Nokea
A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, 'I feel the same.' Which intervention supports the nurse's assessment while preserving the patient's autonomy?
- A. Arrange for a short hospitalization.
- B. Schedule weekly clinic appointments.
- C. Refer the patient to the crisis intervention clinic.
- D. Call the family and ask them to observe the patient closely.
Correct Answer: B
Rationale: Scheduling clinic appointments at shorter intervals will give the opportunity for more frequent assessment of symptoms and allow the nurse to use early intervention. If the patient does not admit to having a crisis or problem, a referral would be useless. The remaining options may produce unreliable information, violate the patient's privacy, and waste scarce resources.
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Which patient would a nurse refer to partial hospitalization?
- A. One who spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal.
- B. One who is experiencing agoraphobia and panic episodes and who would benefit from psychoeducation for relaxation therapy.
- C. One who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
- D. One who states, 'I'm not sure I can avoid using alcohol when my spouse goes to work every morning.'
Correct Answer: D
Rationale: This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume supervision responsibilities. The patient who is actively suicidal needs inpatient hospitalization. The patient in need of psychoeducation can be referred to home care. The patient who reports regularly for blood tests and clinical follow-up can continue on the same plan.
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.
A suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spends the remaining daily food allowance on cigarettes. Select the community psychiatric nurse's best initial action.
- A. Report the situation to the manager of the shelter.
- B. Tell the patient, 'You must stop smoking to save money.'
- C. Assess the patient's weight; determine the foods and amounts eaten.
- D. Seek hospitalization for the patient while a new plan is being formulated.
Correct Answer: C
Rationale: Assessment of biopsychosocial needs and general ability to live in the community is called for before any action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. Nurses assess before taking action. Hospitalization may not be necessary.
A community psychiatric nurse facilitates medication adherence for a patient by having the health care provider prescribe medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance?
- A. Attitude of significant others toward the patient
- B. Nutritional services in the patient's neighborhood
- C. Level of trust between the patient and the nurse
- D. Availability of transportation to the clinic
Correct Answer: D
Rationale: The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The depot medication relieves the patient of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, noncompliance will again be the issue. Attitude toward the patient, trusting relationships, and nutrition are important but not fundamental to this particular problem.
A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, 'I'm willing to take my medicine, but I forgot to get my prescription refilled.' Which outcome should the nurse add to the plan of care?
- A. Nurse will obtain prescription refills every 90 days and deliver them to the patient.
- B. Patient's spouse will mark dates for prescription refills on the family calendar.
- C. Patient will report to the hospital for medication follow-up every week.
- D. Patient will call the nurse weekly to discuss medication-related issues.
Correct Answer: B
Rationale: The nurse should use the patient's support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary if the patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as he or she continues to take the medications as prescribed. No patient issues except failure to obtain medication refills were identified.