PSYCH EXAM 2 LIPPINCOTT

After teaching a group of students who are volunteering for a local crisis hotline, the nurse judges that further education about crisis and intervention is needed when a student makes which statement?

"Most people in crisis will be calling the line once every day for at least a year."

A client with substance use disorder and bipolar disorder has recently stabilized after experiencing a crisis resulting from a psychotic episode. The client tells the nurse, "I want to live in the community again." What is most important for the nurse to communicate with the health care provider if advocating for the client's discharge into the community?

"There's extensive documentation to support the client's improved functioning level."

A client is admitted to the psychiatric hospital for evaluation after numerous incidents of threatening, angry outbursts, and two episodes of hitting a coworker at the grocery store where they work. The client is very anxious and tells the nurse who admits them, "I didn't mean to hit them. They made me so mad that I just couldn't help it. I hope I don't hit anyone here." How should the nurse respond?

"When you start to feel angry here, talk to the staff about your feelings."

An agitated client demands to see the chart to read what has been written about the client. Which statement is the nurse's best response to the client?

"You have the right to see your chart. Please discuss your wish with your health care provider."

A client with anxiolytic withdrawal is prescribed lorazepam in daily decreasing dosages for 2 weeks. The client had been taking 60 mg of diazepam daily for 8 months but now has been taking lorazepam for 3 days. The client states they feel shaky, are having problems sleeping, and do not want to continue with lorazepam. The client asks the nurse if they can stop taking the lorazepam now. What is the nurse's best response?

"You need to continue the lorazepam as prescribed to ensure a slow and safe withdrawal."

A nurse is leading a group on medication management. One of the group members is beginning to monopolize the session, talking about experiences with medications. Which statement by the nurse would be best?

"You're doing well in contributing to the group, but I'd like to hear what others are thinking."

A client is having a severe reaction to cocaine and seems to have lost touch with reality. They are very suspicious of their friends who came with them and do not want to talk to the nurse. Suddenly, they yell out, "I'll kill you before I let you take me!" Which comment by the nurse would be most useful to help the client reestablish their self-control and orientation?

"You're reacting to the cocaine you used. You're safe here in the hospital."

A true crisis state, involving a period of severe disorganization, is difficult to endure emotionally and physically. The nurse recognizes that a client will only be able to tolerate being in crisis for how long?

4 to 6 weeks

A nurse is working with a client who has alcohol use disorder. Which fact should the nurse communicate to the client?

Abstinence is the basis for successful treatment.

A client found sitting on the floor of the bathroom in the day treatment clinic has moderate lacerations on both wrists. Surrounded by broken glass, the client sits staring blankly at the lacerations. What is the most important action for the nurse to take toward the client?

Approach the client slowly while speaking in a calm voice, calling the client by name, and saying that the nurse is there to help.

An older client is seeking crisis intervention in a community senior citizen center. The client states that there are very few financial resources available and the client's children never call or visit. The client is sobbing and states, "I can't take it anymore. My life is so lonely and hard. I am living too long and shouldn't be here anymore." What is the most important action for the nurse to take?

Assess the meaning of the client's statement, "I cannot take it anymore."

A 75-year-old client was brought to the crisis center by their spouse. The spouse reports that the client has been in shock and anxious since their purse was stolen outside of their home. The client blames themself for being robbed, is worried about their stolen wallet and credit cards, and is afraid to go home. What nursing action(s) would be indicated? Select all that apply.

Encourage the client to talk about the robbery and their feelings. Discuss what changes at home would help them feel safe. Investigate if the client has physical injuries from the robbery

The campus health nurse is caring for a client after they were sexually assaulted. Which of the following intervention would be most beneficial for this client?

Explore the client's strengths and resources with them.

A client is reporting to other clients about not being allowed by staff to keep food in their room. What action should the nurse take?

Set limits on the behavior

A client is disruptive to other clients and constantly walks about the unit interrupting others. Which plan should the nurse institute first?

Set limits on the client's behavior; explain what is expected and what the consequences will be if limits are violated.

The treatment team recommends that a client take an assertiveness training class offered in the hospital. Which behavior indicates that the client is becoming more assertive?

