Question 1

The multidisciplinary team is meeting to discuss discharge planning with the family of a patient who recently attempted suicide.Which statement by a family member might constitute criteria for delaying discharge?

Accepted Answer

From the time the patient is admitted,discharge planning begins.Discharge occurs when the patient is stabilized.If information that is highly volatile and a likely trigger is uncovered,this might be a consideration for delaying discharge until the patient is informed,the response to the information is assessed,coping skills are evaluated,and additional supports can be provided.

Question 2

A patient with a history of chronic alcohol abuse and impaired cognitive function has been successfully taught to interpret a community bus schedule.The nurse should now be confident that the patient would benefit from attending:

Accepted Answer

Community resource groups are assigned on the basis of the patient's learning needs.Topics in the group may be provided on a rotating basis to assist patients to use community resources,including the public library,social services,and other agencies.Skills such as reading a newspaper or telephone book are also topics that may be shared.Patients in the group also often share their problem-solving skills about pertinent issues.

Question 3

A patient shares with a nurse,"I don't seem to be sleeping any better since I came here." Which nursing intervention will the nurse implement initially?

Accepted Answer

The first step is to assess the patient's complaint of sleeplessness.Patients often perceive that they sleep less than they do.Although the other techniques suggested may promote sleep,they would be implemented only if the nurse's assessment confirmed the patient's complaint of sleeplessness.

Question 4

The activity room is severely damaged while the nurse is addressing an emergency on the inpatient unit.Which communication by the nurse to the entire milieu would be the most therapeutic when the destruction is first discovered?

Accepted Answer

Physically destructive behavior is a response that is derived from an unspoken anger or fear.The most therapeutic communication for the situation is the one that validates and supports the underlying feeling but sets limits on the maladaptive action taken.The nurse's task is to help the destructive patients learn more adaptive ways to deal with anger,such as verbalization.Disparagement reflects the nurse's anger,and humiliation is aggressive to patients and nontherapeutic.Enlisting everyone to help clean up is the most therapeutic option,because it promotes cohesion and may encourage patients who did not do the damage to speak up and voice their anger at the offenders for spoiling their activity room.Peer input is always very effective.

Question 5

Which statement made by a nurse manager to personnel working short-staffed best reflects an understanding of the importance of safe unit staffing?

Accepted Answer

An assertive nurse describes the unit situation,asks clearly for what is needed,and describes interim behavior or the consequence.TJC clearly states the staffing patterns that constitute safe standards of care.

Question 6

A nurse would determine that medication teaching was most successful for a patient starting on lithium (Lithobid) if the patient stated:

Accepted Answer

Patients on lithium usually start lithium with blood levels drawn three times per week and then monthly.When the patient is on maintenance medication,the psychiatrist may extend the testing of the blood levels to every 3 to 6 months.

Question 7

When the nursing staff from the incoming and outgoing shifts has open report on the inpatient unit,which concept underlies this approach?

Accepted Answer

Open report is a good example of the therapeutic community recommended by Maxwell Jones in 1953.

Question 8

Which is the initial nursing care intervention for a nurse admitting a patient recently discharged from an inpatient unit into a partial-hospitalization program?

Accepted Answer

Support includes the staff's conscious efforts to help patients feel better and improve their self-esteem.It is the unconditional acceptance of the patient,whatever his or her circumstances.The function of support is to help patients feel comfortable and secure and reduce their anxiety.It may take many forms,but it falls under the general heading of paying attention to the patient.

Question 9

During a group session,a flirtatious patient with mania shares that several patients and the nurse "have bodies that are really nice." The most therapeutic response from the nurse would be:

Accepted Answer

When patients are inappropriate and intrusive on the unit,the nurse will want to protect the patient (who will probably be embarrassed when his or her thinking clears),other inpatients,and self.The most therapeutic intervention is one that distracts the patient and enlists cooperation for a time-out before escalation of the behavior occurs.As the patient's mental status clears,the nurse's sensitivity to the patient will foster trust in the therapeutic relationship.

Question 10

Which intervention by the nurse is most therapeutic when a patient loses a pool game on the unit and begins acting aggressively?

Accepted Answer

It is important to communicate to the patient in a way that helps the patient view the inappropriate behavior from others' viewpoints,to observe the catalysts that trigger the behavior,and to view adaptive alternatives.Confrontation can escalate aggression on the unit and is nontherapeutic in that it can promote a regressive struggle between the nurse and the patient.

