Psych Exam 2
A nurse is explaining client rights for psychiatric patients to a client who has voluntarily sought admission to an inpatient psychiatric facility. Which rights would the nurse include in the discussion? Select all that apply. 1. Right to select health care team members 2. Right to refuse treatment 3. Right to a written treatment plan 4. Right to obtain disability benefits 5. Right to confidentiality 6. Right to personal mail
- right to refuse treatment - right to a written treatment plan - right to confidentiality - right to personal mail RATIONALE: An inpatient client usually receives a copy of client rights, which may include the Bill of Rights for psychiatric patients in the United States, province-specific Charter of Rights and Freedoms, or the British Columbia Mental Health Act. These documents include the right to refuse treatment, to have a written treatment plan, to have all medical information kept confidential, and to receive mail. A client in an inpatient setting does not have the right to select health care team members. Although the client may apply for disability benefits as a result of a chronic or incapacitating illness, obtaining disability compensation is not a client right and members of a psychiatric institution do not decide who would receive it.
During orientation to the behavioral care unit, the new nurse asks, "How will I know which clients are potentially violent?" Which response by the nurse educator is best? A: "Just be alert and aware of your client's behavioral clues." B: "The client prone to violence will usually tell you they are angry about something." C: "As you plan care, review the clients' charts to determine who has a history of violence." D: "Your orientation will include an in-service on violent clients and how to identify them."
C: "As you plan care, review the clients' charts to determine who has a history of violence." RATIONALE: Suggesting that the staff be alert and aware does not effectively address the staff's concerns about identifying potential violent clients. The staff needs to be aware of potential violence well before the client verbally expresses the anger. The two most significant predictors of violence are a history of violence and impulsivity. Thus reviewing the client's chart for this information is best. Telling the nurse that the information will be provided during in-service education does not answer the nurse's question.
A client is admitted to the psychiatric hospital for evaluation after numerous incidents of threatening others, angry outbursts, and two episodes of hitting a coworker at the client's place of employment. The client is very anxious and tells the nurse, "I didn't mean to hit him. He made me so mad that I just couldn't help it. I hope I don't hit anyone here." To ensure a safe environment, what should the nurse do first? A: Let other clients know that the client has a history of hitting others so that they will not provoke the client B: Put the client in a private room, and limit the client's time out of the room to when staff can be with the client. C: Tell the client that hitting others is unacceptable behavior, and ask the client to tell a staff member when feeling angry. D: Obtain a prescription for a medication to be administered to decrease the client's anxiety and threatening behavior.
C: Tell the client that hitting others is unacceptable behavior, and ask the client to tell a staff member when feeling angry. RATIONALE: The nurse must clearly address behavioral expectations, such as telling the client that hitting is unacceptable, and also provide alternatives for the client, such as letting staff members know when the client begins to feel angry. Making others responsible for the client's behavior or isolating the client in a room is inappropriate because it does not include the client in managing the behavior. Although medication may be helpful, this action does not give the client responsibility for the behavior and is not warranted at this time.
Based on a client's history of violence toward others and inability to cope with anger, what should the nurse use as the most important indicator of goal achievement before discharge? A: acknowledgment of the client's angry feelings B: ability to describe situations that provoke angry feelings C: development of a list of how anger has been handled in the past D: verbalization of feelings in an appropriate manner
D: verbalization of feelings in an appropriate manner RATIONALE: Verbalizing feelings, especially feelings of anger, in an appropriate manner is an adaptive method of coping that reduces the chance that the client will act out these feelings toward others. The client's ability to verbalize feelings indicates a change in behavior, a crucial indicator of goal achievement. Although acknowledging feelings of anger and describing situations that precipitate angry feelings are important in helping the client reach her goal, they are not appropriate indicators that behavior has changed. Asking the client to list how anger has been handled in the past is helpful if the nurse discusses coping methods with the client. However, based on this client's history, this would not be helpful because the nurse and client are already aware of the client's aggression toward others.
The former wife of the hospitalized client telephones to ask the nurse for a status report on the client's condition. Which statement by the nurse is most appropriate? A: "He has been comfortable throughout the day. He'll be discharged tomorrow." B: "I'm sorry; I can neither confirm nor deny whether this person is at the hospital." C: "You may contact your ex-husband. Here is the room's telephone number." D: "Due to confidentiality laws, I need to know your name before I can give you information."
B: "I'm sorry; I can neither confirm nor deny whether this person is at the hospital." RATIONALE: Telling the former wife about the status of the client is a breach of confidentiality. HIPAA requires nurses to comply with privacy standards, including implementing measures to ensure privacy. If there is no permission for release of information, it may not be shared with anyone. Providing the telephone number for the client's room still acknowledges that the client is hospitalized. Obtaining the divorced spouse's name and then providing information is a breach of client confidentiality.
Staff members have expressed fear of the client who has a history of violent behavior. Which response made by the lead nurse would be most beneficial in addressing the staff's expressed concerns? A: "Let's not prejudge him. His medication should help him control his behavior." B: "I will be very attentive to his behavior, monitoring it for any signs of escalation." C: "It may be hard, but we need to appear calm and nonthreatening but alert to his behavior." D: "As staff we are all trained to manage violent clients, and we can handle any crisis behavior."