The client asks a roommate to put away dirty clothes because the untidiness bothers the client

Two days after a client's spouse and child were found dead in a flood, the client returns to the crisis center and says they think it would be better to "end it all right now and join my spouse and kid, wherever they are." The nurse has already determined that the client has no history of psychiatric problems. What should the nurse consider this client's risk for suicide to be?

The risk is high; the client's suicide threat can be considered a call for help and should be taken seriously.

A client with a diagnosis of bipolar disorder is energetic, impulsive, and verbalizing loudly in the community room. To prevent injury while complying with the principle of the least-restrictive environment, which action should the nurse take to prevent escalation of the client's mood?

Try to channel the client's energy into appropriate activities.

The charge nurse is observing care for a client on a psychiatric floor diagnosed with suicidal ideations. The client is lying in bed in the hospital room. Which observation would cause the charge nurse to intervene?

Unlicensed assistive personnel closing the client's door to allow for uninterrupted rest

A nurse is assessing a client at a mental health clinic who threatens suicide and describes having a plan. Which should the nurse recognize as the priority goal for the client?

Working with the client to resolve the immediate crisis and admitting the client, if necessary

The partner of a 22-year-old client dies in a drunk-driving accident. The client reports difficulty eating, sleeping, and working. The reaction is considered:

a crisis caused by traumatic stress.

A client is admitted for detoxification following a cocaine overdose. The client reports frequent cocaine use but claims the ability to control use. Which coping mechanism is the client using?

denial

A voluntary client in a facility decides to leave the unit before treatment is complete. To detain the client, the nurse refuses to return the client's personal effects. This action is an example of:

false imprisonment.

While the nurse is teaching a group of volunteers for a crisis hotline, a volunteer asks, "What if I'm not sure why someone is calling?" Which statement by the nurse is most helpful?

"Ask the caller to tell you why they are calling you today."

A nurse is interviewing a client who has experienced both physical and psychological intimate partner violence. The client has two children with the partner and currently lives with them. What is the best statement by the nurse?

"Do you feel safe where you are currently living?"

A nurse is working with an adolescent who has reported low self-esteem. When developing a plan of care, the nurse considers the adolescent's psychosocial needs. Which question will best assist the nurse in assessing the adolescent's psychosocial development?

"How did you come to understand your feelings about yourself?"

A nurse is teaching self-esteem to a client. Which statements by the client would indicate understanding of the concept? Select all that apply.

"I need to have consistent limits." "Living in a critical environment is not good for me." "I need to have healthy boundaries."

The nurse is admitting a client who is anxious, fearful, and pleads not to be left alone. The client states, "I'm worthless!" Which statement(s) by the nurse will help build a strong, therapeutic nurse-client relationship? Select all that apply.

"I'm here if you would like to talk about anything." "I'll stay with you until you feel less anxious."

A client is admitted to the hospital because of threatening, aggressive behavior toward their family. In the first group meeting after the client is admitted, another client sits near the nurse and says loudly, "I'm sitting here because I'm afraid of Ted. He's so big, and I heard them talk about hitting people." The nurse should say to the client:

"It's frightening to have new people on the unit. We're here to talk about things like being afraid."

The nurse manager overhears two staff members talking in the snack room. One of the staff members states, "Those superficial cuts are just a means of getting our attention. That client never should have been admitted. I hope they are out of here soon." Which response by the nurse manager is most appropriate?

"No matter what the intent, all suicidal behavior is serious and deserves our serious consideration."

The nurse teaches a client about preventing alcohol relapse. Which client statement indicates an understanding of the risk for alcohol relapse?

"Stopping support groups and not expressing feelings can lead to relapse."

While helping clients brought to a crisis center during a severe flood, the nurse interviews a client whose pregnant spouse is missing and whose home has been destroyed. The client keeps talking rapidly about their experience and says, "I can't see how I can ever rebuild my life." Which response by the nurse would be most appropriate?

"This has been a terrible experience. Tell me more about how you feel."

An adolescent client tells the nurse that the reason they are depressed and suicidal is that they are being bullied at school. While discussing the circumstances of the bullying, the client indicates that they are gay, which they think contributes to the bullying. The client tells the nurse their sexual orientation in confidence, stating that their parents do not know and that the client does not want that information revealed to them. Which action(s) should the nurse take? Select all that apply.

