Nokea
A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitor's closet is locked, and all sharp objects are being used under staff supervision. These observations relate to what nursing responsibility?
- A. Management of milieu safety
- B. Coordinating care of patients
- C. Management of the interpersonal climate
- D. Use of therapeutic intervention strategies
Correct Answer: A
Rationale: Members of the nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse's concerns, are unrelated to the observations cited.
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The relapse of a patient diagnosed with schizophrenia is related to medication nonadherence. The patient is hospitalized for 5 days, medication is restarted, and the patient's thoughts are now more organized. The patient's family members are upset and say, 'It's too soon for discharge. Hospitalization is needed for at least a month.' The nurse should implement what intervention?
- A. Call the psychiatrist to come explain the discharge rationale.
- B. Explain that health insurance will not pay for a longer stay for the patient.
- C. Notify security to handle the disturbance and escort the family off the unit.
- D. Explain that the patient will continue to improve if medication is taken regularly.
Correct Answer: D
Rationale: Patients no longer stay in a hospital until all evidence of a symptom disappears. The nurse must assume responsibility to advocate for the patient's right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Calling security is unnecessary. The nurse can handle this matter.
Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for a patient presenting with what characteristic?
- A. Presents a clear danger to self or others.
- B. Consistently noncompliant with medications at home.
- C. Has no reliable support systems in the local community.
- D. Develops new symptoms during the course of an illness.
Correct Answer: A
Rationale: Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The incorrect options do not necessarily describe patients for whom less restrictive treatment is indicated.
To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?
- A. Problem-solving skills
- B. Calm and caring manner
- C. Ability to cross service systems
- D. Knowledge of psychopharmacology
Correct Answer: C
Rationale: A community mental health nurse must be able to work with schools, corrections facilities, shelters, health care providers, and employers. The mental health nurse working in an inpatient unit needs only to be able to work within the single setting. Problem-solving skills are needed by all nurses. Nurses in both settings must have knowledge of psychopharmacology.
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.
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.