Foundations of Psychiatric Nursing
A client diagnosed with pain disorder is talking with the nurse about fishing when he suddenly reverts to talking about the pain in his arm. Which of the following should the nurse do next? A) Allow the client to talk about his pain. B) Ask the client if he needs more pain medication. C) Get up and leave the client. D) Redirect the interaction back to fishing.
D) Redirect the interaction back to fishing. Reason: The nurse should redirect the interaction back to fishing or another focus whenever the client begins to ruminate about physical symptoms or impairment. Doing so helps the client talk about topics that are more therapeutic and beneficial to recovery. Allowing the client to talk about his pain or asking if he needs additional pain medication is not therapeutic because it reinforces the client's need for the symptom. Getting up and leaving the client is not appropriate unless the nurse has set limits previously by saying, "I will get up and leave if you continue to talk about your pain."
A nurse makes a home visit to a client who was discharged from a psychiatric hospital. The client is irritable and walks about her room slowly and morosely. After 10 minutes, the nurse prepares to leave, but the client plucks at the nurse's sleeve and quickly asks for help rearranging her belongings. She also anxiously makes inconsequential remarks to keep the nurse with her. In view of the fact that the client has previously made a suicidal gesture, which of the following interventions by the nurse should be a priority at this time? A) Ask the client frankly if she has thoughts of or plans for committing suicide. B) Avoid bringing up the subject of suicide to prevent giving the client ideas of self-harm. C) Outline some alternative measures to suicide for the client to use during periods of sadness. D) To draw out the client, mention others the nurse has known who have felt like the client and attempted suicide.
A) Ask the client frankly if she has thoughts of or plans for committing suicide. Reason: Investigating the presence of suicidal thoughts and plans by overtly asking the client if she is thinking of or planning to commit suicide is a priority nursing action in this situation. Direct questioning about thoughts or plans related to self-harm does not give a person the idea to harm herself. Self-harm is an individual decision. Avoiding the subject when a client appears suicidal is unwise; the safest procedure is to investigate. It would be premature in this situation to outline alternative measures to suicide. Describing other clients who have attempted suicide is too indirect to be helpful and minimizes the client's feelings.
A client is irritable and hostile. He becomes agitated and verbally lashes out when his personal needs are not immediately met by the staff. When the client's request for a pass is refused by the primary care provider, he utters a stream of profanities. Which of the following statements best describes the client's behavior? A) The client's anger is not intended personally. B) The client's anger is a reliable sign of serious pathology. C) The client's anger is an intended attack on the primary care provider's skills D) The client's anger is a sign that his condition is improving.
A) The client's anger is not intended personally. Reason: Staff members sometimes are the recipients of a client's angry behavior because they are safe targets and are available for attack. The display of anger is rarely intended to be personal. Such behavior is not necessarily a sign of serious pathology but must be weighed in conjunction with other behaviors. An angry outburst is not an attack on a primary care provider's skills. While not necessarily pathologic, the client's behavior isn't a sign that his condition is improving.
A nurse is instructing a client with bipolar disorder on proper use of lithium carbonate (Eskalith), the drug's adverse effects, and symptoms of lithium toxicity. Which client statement indicates that additional teaching is required? A) "I can still eat my favorite salty foods." B) "When my moods fluctuate, I'll increase my dose of lithium." C) "A good blood level of the drug means the drug concentration has stabilized." D) "Eating too much watermelon will affect my lithium level."
B) "When my moods fluctuate, I'll increase my dose of lithium." Reason: A client who states that he'll increase his dose of lithium if his mood fluctuates requires additional teaching because increasing the dose of lithium without evaluating the client's laboratory values can cause serious health problems, such as lithium toxicity, overdose, and renal failure. Clients taking lithium don't need to limit their sodium intake. A low-sodium diet causes lithium retention. A therapeutic lithium blood level indicates that the drug concentration has stabilized. The client demonstrates effective teaching by stating his lithium levels will be affected by foods that have a diuretic effect, such as watermelon, cantaloupe, grapefruit juice, and cranberry juice.
