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A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurse's most caring comment.
- A. Let's discuss healthy means of coping when you have suicidal feelings.
- B. I understand why you're so depressed. When I got divorced, I was devastated too.
- C. You should forget about your marriage and move on with your life.
- D. How did you get so depressed that hospitalization was necessary?
Correct Answer: A
Rationale: The nurse's communication should evidence caring and a commitment to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful for therapeutic interventions.
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Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, 'Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills.' Select the best response by the student interested in psychiatric nursing.
- A. Psychiatric nurses' practice in safer environments than other specialties and nurse-to-patient ratios are better because of the nature of patients' problems.
- B. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. I'm challenged by those situations.
- C. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate.
- D. Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses. That appeals to me.
Correct Answer: B
Rationale: The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric nursing involves clinical practice, not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain.
A nurse says, 'When I was in school, I learned to call upset patients by name to get their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name.' Which statement is the best appraisal of this nurse's comment?
- A. One descriptive research study rarely provides enough evidence to change practice.
- B. Staff nurses apply new research findings only with the help from clinical nurse specialists.
- C. New research findings should be incorporated into clinical algorithms before using them in practice.
- D. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
Correct Answer: A
Rationale: Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical algorithms use flowcharts to manage problems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change.
A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the website's address most alerts the nurse that the site may have biased and prejudiced information?
- A. Address ends in '.org.'
- B. Address ends in '.com.'
- C. Address ends in '.gov.'
- D. Address ends in '.net.'
Correct Answer: B
Rationale: Financial influences on a site are a clue that the information may be biased. '.com' at the end of the address indicates that the site is a commercial one. '.gov' indicates that the site is maintained by a government entity. '.org' indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. '.net' can have multiple meanings.
Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will demonstrate what behavior?
- A. Denying suicidal ideation
- B. Reporting a sense of well-being
- C. Taking medications as prescribed
- D. Attending clinic appointments on time
Correct Answer: B
Rationale: Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on the classic medical model rather than recovery.
In the shift-change report, an off-going nurse criticizes a patient who wears extremely heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy?
- A. This is a psychiatric hospital, so we expect our patients to behave bizarrely.
- B. Let's all show acceptance of this patient by wearing lots of makeup too.
- C. Your comments are inconsiderate and inappropriate. Keep the report objective.
- D. Our patients need our help to learn behaviors that will help them get along in society.
Correct Answer: D
Rationale: Accepting patients' needs for self-expression and seeking to teach skills that will contribute to their well-being demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to prevent prejudice against the patient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict.