband and says, Do you have any questions?
Correct Answer: Patient demonstrates the use of the machine and the application of the mask.
Rationale: The nurse is attempting to evaluate the success of instruction. The best way for the nurse to
assess the patients learning is to have the patient demonstrate the use of the machine and the
application of the mask. Pointing to the instructions does not ensure learning of the process or
materials. Stating, I know how to do it may or may not be sufficient to assess that learning has taken
place. Asking her husband if he has any questions would indicate that the patient is not clear on the use
of the equipment.
Nursing Process: Evaluation
LO: 4
13. A patient undergoing chemotherapy tells the nurse that his wife lost her job and now they do not
have any health insurance. The patient has no way of paying for the treatments and tells the nurse that he
is going home to die. Which of the following can the nurse do to help with this patients crisis?
1. Ask the patient if the wife has been offered a continuation of health care benefits from her
previous employer that would cover the costs of chemotherapy.
2. Find out if the chemotherapy can be billed at a later time, once the wife has other employment.
3. Contact the health care provider and document that the patient is unable to pay for ongoing
treatment.
4. Suggest that the patient visit an emergency room for care because they cannot deny him
treatment.
Correct Answer: Ask the patient if the wife has been offered a continuation of health care benefits
from her previous employer that would cover the costs of chemotherapy.
Rationale: The problem of lack of health insurance has initiated a crisis for the patient. Since the
problem is already identified, the nurse and patient can move quickly into developing an initial plan of
care that, in this case, would be for the patient to find out if his wife has been offered continuation of
health care benefits from the previous employer. Postbilling for the chemotherapy is not an option. The
nurse should not contact the health care provider and document that the patient is unable to pay for
ongoing treatment. It would be inappropriate for the nurse to suggest that the patient go to an
emergency room for care.
LO: 5
14. The daughter of a patient tells the nurse that her mother was sitting at the kitchen table and then went
totally limp and was disoriented. Currently, the daughter is pacing in the emergency room cubicle and
continues to try to arouse her mother. Which of the following should the nurse do?
1. Explain to the daughter that her mother is in the best place to figure out what has happened to
cause her to become disoriented.
2. Ask the daughter to have a seat in the waiting room until the doctor has finished examining her
mother.
3. Encourage the daughter to return home to wait for information.
4. Tell the daughter that being obviously stressed out will not help her mother.
Correct Answer: Explain to the daughter that her mother is in the best place to figure out what has
happened to cause her to become disoriented.
Rationale: The daughter is reacting to the sudden change in her mothers health status. The daughters
reaction to the event is creating a crisis. The nurse needs to explain to the daughter that the mother is
in the best possible place to determine the cause for the change in her health status. The nurse should
not ask the daughter to leave her mother by going to the waiting room or returning home. The nurse
should also not threaten the daughter by stating that being stressed out will not help her mother.
LO: 5
15. After being hit by an automobile, a patient tells the nurse that he lay on the pavement until the
ambulance arrived and was thinking about how his wife would continue to survive without him.
Which of the following is the best action by the nurse to help this patient with the crisis?
1.
2.
3.
4.
Offer to contact his wife to explain where he is and what his condition is.
Provide the patient with a telephone so he can contact his wife.
Tell the patient that once his injuries are stabilized, someone will contact his wife.
Suggest that the patient should not worry about anything.
Correct Answer: Offer to contact his wife to explain where he is and what his condition is.
Rationale: The patient was a victim of a pedestrian-automobile accident and is concerned about his
wife. At the onset of a crisis, the nurse might have to intervene and do some things for the patient that,
under different circumstances, the patient could do for himself. While the nurse could provide the
patient with a phone for him to call his wife, he may not be in a condition to make the call, and will
not be able to provide factual answers to the wife about his condition. The nurse should not make the
patient wait to contact his wife by telling him that once he is stabilized, someone will call her. Telling
the patient not to worry is dismissive of his concerns.
LO: 5
16. A patient tells the nurse that he is sick and will do whatever he is told to do. The nurse realizes this
patient is demonstrating:
1.
2.
3.
4.
Sick role behavior.

Internal locus of control.
Crisis response.
Denial.
Correct Answer: Sick role behavior.

Rationale: When individuals become ill and must be hospitalized, they are expected to behave in
certain ways and assume a sick role. A sick role is a set of expectations that people who are ill should
meet and that society, including caregivers, expects of them. When a person enters the hospital, that
person is immediately oriented to hospital rules, regulations, policies, and procedures. It is expected
that patients and their families will adhere to these rules. The patient is expected to be cooperative,
dependent, and nondemanding. Internal locus of control is the perception that people have control over
events that happen in their lives. This patient is not demonstrating denial or a response to a crisis.
LO: 6
17. A male patient, newly diagnosed with prostate cancer, tells the nurse that his wife died a few
weeks ago and he does not know how he is going to deal with this new health problem. Which of the
following can the nurse do to help this patient?
1.
2.
3.
4.
Talk with the patient about his support systems and what he can do to maintain stability.
Suggest that the patient talk with a spiritual counselor.
Listen quietly while the patient talks.
Tell the patient that it seems overwhelming now, but everything is going to work out all right.
Correct Answer: Talk with the patient about his support systems and what he can do to maintain
stability.
Rationale: The best approach would be for the nurse to talk with the patient about his support systems
and what he can do to maintain autonomy and stability. The patient is experiencing two losses: the loss
of his wife and the perceived loss of his health. The patient is still working through the stages of grief
and mourning for his wife when he is confronted with a new crisis. Suggesting that the patient talk
with a spiritual counselor may or not be appropriate, but it does not immediately address the patients
concerns. The nurse needs to do more than listen quietly while the patient talks. The nurse should not
minimize the patients losses by saying that although it is overwhelming now; everything is going to
work out all right. The nurse has no way of knowing if this will occur.
LO: 6
18. The wife of a patient tells the nurse that she realizes that her husbands cancer is in remission but
she cant stop thinking about when he will eventually die and that she cant seem to be motivated to do
anything anymore. The nurse realizes the wife is demonstrating which of the following stages of grief
and mourning?
1.
2.
3.
4.
Depression
Denial
Anger
Acceptance
Cognitive Level: Depression

