A 45-year-old man with a history of anxiety comes into the ...

[schs14]

A 45-year-old man with a history of anxiety comes into the emergency department and is diagnosed with a myocardial infarction (MI). He says to the nurse, This is the most ridiculous thing I've ever heard of.
 
  I eat well, exercise, and am too young to have a heart attack. The nurse recognizes that this man is most likely experiencing:
  a. Fear related to the diagnosis
  b. Anxiety related to the diagnosis
  c. Ineffective denial
  d. Overreaction

Question 2

A 16-year-old male tells the nurse that he is not in the mood to do anything with his friends. He states, For weeks now I am just not interested in doing anything and I've stopped all my sports activities.
 
  I just feel sad all the time and I just don't want to go on. The nurse completes her assessment and begins her plan of care. What is the most appropriate nursing intervention at this time?
  a. Inform the patient you will be contacting his parents
  b. Inform the patient you are completing a mental health referral
  c. Teach the male coping strategies
  d. Contact the patient's teachers for further information

[dominiqueenicolee]

Answer to Question 1

C
Ineffective denial occurs when a person consciously or unconsciously rejects the knowledge or meaning of an event such as having a heart attack. The patient may frequently respond with statements such as This can't be me, They've made a mistake. In this item, the man is denying he has had a heart attack because he believes he is too healthy and too young to be having a heart attack. Fear is a response associated with anxiety; however, it is usually a response to a perceived threat that is recognized as a danger. Decisional conflict arises when a person is uncertain about what action to take when making choices among alternatives. There is no evidence in this item that the man is making any decisions. Overreaction can occur with some psychosocial disorders; however, the patient statements are not reflective of overreacting, as he has been diagnosed as having a heart attack.

Answer to Question 2

B
Depression affects up to 8.3 of adolescents in the United States and the percentage may even be higher. Adolescents who report feeling sad or hopeless almost every day for more than 2 weeks usually stop doing some activities they considered fun. Additionally, they may have difficulty identifying and describing their emotional or mood states. In this item, the male is expressing how he feels. He is also describing a severe depressive state by citing, I do not want to go on. The nurse must be alerted to this and immediately intervene by making a mental health referral, as this male is at high risk for suicide. Confidentiality is important in this age group; however, if there is concern about suicide, explain to the adolescent that you are required to share this information with others including mental health specialists and parents. Contacting the parents is important but the first action is to make a mental health referral.

[schs14]

TYSM

[T4T]

Excellent