Quiz: Chapter 4, Settings for Psychiatric Care

Which structural safety precaution is most important to prevent the most common type of inpatient suicides? 1 Break-away closet bars to prevent hanging 2 Bedroom and dining areas with locked windows to prevent jumping 3 Double-locked doors to prevent escaping from the unit 4 Platform beds to prevent crush injuries

1 Hangings are the most common method of inpatient suicide. Bedroom and dining areas with locked windows, double-locked doors to prevent escape, and platform beds to prevent crush injuries are important safety measures but don't directly address the suicide method of hanging.

Select the example of primary prevention. 1 Teaching school age children about drug and alcohol abuse. 2 Genetic counseling with a middle age couple expecting their first child. 3 Helping a person with a long history of mental illness learn to manage money. 4 Assisting a new amputee to talk about feelings associated with body image changes.

1 Primary prevention occurs before any problem is manifested and seeks to reduce the incidence or rate of new cases. In this instance, teaching school age children about substance abuse occurs before any problem has developed. Secondary prevention includes early identification of problems, screening, and prompt and effective treatment intended to delay or avert progression. Tertiary prevention is the treatment of disease with a focus on preventing the progression to a severe course, disability, or death. Tertiary prevention encompasses rehabilitation.

What is the primary role of a registered nurse in a psychiatric unit? Select all that apply. 1 Provide essential teaching 2 Encourage therapeutic communication 3 Conduct thorough assessments 4 Prescribe psychiatric medications 5 Refer to the tertiary health care center

1 Provide essential teaching 2 Encourage therapeutic communication 3 Conduct thorough assessments The role of the registered nurse in a psychiatric unit is to provide essential teaching, promote therapeutic communication, and conduct thorough assessments. Teaching is an essential nursing function which helps patients to better understand their mental illnesses and treatments. Therapeutic communication helps patients feel comfortable about their psychiatric symptoms. Thorough assessments of the patient's physical health, the nurse gains information about mental health symptoms that the patient has not mentioned specifically. The nurse would not prescribe medication or refer patients to the tertiary health care center; these are responsibilities of a health care provider.

On a hospital inpatient unit, the nurse manager's primary responsibility is to 1 Assure the safety of both patients and staff on the unit 2 Assist the patient to prepare a support system by the time of discharge 3 Provide medication therapy for the patients on the unit 4 Help the inpatient community remain supportive of each other

1 Assure the safety of both patients and staff on the unit The nurse manager is responsible for an awareness of the safety of the unit, its effectiveness in the delivery of services, and how well the components of the health care team integrate their services.

A patient admitted to the behavioral health unit with a diagnosis of schizophrenia tells the nurse that she does not wish to see her husband if he visits. The nurse tells the patient's husband that 1 His wife has the right to refuse visitors if she wishes 2 He is welcome to visit but may receive a cool reception 3 The patient's plan of care calls for limiting visitors for two days 4 The patient is acutely psychotic and not responsible for her present behavior

1 The patient has the right to choose or refuse visitors.

A staff nurse on an inpatient psychiatric unit informs a patient diagnosed with schizophrenia, "The treatment team has suspended your telephone privileges for the next 24 hours." Which behavior by this patient provides adequate justification for this limitation of the patient's rights? The patient: 1 interfered with others patients' access to using the telephone 2 telephoned the Federal Bureau of Investigations (FBI) with threats to assassinate the president 3 repeatedly exceeded the 10-minute time limit for phone calls 4 listened to other patients' phone calls with their family and friends

2 Patients admitted to any psychiatric unit retain rights as citizens and are entitled to certain privileges, including use of a telephone. Any infringement by the team during the patient's hospitalization must be documented and actions must be justifiable. In this instance, the patient engaged in illegal behavior by way of the telephone, so suspension of the privilege is justifiable. Interfering with other patients' access to using the telephone, repeatedly exceeding time limits for phone calls, and listening to other patients' phone calls represent situations that should be addressed in a meeting of the therapeutic milieu or through individual discussion with this patient.

Why are continuous hinges used on doors in psychiatric units? 1 They are easily available. 2 They prevent hanging risk. 3 They hold a minimal amount of weight. 4 They look better than three butt hinges

2 hanging Patients in psychiatric units are at a high risk for suicide, and patients with psychiatric disorders may attempt suicide. Continuous hinges are used on doors to prevent hanging risk. Easy availability and holding a minimal amount of weight are not important factors. Continuous hinges are not used for their visual appeal.

Which patient has met the criteria for involuntary admission? 1 A college student who has developed symptoms of anxiety and is missing classes and work 2 An accountant who has developed symptoms of depression 3 A kindergarten teacher who was found confused and wandering about on a busy road 4 A retired librarian who is experiencing memory loss and some confusion at times

3 Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). An anxious college student, a depressed accountant, and a confused, retired librarian can all be managed at this point in the community setting and do not meet criteria (risk of harm to self or others) for admission

A patient's family called for help when the patient, suffering from bipolar disorder, had a manic episode. A team consisting of a psychiatrist, a social worker, and a psychiatric nurse arrived at the location and stabilized the patient's condition. What kind of care setting was used in response to this emergency? 1 Comprehensive emergency service model 2 Hospital-based consultant model 3 Mobile crisis team model 4 Crisis stabilization and observation unit

3 The mobile crisis team model serves patients in emergency conditions wherever they may be located. Psychiatric evaluations are performed in the community in which the crisis occurs, with the goal of stabilizing the patient without a visit to an emergency department. The team may comprise psychiatrists, social workers, psychiatric nurses, advanced practice nurses, and counselors, depending on the crisis at hand. The comprehensive emergency service model works with a full-service emergency department in a hospital or other medical facility. Specialty staff and a multidisciplinary workforce operate in a dedicated space with a focus on triage and stabilization of psychiatric emergencies. The hospital-based consultant model works on the same concept as the comprehensive emergency service model but does not include a dedicated space or special workforce. The patients are stabilized by clinicians and discharged or transferred to psychiatric care for further treatment. The crisis stabilization/observation unit is not a model for emergency care.

A nurse monitoring a patient with a psychotic disorder observes that the patient is excessively sedated. What is the priority nursing action? 1 Stop the antipsychotic medication 2 Switch the antipsychotic medication 3 Discuss the benefits of psychiatric home care with the patient 4 Notify the health care provider

4 Most antipsychotic drugs cause sedation as a side effect. The nurse should notify the health care provider about excessive sedation and obtain a prescription to decrease the dose of medication. Decreasing the dose of the antipsychotic medication can decrease the effect of sedation. The nurse is not authorized to stop medication, which may deprive the patient of the therapeutic effect and may worsen the mental illness. The nurse is not authorized to switch the medication, which may not be a suitable option. The patient does not need psychiatric home care to manage sedation.

Which situation demonstrates the nurse functioning in the role of advocate? 1 Providing one-to-one supervision for a patient on suicide precautions 2 Co-leading a medication education group for patients and families 3 Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation 4 Negotiating with the patient's HMO for extension of a three-day hospitalization to five days

4 In the inpatient setting, case managers on the hospital team communicate daily or weekly with the patient's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.

A function shared by advanced practice and general practice psychiatric nurses is 1 Prescriptive authority 2 Hospital privileges 3 Provision of consultation services 4 Collaboration with a multidisciplinary team

4 Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.