PN PASSPOINT: Foundations of Psychiatric Nursing
A nurse is caring for a client with antisocial personality disorder. The client states to the nurse, "When I leave here, I want to take you on a date. You have been the best nurse in this place." What is the best response by the nurse?
"That type of relationship is not appropriate between a nurse and a client."
The nurse is caring for five clients. Which client does the nurse identify who requires screening for suicidal ideation? Select all that apply.
A 19-year-old male who moved across the country to begin college A 28-year-old female with bipolar disorder who was recently married A 36-year-old female who gave birth 6 months ago to her first child A 44-year-old male who recently lost his job due to being furloughed A 52-year-old female whose daughter experienced an unplanned pregnancy
After learning that a roommate has tested positive for the human immunodeficiency virus (HIV), a client asks a nurse about moving to another room on the psychiatric unit because the client does not feel "safe" now. What should the nurse do first?
Ask the client to describe their fears
A client was sexually assaulted after returning home from the store late one evening. The client arrives, tearful, at the emergency department. What is the priority intervention for this client?
Assess the client's physical and mental state.
A client in an acute care mental health program refuses his morning dose of an oral antipsychotic medication and believes he's being poisoned. The nurse should respond by taking which action?
Consulting with the physician about a plan of care
The nurse has identified that several of the newer unlicensed assistive personnel (UAP) are not always maintaining adequate professional boundaries when interacting with clients. Which action(s) should the nurse take? Select all that apply.
Identify clients who are more likely to attempt to challenge appropriate relationship boundaries during team meetings. Correct response: Identify clients who are more likely to attempt to challenge appropriate relationship boundaries during team meetings. Provide staff in-services that involve clinical vignettes and scenarios related to common professional boundary issues. Provide written policies with examples about what constitutes unethical behavior and the consequences for this behavior.
The nurse, along with the treatment team for the client, uses critical pathways of care. Which statement regarding critical pathways is correct?
It is a care plan that provides outcome-based guidelines with a designated length of stay.
A nurse is conducting a sexual awareness group of known pedophiles. What will the nurse highlight as the primary focus of this group?
cognitive restructuring
A client reports having a strong desire to live and be treated as the opposite sex and is uncomfortable with the current anatomical sex. Based on the client's comments, for what psychiatric condition will the nurse assess?
gender dysphoria
A client was admitted for treatment of the symptoms of bipolar disorder after failing to comply with community treatment and continuing to expose their sexual partners to a sexually transmitted form of hepatitis. The court appointed a guardian because this client was not able to understand the consequences of the decisions being made. Which terms describes the status of this client?
legally incompetent
As the nurse arrives to visit a family 2 days after release from the hospital, she hears shouting and swearing between the mother and father and several loud crashes, just as she is going to knock on the door. What action by the nurse is the most appropriate?
return to the car and call the police
A client refuses the evening dose of haloperidol and then becomes extremely agitated in the day room while other clients are watching television. The client begins cursing and throwing furniture. The nurse's first action is to:
remove all other clients from the day room.