Give the client the crisis phone line number. Provide contact information for a support group for gay teens. Assess the client's current status regarding suicidal thoughts or plans. Help the client develop a safety plan regarding suicidal thoughts or plans. Question the client about the bullying.

A client who has been a victim of intimate partner violence by their spouse agrees to meet with the nurse. What is most important for the nurse to do before the nurse ends the meeting?

Give the client the telephone numbers of a shelter or a safe house and the crisis line.

A client has chronic low self-esteem related to self-doubt as evidenced by self-deprecatory statements. What goal should the nurse establish for the client?

Identify positive aspects of self.

During a meeting with nurse managers from the crisis intake unit, acute mental health unit, and mental health long-term care unit, the hospital risk manager says, "Approximately 57% of our client safety problems can be directly attributed to poor handoffs." What solution might the nurse managers implement to improve these statistics?

Initiate a template of transfer information to be communicated when a client is transferred from one care setting to another.

The nurse understands that with the right help at the right time, a client can successfully resolve a crisis and function better than before the crisis. Which factor supports improved functioning?

acquisition of new coping skills

A nurse is counseling a client at a crisis center after the client's house burned down and the client's child was killed. Which action by the nurse is a priority?

assisting in psychological resolution of the immediate crisis

A client who's at high risk for suicide needs close supervision. To best ensure the client's safety, the nurse should:

check the client frequently at irregular intervals.

A young adult client is admitted to a psychiatric unit with a diagnosis of alcohol use disorder and personality disorder. The client's parent states, "They're always in trouble, just like when they were little. Now they're just a bigger prankster and out of control." In view of the client's history, which intervention is most important initially?

closely observing the client's behavior to establish a baseline pattern of functioning

A client tells the nurse that they have been raped but has not reported it to the police. After determining whether the client was injured, whether it is still possible to collect evidence, and whether the client wants to file a report, the nurse's next priority is to offer which intervention to the client?

crisis intervention

The nurse leads a group therapy session for clients with substance use disorder. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, "I do not have a drug problem. I can quit whenever I want. I have done it before." The nurse includes interventions in the client's plan of care to address which ineffective coping strategy being displayed by the client's comments?

denial

A major role in crisis intervention is getting a client's family and friends involved in helping with the immediate crisis as soon as possible. The nurse should determine that the support persons are prepared to help when they verbalize what information?

emergency resources and when to use them

Several former clients from a mental health facility have recently collected their stories to corroborate that a nurse working there has attempted to befriend them. The clients state that during their therapy, the nurse encouraged them to invest in a new business. The nursing supervisor, upon hearing of the clients' reports, begins an investigation. How can the nursing supervisor best describe the nurse's behavior with these former clients?

having poor boundaries

A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. A behavior contract is planned. To promote client compliance the nurse should anticipate that the contract will be written:

jointly by the client and the nurse.

The nurse is performing a psychological assessment on a client with history of alcohol use disorder. Which findings should the nurse anticipate? Select all that apply.

low self-esteem and depression family history of alcohol use disorder

The nurse assesses an aggressive client. Which behavior warrants the nurse's prompt reporting and use of safety precautions?

naming another client as their adversary

A nurse is obtaining a history from a client. The client reports being a waiter. When asked about the work environment, the client says, "If customers confront me for not being attentive enough, I just spit on their food." The nurse suspects the client is prone to which type of behavior?

passive-aggressive

Which action demonstrates the role of the psychiatric nurse in primary prevention?

providing sexual education classes for adolescents

The nurse incorporates the underlying premise of crisis intervention into the plan of care. What is the initial goal of providing "the right kind of help at the right time"?

regaining emotional security and equilibrium

A client brought by ambulance to the emergency department after taking an overdose of barbiturates is comatose. The nurse should assess the client for which complication?

respiratory failure

A nurse is assessing a client who is being abused. The nurse should assess the client for which characteristic(s)? Select all that apply.

self-blame alcohol use disorder suicidal thoughts guilt

Assertive behavior involves:

standing up for one's rights while respecting the rights of others

A client is admitted to the hospital because of threatening, aggressive behavior toward their family. Which factor is most important for the nurse to consider when assessing the angry client's potential for violence?

the client's past history of violent behavior

The client has tearfully described negative feelings about themself to the nurse during their last three interactions. Which goal would be most appropriate for the nurse to include in the plan of care at this time?

verbalizing three things they like about themself