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A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, 'Only a traitor would make me go to the hospital.' Which solution is best?
- A. Arrange a bed in a local homeless shelter with nightly onsite supervision.
- B. Negotiate a way to provide medication so the patient can remain at home.
- C. Hospitalize the patient until the symptoms have stabilized.
- D. Seek inpatient hospitalization for up to 1 week.
Correct Answer: B
Rationale: Hospitalization may damage the nurse-patient relationship even if it provides an opportunity for rapid stabilization. If medication can be obtained and restarted, the patient can possibly be stabilized in the home setting, even if it takes a little longer. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first because the patient is not dangerous.
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A nurse surveys the medical records for violations of patients' rights. Which finding signals a violation?
- A. No treatment plan is present in record.
- B. Patient belongings were searched at admission.
- C. Physical restraints were used to prevent harm to self.
- D. Patient is placed on one-to-one continuous observation.
Correct Answer: A
Rationale: The patient has the right to have a treatment plan. Inspecting a patient's belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self that occur as a result of a mental disorder.
A nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following?
- A. Housing adequacy and stability
- B. Income adequacy and stability
- C. Family and other support systems
- D. Early psychosocial development
- E. Substance abuse history and current use
Correct Answer: A,B,C,E
Rationale: Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment.
A patient tells the nurse at the clinic, 'I haven't been taking my antidepressant medication as directed. I leave out the midday dose. I have lunch with friends and don't want them to ask me about the pills.' What is the nurse's most appropriate intervention?
- A. Investigate the possibility of once-daily dosing of the antidepressant.
- B. Suggest to the patient to take the medication when no one is watching.
- C. Explain how taking each dose of medication on time relates to health maintenance.
- D. Add the following nursing diagnosis to the plan of care: ineffective therapeutic regimen management, related to lack of knowledge.
Correct Answer: A
Rationale: Investigating the possibility of once-daily dosing of the antidepressant has the highest potential for helping the patient achieve compliance. Many antidepressants can be administered by once-daily dosing, a plan that increases compliance. Explaining how taking each dose of medication on time relates to health maintenance is reasonable but would not achieve the goal; it does not address the issue of stigma. The self-conscious patient would not be comfortable doing this. A better nursing diagnosis would be related to social stigma. The question asks for an intervention, not analysis.
The following patients are seen in the emergency department. The psychiatric unit has one bed available. The patient demonstrating which problem should the admitting officer recommend for admission to the hospital?
- A. Experiencing dry mouth and tremor related to side effects of haloperidol
- B. Experiencing anxiety after divorcing a spouse after 10 years of marriage
- C. Has a self-inflicted a superficial cut on the forearm after a family argument
- D. Has begun hearing voices encouraging her to, 'Smother your infant'
Correct Answer: D
Rationale: Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.
Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises?
- A. Resolve behavioral crises using the least restrictive intervention possible.
- B. Rights of the majority of patients supersede the rights of individual patients.
- C. Swift intervention is justified to maintain the integrity of the therapeutic milieu.
- D. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.
Correct Answer: A
Rationale: The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patient's legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.