A nurse working on a unit in a psychiatric hospital is responsible for performing a variety of functions. Which are the ones that a registered nurse is
... [Show More] legally permitted to perform? Select all that apply.
1. Psychotherapy
2. Health promotion
3. Case management
4. Prescribing medication
5. Treating human responses
2. Health promotion
3. Case management
5. Treating human responses
The psychiatrist orders "Restraints PRN" for a client who has a history of violent behavior. Then nurse should:
1. Utilize the restraint order if the client begins to act-out
2. Ask the psychiatrist to clarify the type of restraint order
3. Ensure that the entire staff is aware of the restraint order
4. Recognize that PRN orders for restraints are unacceptable
4. Recognize that PRN orders for restraints are unacceptable
New orders must be written each time a client requires restraints. When a client is acting-out, the nurse may use restraints or a seclusion room and then obtain the necessary order.
A client on the psychiatric unit asks the nurse about psychiatric advance directives (PAD). The nurse explains that these advanced directives:
1. Make the appointment of a surrogate decision maker unnecessary
2. Permit the client to dictate what treatment will be given during the future hospitalizations
3. Eliminate the need for involuntary admissions when the client is a threat to self or others
4. Allow the client, while having the capacity, to consent or refuse potential psychiatric treatments in the event of a future incapacitating mental health crisis
4. Allow the client, while having the capacity, to consent or refuse potential psychiatric treatments in the event of a future incapacitating mental health crisis
The purpose of a PAD is to allow psychiatric clients the opportunity to provide input into future treatment decisions.
The statement that best describes the practice of psychiatric nursing is:
1. Helps people with present or potential mental health problems
2. Ensures clients' legal and ethical rights by acting as a client advocate
3. Focuses interpersonal skills on people with physical or emotional problems
4. Acts in a therapeutic way with people who are diagnosed as having a mental disorder
1. Helps people with present or potential mental health problems
An important aspect of the role of the psychiatric nurse is primary, secondary, and tertiary interventions to promote emotional equilibrium.
A 45-year-old physician is admitted to the psychiatric unit of a community hospital. The client is restless, loud, aggressive, and resistive during the admission procedure and states, "I will take my own blood pressure." What is the most therapeutic response by the nurse?
1. "Right now, doctor, you are just another client."
2. "If you would rather, doctor, I'm sure you will do it OK."
3. "If you do not cooperate, I will get the attendants to hold you down."
4. "I am sorry, but I cannot allow that. I must take your blood pressure."
4. "I am sorry, but I cannot allow that. I must take your blood pressure."
This simply states facts without getting involved in role conflict.
For most nurses the most difficult part of the nurse-client relationship is:
1. Remaining therapeutic and professional
2. Being able to understand and accept the client's behavior
3. Developing an awareness of self and the professional role in the relationship
4. Accepting responsibility in identifying and evaluating the real needs of the client
3. Developing an awareness of self and the professional role in the relationship
The nurse's major tool in psychiatric nursing is the therapeutic use of self. Psychiatric nurses must learn to identify their own feelings and understand who they affect the situation.
The father of a 16-year-old boy who has just been diagnosed with Hodgkin's disease tells the nurse he does not want his son to know the diagnosis. What response by the nurse is best in this situation?
1. "It is best is he knows the diagnosis."
2. The cure rate for Hodgkin's disease is high."
3. "Would you like someone with Hodgkin's to talk to you?"
4. "Let's talk about why you don't want him to know."
4. "Let's talk about why you don't want him to know."
This statement does not prejudge the father; if encourages communication.
A male nurse is caring for a client. The client states, "You know, I've never had a male nurse before." The nurse's best reply should be:
1. "Does it bother you to have a male nurse?"
2. "There aren't many of us; we're a minority."
3. "How do you feel about having a male nurse?"
4. "You sound upset. I will get a female nurse to care for you."
3. "How do you feel about having a male nurse?"
This statement encourages the client to express and explore feelings; also, it is open and nonjudgmental.
A male nurse reminds a client that it is time for group therapy. The clients responds by yelling at the nurse, "You are always telling me what to do, just like my father." This clients response is an example of:
1. Regression
2. Transference
3. Reaction formation
4. Counter transference
2. Transference
With transference a client assigns to someone the feelings and attitudes originally associated with an important significant other.
