Nokea
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.
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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.
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.
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.
Which research evidence would most influence a group of nurses to change their practice?
- A. Expert committee report of recommendations for practice
- B. Systematic review of randomized controlled trials
- C. Nonexperimental descriptive study
- D. Critical pathway
Correct Answer: B
Rationale: Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is level A and provides the strongest evidence for changing practice. Expert committee recommendations and descriptive studies lend less powerful and influential evidence. A critical pathway is not evidence; it incorporates research findings after they have been analyzed.
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.