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A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient?
- A. Clinical algorithm
- B. Clinical pathway
- C. Clinical practice guideline
- D. International Statistical Classification of Diseases and Related Health Problems (ICD)
Correct Answer: A
Rationale: A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions cognizant of an individual patient's needs, such as ethnic origin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases.
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An experienced nurse says to a new graduate, 'When you've practiced as long as I have, you will instantly know how to take care of psychotic patients.' What is the new graduate's best analysis of this comment?
- A. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice.
- B. New research findings must be continually integrated into a nurse's practice to provide the most effective care.
- C. Experience provides mental health nurses with the tools and skills needed for effective professional practice.
- D. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error.
- E. Effective psychiatric nurses should be continually guided by an intuitive sense of patients' needs.
Correct Answer: A,B
Rationale: Evidence-based practice involves using research findings to provide the most effective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.
An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patient's perception that his or her nurse is caring?
- A. My nurse always asks me which type of juice I want to help me swallow my medication.
- B. My nurse explained my treatment plan to me and asked for my ideas about how to make it better.
- C. My nurse told me that if I take all the medicines the doctor prescribes, I will get discharged soon.
- D. My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone.
Correct Answer: D
Rationale: Caring evidences empathic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The incorrect options give examples of statements that demonstrate advocacy or giving advice.
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 consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction reported by a patient indicates this nurse is most effective?
- A. Feeling less distrustful of others
- B. Sensing a connection with others
- C. Experiencing only minimal uneasiness about the future
- D. Being somewhat encouraged with efforts to improve
Correct Answer: B
Rationale: A patient is likely to respond most to caring with a sense of connectedness with others. The absence of caring can make patients feel some degree of distrustful, disconnection, unease, and discouragement.
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.