Rationale: The patients wife has accepted the patients diagnosis and inevitable outcome but is having
difficulty continuing with life, which is demonstrative of depression. Denial is not accepting the
diagnosis and outcome. Anger is asking why me and voicing hostility over the diagnosis and
outcome. Acceptance is peacefully accepting the inevitable outcome.
LO: 6
19. A patient who is waiting for a diagnostic test tells the nurse that she is nervous because this test
has been on her mind for weeks. The nurse realizes that the result of this patients ongoing anxiety
can lead to:
1.
2.
3.
4.
Wear and tear on the body.

Improved decision-making ability.
A variety of coping skills.
Nausea, headache, and dizziness.
Correct Answer: Wear and tear on the body.

Rationale: The patient has been experiencing anxiety for several weeks. The anxiety can become
chronic, which leads to dangerous wear and tear on the body. Improved decision-making ability is seen
in mild anxiety. A variety of coping skills is also seen in mild anxiety. Nausea, headache, and dizziness
are symptoms of severe anxiety.
LO: 7
20. A patient tells the nurse that she is worthless and to send in someone who knows what they are
doing. Which of the following should the nurse do in this situation?
1.
2.
3.
4.
Realize the patient is anxious and attempt to calm the patient and find out what the patient needs.
Tell the patient that there is no one else available and he has to work with her today.
Leave the room and find someone else to work with the patient.
Tell the patient that he is not the easiest person in the world to work with, either.
Correct Answer: Realize the patient is anxious and attempt to calm the patient and find out what the
patient needs.
Rationale: This patients anger should be conceptualized as anxiety. Once the nurse realizes the patient
is anxious, she can attempt to calm the patient and find out what the patient needs. The nurse should
not respond with feelings of anger or anxiety. Telling the patient there is no one else available, leaving
the room, or scolding the patient are not approaches that address the patients underlying anxiety.
LO: 7
21. A patient is found sitting on the side of the bed crying and repeating I cant take one more thing.
The nurse realizes this patient is most likely demonstrating:
1.
2.
3.
4.
Depression.
Anxiety.
Frustration.
Anger.
Correct Answer: Depression.

Rationale: The crying patient is demonstrating depression. Depression is a predictable response to
illness and hospitalization and often accompanies loss and grief. Anxiety is an uncomfortable feeling
of discomfort, dread, apprehension, and unease; crying is not usually seen with anxiety. Frustration is
an emotion that is often seen with anxiety and accompanies the feeling of helplessness and
powerlessness. Anger develops as a response to the feelings of powerlessness and helplessness and
helps the person feel more in control.
LO: 7
22. A patient who is waiting to go for a diagnostic test that will determine the presence of cancer tells
the nurse that she is having difficulty breathing and feels like her heart is pounding out of her chest. To
best help this patient, the nurse should:
1.
2.
3.
4.
Stay with the patient and provide emotional support.

Darken the room and let the patient rest quietly alone.
Encourage the patient to walk around in the room.
Offer the patient a light snack to eat.
Correct Answer: Stay with the patient and provide emotional support.
Rationale: The patient is demonstrating a panic level of anxiety. In this situation, the nurse should not
leave the patient but should provide emotional support. Leaving the patient alone in a darkened room,
or encouraging the patient to ambulate or eat, does not provide supportive care to the patient.
LO: 8
23. A patient tells the nurse that he has been having trouble sleeping and it has gotten worse over the
last several weeks. The nurse realizes sleep deprivation is most closely associated with which of the
following behavioral responses?
1.
2.
3.
4.
Anxiety
Frustration
Anger
Loss
Correct Answer: Anxiety

Rationale: Nursing diagnoses for the patient with anxiety include Sleep Deprivation. Sleep deprivation
is not typically associated with frustration, anger, or loss.
LO: 8
24. A patient tells the nurse that she has been losing weight and has no appetite or energy to do
anything. The nurse believes this patient is demonstrating signs of which of the following behavioral
health problems?
1.
2.
3.
4.
Depression
Anxiety
Frustration
Anger
Correct Answer: Depression

Rationale: Physical changes seen in depression include weight loss, loss of appetite, and low energy
levels. Weight loss, appetite change, and low energy and not typically associated with anxiety,
frustration, and anger.
LO: 8

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[Osborn] chapter 13

Learning Outcomes [Number and Title]

Correct Answer: Regression

Correct Answer: Personalization

Correct Answer: Cognitive triad.

Develop self-awareness to focus on being helpful to patients.

Correct Answer: Develop self-awareness to focus on being helpful to patients.

Correct Answer: Working

Going the extra mile.

Correct Answer: Going the extra mile.

Review the patients culture to ensure cultural awareness.

Correct Answer: Review the patients culture to ensure cultural awareness.

Correct Answer: Exploring

Correct Answer: Giving reassurance

Discussion with printed materials.

Correct Answer: Discussion with printed materials.

Sick role behavior.

Correct Answer: Sick role behavior.

Cognitive Level: Depression

Wear and tear on the body.

Correct Answer: Wear and tear on the body.

Correct Answer: Depression.

Stay with the patient and provide emotional support.

Correct Answer: Anxiety

Correct Answer: Depression

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