In psychiatric nursing, the most important tool the nurse brings to a helping relationship is:
1. Oneself and a desire to help
2. Knowledge of psychopathology
3. Advanced communication skills
4. Years of experience in psychiatric nursing and milieu management
1. Oneself and a desire to help
The nurse brings to a therapeutic relationship the understanding of self and basic principles of therapeutic communication; this is the unique aspect of the helping relationship.
A Latino American client with schizophrenia is admitted to an emergency department crisis unit in an aggravated and disheveled state after failing to take prescribed medication for the last 5 days. When developing a plan of care that incorporates the client's cultural background, the nurse gives priority to:
1. Inclusion of the family in the client's plan of care
2. The client's need to control personal and social space
3. The meaning and attention the client places on the future
4. Socioeconomic considerations regarding hospitalization
1. Inclusion of the family in the client's plan of care
In the Latino American culture, usually there is a strong family bond, and the support of the family is essential during problematic times.
A 30-year-old woman is brought to the local community hospital by a family member because the woman "has been acting strange." When the nurse assess the client, which statements meet involuntary hospitalization criteria? Select all that apply.
1. "I cry all the time I am so depressed."
2. "I would like to end it all with sleeping pills."
3. "The voices say it is okay for me to kill all prostitutes."
4. "My boss is always picking on me and it makes me angry."
2. "I would like to end it all with sleeping pills."
This statement indicates a suicide threat; it is a direct expression of intent but without action.
3. "The voices say it is okay for me to kill all prostitutes."
The threat to harm others must be heeded; the client must be protected from harming herself as well as harming others
The nurse encourages the client to join self-help group after being discharged from a mental health facility. The purpose of having people work in a group is to provide:
1. Support
2. Confrontation
3. Psychotherapy
4. Self-awareness
1. Support
Self-help group members share similar experiences and an provide valuable understanding and support to each other.
As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join because, "I have nothing to talk about." What is the best response by the nurse?
1. "Maybe tomorrow you will feel more like talking."
2. "Could you start off by talking about your family?"
3. "A person like you has a great deal to offer the group."
4. "You feel you will not be accepted unless you have something to say?"
4. "You feel you will not be accepted unless you have something to say?"
This reflective statement allows the client to either validate or correct the nurse.
During a group meeting a male client tells everyone of his impending discharge from the hospital. It is most appropriate of the nurse leading the group to respond:
1. "You ought to be happy that you're leaving."
2. "Maybe you're not ready to be discharged yet."
3. "Maybe others in the group have similar feelings that they would share."
4. "How many in the group feel that this member is ready to be discharged?"
3. "Maybe others in the group have similar feelings that they would share."
This permits the client to see that personal feelings are not unique but are shared by others.
When a psychiatric nurse uses the family systems theory in practice, which statement by the nurse is most typical of this theory?
1. "Describe for me in your own words what caused this situation."
2. "You need to abide by the unit rules and attend the community meetings."
3. "Whenever someone permanently leaves the home, the boundaries are upset."
4. "You're doing better; let's talk to the doctor about lowering your medication dosage
3. "Whenever someone permanently leaves the home, the boundaries are upset."
Boundaries relate to family systems theory.
A week after the admission of a client with the diagnosis of paranoid schizophrenia, the client stands up in the lounge and throws a chair across the room and starts yelling at the other clients. Several of the other clients have frightened expressions, one starts to cry, and another beings to pace. After removing the agitated client from the room, what should the nurse do next?
1. Refocus the clients' negative comments to more positive ones
2. Arrange a unit meeting to discuss what just happened
3. Continue the unit's activities as if nothing has happened
4. Have a private talk with the clients who cried and started to pace
2. Arrange a unit meeting to discuss what just happened
This provides an opportunity for the other clients to voice and share feelings and to identify and separate real from imaginary fears; an open expression of feelings allows the nurse to deal with client's fears and provide reassurance.
A female client, whose long-term live-in lover has just terminated their relationship, comes to the emergency service in severe crisis. After being seen by the nurse, the client agrees to call the local mental health clinic for short-term counseling. Which client behavior helps the nurse evaluate whether the nursing intervention was effective? The client:
1. Is seeking out assistance for help with coping
2. Has returned to her pre crisis level of functioning
3. Has learned new methods of coping with her loss
4. Is demonstrating diminished symptoms of anxiety
1. Is seeking out assistance for help with coping
Going for counseling demonstrates the client's recognition that assistance is needed.