C: "It may be hard, but we need to appear calm and nonthreatening but alert to his behavior." RATIONALE: This response focuses on the client and fails to address the concerns expressed by the staff members. The concerns expressed by the staff are not taken into consideration. The lead nurse's response does not appear to value the staff's opinions. When dealing with potentially violent clients, although it may be very difficult, it is imperative to present a calm, relaxed, nonthreatening demeanor. This option both addresses the staff concerns and offers direction regarding client management. This response fails to address the concerns expressed and a means of controlling the feared behavior.
The nurse observes that the client diagnosed with intermittent explosive disorder is becoming aggressive and that lorazepam was prescribed. The client is now exhibiting a tense posture, a clenched fist, and a defiant affect. Prioritize the nurse's actions to de-escalate the client's aggression. 1. Call other staff for assistance. 2. Attempt to talk the client down. 3. Apply wrist restraints. 4. Offer the client the choice of taking the medication voluntarily. 5. Provide an alternate use of physical energy, such as suggesting punching a pillow.
- Attempt to talk the client down - Provide an alternate use of physical energy, such as suggesting punching a pillow. - offer the client the choice of taking medication voluntarily - call other staff for assistance - apply wrist restraints
A hospitalized client becomes angry and belligerent toward a nurse after speaking on the phone with his mother. The nurse learns that the mother cannot visit as expected. Which interventions will the nurse use to help the client deal with the displaced anger? Select all that apply. 1. Explore the client's unmet needs. 2. Acknowledge the client's behavior as inappropriate. 3. Suggest that the client direct the anger at his mother. 4. Invite the client to a quiet place to talk after he has settled down. 5. Assist the client in identifying alternate ways of approaching the problem.
- Explore the client's unmet needs. - Acknowledge the client's behavior as inappropriate. - Invite the client to a quiet place to talk after he has settled down. - Assist the client in identifying alternate ways of approaching the problem. RATIONALE: Feelings of displacement or directing his anger toward the nurse need to be identified as inappropriate and understood by the client before the nurse can help guide him to choose appropriate actions. Having the client direct anger at another person is inappropriate. Approaching the client in a calm manner and offering to assist in the problem-solving process allow the client to identify needs that are not being met and explore constructive ways of dealing with his anger.
A client becomes increasingly irritable after being diagnosed with cancer. The client is rude to visitors and pushes nurses away when they attempt to give medications and treatments. What should the nurse do when the client has a hostile outburst? A: Offer the client positive reinforcement each time the client cooperates. B: Encourage the client to discuss immediate concerns and feelings. C: Continue with the assigned tasks and duties as though nothing has happened. D: Limit visitation until the client is less irritable.
B: Encourage the client to discuss immediate concerns and feelings. RATIONALE: When the client has hostile outbursts, it is best for the nurse to help the client express feelings. This serves as a release valve for the client. Offering positive reinforcement for cooperation does not help the client express feelings appropriately. Continuing with assigned tasks ignores the client's feelings and may lead to further escalation. Limiting visitation reduces the client's support systems and does not address the underlying problem.
1. In which situation can a client's confidentiality be breached legally? A: to answer a request from client's spouse about the client's medication B: in a student nurse's clinical paper about a client C: when a client near discharge is threatening to harm an ex-partner D: when a client's employer requests the client's diagnosis to initiate medical claims
C: when a client near discharge is threatening to harm an ex-partner RATIONALE: Legally, there is a duty to warn a potential victim of a client's intent to harm. Staff can be held accountable if the client injures the ex-partner and the staff failed to warn that person. The client's permission is needed to share information with a spouse. Student papers should not contain identifying information. Release of information is made directly to the client's insurance company, not to the employer
A client loses control and throws two chairs toward another client. What should the nurse do next? A: As the client to go to the quiet area and talk about the behavior. B: Administer an oral PRN tranquilizer and prepare for a show of determination. C: Process the incident with the client and discuss alternative behaviors. D: Call for assistance to restrain the client and administer a PRN intramuscular tranquilizer.
D: Call for assistance to restrain the client and administer a PRN intramuscular tranquilizer. RATIONALE: The client is in the crisis phase of the assault cycle. Therefore, the nurse must act immediately, using restraints and an intramuscular tranquilizer to prevent injury to others or further property damage. It is too late to ask the client to go to a quiet area to talk because the client's behavior is past the triggering phase. Giving the client an oral tranquilizer and preparing for a show of determination are nursing interventions used in the escalation phase. Processing the incident with the client and discussing alternative behaviors are interventions used in the postcrisis phase.
When the client is involuntarily committed to a hospital because the client is assessed as being dangerous to himself or others, which client rights are lost? A: the right to access health care B: the right to send and receive uncensored mail C: freedom from seclusion and restraints D: the right to leave the hospital against medical advice
D: the right to leave the hospital against medical advice RATIONALE: When a client is committed involuntarily, the right to leave against medical advice is forfeited. All the other rights are preserved unless there is further court action or a case of imminent danger to self or others (hitting staff, cutting self).