Question 11

A patient has contracted to be allowed to walk about outside after meals with staff supervision.When the patient begins to make a habit of asking if it's time to go outside well before meals,the nurse should:

Accepted Answer

Steps to support patients to be more independent need to be carefully weighed with regard for safety,readiness,and capacity for inner control.By checking the time the outside break is due and allowing the patient to clock the time rather than totally removing independence,the nurse is improving the patient's orientation and socialization skills and reducing the amount of dependence and potentially intrusive behavior by the patient.

Question 12

Which of these patients is the most appropriate candidate for assignment to a crisis bed? A patient who:

Accepted Answer

Lethality assessment is the primary reason for using a crisis bed in the hospital.Although the other patients described would seem to benefit from hospitalization,crisis beds are used for patients who are suicidal and homicidal.

Question 13

When a partial-hospitalization patient is assessed as possibly having suicidal ideations,the treatment plan will focus on:

Accepted Answer

Stabilization is sought and then treatment continues in the community.Diagnostic evaluation already would have been performed,and institutionalization (an unwanted passive dependency that develops with long hospital stays) is not an appropriate outcome.

Question 14

A young adult patient is alienated by others who are offended by the patient's poor hygiene and body odor.Which nursing intervention should occur first for this patient?

Accepted Answer

Poor hygiene in any patient is a concern.A few of the variables that may be affecting the situation are physical illness associated with this age (e.g.,yeast infections,sexually transmitted diseases,urinary tract infections),sociocultural factors,and gender-related issues.The first step in identifying a problem is to explore the underlying knowledge and factors that contribute to it and then to work with the patient to solve the problem.The other answers,such as teaching or mandating grooming,should be used only after a nonjudgmental assessment has been performed.

Question 15

A patient has just received information regarding the goals of a partial-hospitalization program.Which statement best indicates patient understanding?

Accepted Answer

Partial hospitalization provides a highly structured and organized treatment plan that is comprehensive and individualized for its patients.Treatment plans include group therapy; education for patient and family members regarding,among other topics,stress management; and other treatments to promote continuing stabilization and intermediate-term treatment.

Question 16

Which nursing intervention has priority when assisting a patient who has been transported to the hospital admissions unit by police for wandering barefoot and naked on the street in freezing weather?

Accepted Answer

When patients are severely confused and unable to care for themselves because of maladaptive coping,the multidisciplinary team will perform a rapid diagnostic evaluation,medicate to calm the patient as needed,and escort a patient to the inpatient unit.There,the goals will include stabilization with safety concerns at the forefront of the discharge planning (which starts with admission).

Question 17

A nurse observes that a patient diagnosed with bipolar disorder who has left the seclusion room is soiled with feces.Which nursing intervention would be most likely to encourage a patient to comply with bathing?

Accepted Answer

Successful nursing approaches for disorganized patients include reassuring them and working with them to reduce the degree to which their behaviors inhibit therapeutic processes.Analyzing the extent to which fecal smearing interferes with successful functioning (Maslow's hierarchy) and promoting optimal adaptation constitute primary nursing strategies for such a patient.Passivity implies approval or insensitivity.Therapeutic use of self,that is,asking how you would be able to problem solve when so soiled,is a therapeutic approach to deciding nursing action.The correct option provides anticipatory guidance,which is an effective teaching approach for all patients.

Question 18

In order to best demonstrate the broad scope of practice knowledge and expertise required for contemporary psychiatric nursing a nurse must:

Accepted Answer

The scope of contemporary psychiatric nursing practice requires knowledge and expertise in three broad areas: managing the therapeutic milieu,implementing caregiving activities,and integrating and coordinating care delivery.All psychiatric nurses,regardless of education or experience,engage in these activities every day.

Question 19

Which nursing action would best promote the psychiatric stabilization of a patient who is both confused and agitated when found wandering barefoot in freezing weather?

Accepted Answer

The priority nursing intervention for such a patient on the inpatient unit would include measures that prevent harm to self or others.

Question 20

A patient who displays dependent tendencies follows the nurse around the unit and repeatedly asks,"What do you think I should do,nurse?" Which is the nurse's most therapeutic response?

Accepted Answer

Working with dependency strivings is a difficult task and one that requires patience and understanding from the nurse.The most therapeutic nursing intervention is the one that encourages mutual problem solving.

Quiz 33: Hospital-Based Psychiatric Nursing Care