The nurse is aware that a co-worker's mother died 16 months ago. The co-worker cries every time someone mentions the word "mother" or if the mother's name is mentioned. Which should the nurse understand in this situation?
1. Everyone cries when their mother dies
2. This behavior is an expected response
3. This person should seek help with grieving
4. The co-worker was extremely attached to the mother
3. This person should seek help with grieving
Crying a release, but the individual should have developed effective coping mechanisms by this time.
During a staff development program, the nurse educator emphasizes that nurse caring for middle-aged adults who are experiencing midlife crisis should understand that this crisis is most often a result of the:
1. Many role changes adults experience at this time
2. Individual's perception of his or her life situation
3. Anticipation of negative changes associated with old age
4. Lack of support of family members who are busy with their own lives
2. Individual's perception of his or her life situation
Th most significant factor in either precipitation or avoiding crisis is not the events but how the individual perceives them.
A 35 year-old is admitted for an amputation of the left leg. Before surgery the nurse observes that the client is diaphoretic, voiding frequently, having difficulty understanding what is being said, and complaining of palpitations. What should the nurse do first after making these assessments?
1. Have a stat ECG done on the client
2. Ask the client to talk about feelings
3. Obtain a urine specimens for culture and sensitivity
4. Ask the physician for a stat order for an IM tranquilizer
2. Ask the client to talk about feelings
The symptoms presented are indicative of a severe anxiety reaction related to a crisis; the client has a need to vent feelings.
During a staff development program, when discussing the reaction of middle-aged women to their children leaving home, the nurse educator reminds the group that recent studies have demonstrated that today's women most commonly experience a feeling of:
1. Anxiety
2. Depression
3. Satisfaction
4. Hopelessness
3. Satisfaction
Studies demonstrate that as more women enter the work force, the experience fewer negative responses to the "empty nest" created by children leaving home.
The nurse identifies that the main goal in planning care for a client in crisis is to:
1. Schedule follow-up counseling for the client
2. Restore the client's psychologic equilibrium
3. Have the client gain insight into the problems
4. Refer the client for occupational and physiotherapy
2. Restore the client's psychologic equilibrium
Crisis intervention is short-term therapy with the major goal of restoring clients to their pre crisis state.
A 30 year old who has been in a gay relationship for the past 3 years comes to the emergency department in a near panic state. He tells the nurse that his lover of many years has just terminated their relationship. What should the nurse do to help the client cope with this loss?
1. Identify his support system
2. Explore his psychotic thoughts
3. Reinforce his current self-image
4. Suggest he explore his sexual orientation
1. Identify his support system
A client in crisis needs to rely on available support systems for assistance; therefore it is vital for the nurse to identify the client's support system.
Which approach should the nurse use during crisis intervention?
1. Passive and reflective
2. Active and goal-directed
3. Future-oriented and passive
4. Interpretative and analytical
2. Active and goal-directed
During crisis intervention the nurse should be goal-directed and active in assessing the current situation and handling the interview with authority.
The nurse understands that the outcome that is unrelated to a client in a crisis state is:
1. Decompensating to a lower level of functioning
2. Learning and using more constructive coping skills
3. Adapting and returning to prior level of functioning
4. Continuing a high level of anxiety for more than 3 months
4. Continuing a high level of anxiety for more than 3 months
This is not an expected outcome of a crisis because by definition a crisis is resolved in 6 weeks.
Which is the most important assessment data for the nurse to gather from the client in crisis?
1. The client's work habits
2. Any significant physical health data
3. A history of any emotional problems in the family
4. The specific circumstances surrounding the client's perceived crisis situation.
4. The specific circumstances surrounding the client's perceived crisis situation
This assessment assists the nurse to determine what the situation means to the client
An extremely anxious client enters a crisis center and asks for help. Which response by the nurse best reflects the nurse's role in crisis intervention?
1. "Tell me what you have done to help yourself."
2. "Can you tell me about what is bothering you?"
3. "I understand in the past you have had problems."
4. "I will be here for you to help you figure things out."
4. "I will be here for you to help you figure things out."
Clients in crisis need assistance with coping; the nurse must be involved with problem solving.
When assisting clients to cope with a crisis, the professional care provider should follow the principles of intervention. Place the following interventions in order of priority when caring for a person experiencing a crisis.
1. Stabilize the victim
2. Intervene immediately
3. Encourage self-reliance
4. Utilize available resources
5. Facilitate understanding of the event
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