A patient with a history of heart failure is being assessed by ...

[abarnes]

A patient with a history of heart failure is being assessed by the admitting nurse. Which of the following inquiries by the nurse reflects the research on the connection between heart disease and mental health?
 
  a. People with heart disease sometimes have nightmares. How do you sleep?
  b. Heart failure can be frightening. Do you find yourself feeling fearful or worried?
  c. Tell me, have you noticed any problems with your memory and concentration?
  d. Heart failure and depression seem to be related. Tell me about your moods lately..

Question 2

A patient being treated for an MI has been transferred from the intensive care unit to a step-down unit. She uses the call bell as often as every 15 minutes. She makes a seemingly small request or complains each time a staff member is summoned.
 
  Several staff tell the primary nurse that the patient is obnoxious and that they feel inadequate because they can never seem to satisfy her needs. The primary nurse decides to intervene directly with the patient. Which response would be most therapeutic? a. I'm wondering if you are feeling anxious about your illness and being left alone..
  b. The staff are concerned that you are not satisfied with the care you are receiving..
  c. Let's talk about why you use your call light so frequently; it's a bit of a problem..
  d. You are frustrating the staff by calling them so often; any idea why you do that?

[janeli1]

Answer to Question 1

D
Depression has been shown to worsen heart failure, and a variety of cardiac disorders appear to cause depression in some patients. Although anxiety often accompanies any serious medical illness, the special connection between depression and cardiac disease makes this depression the mental health issue meriting special attention in cardiac patients. Heart disease does not have a specific relationship to nightmares.

Answer to Question 2

A
I'm wondering if you are anxious focuses on the emotions underlying the behavior rather than the behavior itself. This opening conveys the nurse's willingness to listen to the patient's feelings and an understanding of the commonly seen concern about not having a nurse always nearby as in the intensive care unit. Verbalization is an effective outlet for anxiety. Also, knowing that staff understand her anxiety and will meet her needs without being summoned so frequently can reduce the patient's anxiety level from severe to moderate or lower. The other options focus on the behavior or its impact on nursing and do not help the patient with her emotional needs.