Answer to Question 1
ANS: A
The nurse should identify the stage of change and assess where the patient is currently in this situation. To be most effective, nursing interventions should match the stage of change. The nurse cannot realize the patient is ready for change because only a minority of people are actually in the action stage of changing. While teaching that choices will have to change, it will follow later after the nurse has determined which stage the person is in. As individuals attempt a change in behavior, relapse followed by recycling through the stages occurs frequently.
Answer to Question 2
ANS: B
As the patient and family recognize the reality of a change, they become anxious and may withdraw, refusing to discuss it. This is an adaptive coping mechanism that assists the patient in making the adjustment. Initially, the patient may be shocked by the change. This is followed by withdrawal, acknowledgment, acceptance, and rehabilitation (ready to adapt to the change through use of colostomy bag).
Closed urinary drainage system. Urine being measured after it leaves patient’s body via catheter.
Critial thinking and the nursing diagnostic process
Building competency in patient centered care
Instructing a Patient on Breast Self-Examination
Working and Living and Playing in the City Dump of Phnom Penh, Cambodia