You are a nurse working with a client who has a rare neurological ...

[RRMR]

You are a nurse working with a client who has a rare neurological disease.
 
  In assessing this client, you find that his statements indicate he is suffering grief at his loss of function, wants desperately to live, is somewhat depressed, and has what he calls despair of the soul. He has had no access to his friends or his church. Based on this information, you would select which of the following nursing diagnoses as a priority for this client? a. Spiritual Distress
  b. Family Processes Altered
  c. Hopelessness
  d. Anxiety

Question 2

An older adult patient exhibits bilateral bruising for the second time on both upper outer arms. When the nurse questions the patient about the bruising, the patient starts to cry and pleads, Please don't say anything.
 
  It's not my daughter's fault. I just bruise easily.. Which intervention reflects the best management of this situation? a. Calling the daughter to discuss both the bruising and her parent's reaction
  b. Reporting the elder abuse and informing the patient and the daughter of the action
  c. Notifying the patient's social worker of the bruising after a complete assessment has been completed
  d. Informing the patient and the daughter of the nurse's obligation to document the bruising and report the findings to protective services

[T4T]

Answer to Question 1

A
The most appropriate nursing diagnosis would be spiritual distress. As the client loses function and loses access to his friends and church, he becomes more isolated and experiences increased grief and depression about his situation. The statement by the client of despair of the soul is indicative of spiritual distress.

Answer to Question 2

D
Although it is often difficult to differentiate elder abuse, bilateral bruising on the upper outer arms is a definitive sign. The nurse is responsible for reporting such findings and continuing vigilant observation for further signs of elder abuse and neglect. It is usually best to inform the family of your intention to report elder abuse with the expressed purpose of obtaining help for both; this makes protective services less threatening and preserves the nurse's therapeutic alliance.