The family of an older adult wants their mother to have counseling for depression. During the initial nursing assessment, the client denies the need for counseling. Which of the following comments by the client supports the fact that the client may not need counseling? A) "My doctor just put me on an antidepressant, and I'll be fine in a week or so." B) "My daughter sent me here. She's mad because I don't have the energy to take care of my grandkids." C) "Since I've gotten over the death of my husband, I've had more energy and been more active than before he died." D) "My son got worried because I made this silly comment about wanting to be with my husband in heaven."
C) "Since I've gotten over the death of my husband, I've had more energy and been more active than before he died." Reason: Resolving grief and having increased energy and activity convey good mental health, indicating that counseling is not necessary at this time. Taking an antidepressant or having less energy and involvement with grandchildren reflects possible depression and the need for counseling. Wanting to be with her dead husband suggests possible suicidal ideation that warrants serious further assessment and counseling.
The nursing staff has finished restraining a client. In addition to determining whether anyone was injured, the staff is mandated to evaluate the incident to obtain which of the following ultimate outcomes? A) Coordinate documentation of the incident. B) Resolve negative feelings and attitudes. C) Improve the use of restraint procedures. D) Calm down before returning to the other clients.
C) Improve the use of restraint procedures. Reason: Although coordinating documentation, resolving negative feelings, and calming down are goals of debriefing after a restraint, the ultimate outcome is to improve restraint procedures.
A 28-year-old client with an Axis I diagnosis of major depression and an Axis II diagnosis of dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse, "I don't know if I can make it in an apartment without my parents." The nurse should respond by saying to the client: A) "You're a 28-year-old adult now, not a child who needs to be cared for." B) "Your parents won't be around forever. After all, they are getting older." C) "Your parents need a break, and you need a break from them." D) "Your parents have been supportive and will continue to be even if you live apart."
D) "Your parents have been supportive and will continue to be even if you live apart." Reason: Some characteristics of a client with a dependent personality are an inability to make daily decisions without advice and reassurance and the preoccupation with fear of being alone to care for oneself. The client needs others to be responsible for important areas of his life. The nurse should respond, "Your parents have been supportive of you and will continue to be supportive even if you live apart," to gently challenge the client's fears and suggest that they may be unwarranted. Stating, "You're a 28-year-old adult now, not a child who needs to be cared for," or "Your parents need a break, and you need a break from them," is reprimanding and would diminish the client's self-worth. Stating, "Your parents won't be around forever; after all they are getting older," may be true, but it is an insensitive response that may increase the client's anxiety.
A client in an acute care setting tells the nurse, "I don't think I can face going home tomorrow." The nurse replies, "Do you want to talk more about it?" The nurse is using which technique? A) Presenting reality B) Making observations C) Restating D) Exploring
D) Exploring Reason: The nurse is using the technique of exploring because she's willing to delve further into the client's concern. She isn't presenting reality or making observations or simply restating. The nurse is encouraging the client to explore his feelings.
A client was talking with her husband by telephone, and then she began swearing at him. The nurse interrupts the call and offers to talk with the client. She says, "I can't talk about that bastard right now. I just need to destroy something." Which of the following should the nurse do next? A) Tell her to write her feelings in her journal. B) Urge her to talk with the nurse now. C) Ask her to calm down or she will be restrained. D) Offer her a phone book to "destroy" while staying with her.
D) Offer her a phone book to "destroy" while staying with her. Reason: At this level of aggression, the client needs an appropriate physical outlet for the anger. She is beyond writing in a journal. Urging the client to talk to the nurse now or making threats, such as telling her that she will be restrained, is inappropriate and could lead to an escalation of her anger.
Based on a client's history of violence toward others and her inability to cope with anger, which of the following should the nurse use as the most important indicator of goal achievement before discharge? A) Acknowledgment of her angry feelings. B) Ability to describe situations that provoke angry feelings. C) Development of a list of how she has handled her anger in the past. D) Verbalization of her feelings in an appropriate manner.
D) Verbalization of her feelings in an appropriate manner. Reason: 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 her 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 she has changed her behavior. Asking the client to list how she has handled anger 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.
