Nokea
The following patients are seen in the emergency department. The psychiatric unit has one bed available. The patient demonstrating which problem should the admitting officer recommend for admission to the hospital?
- A. Experiencing dry mouth and tremor related to side effects of haloperidol
- B. Experiencing anxiety after divorcing a spouse after 10 years of marriage
- C. Has a self-inflicted a superficial cut on the forearm after a family argument
- D. Has begun hearing voices encouraging her to, 'Smother your infant'
Correct Answer: D
Rationale: Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.
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A student nurse prepares to administer oral medication to a patient diagnosed with major depressive disorder. What should the student nurse do when the patient refuses the medication?
- A. Share with the patient, 'I'll get an unsatisfactory grade if I don't give you the medication.'
- B. Tell the patient, 'Refusing your medication is not permitted. You are required to take it.'
- C. Attempt to discuss the patient's concerns about the medication, and report to the staff nurse.
- D. Document the patient's refusal of the medication without further comment.
Correct Answer: C
Rationale: The patient has the right to refuse medication in most cases. The patient's reason for refusing should be ascertained, and the refusal should be reported to a unit nurse. Sometimes refusals are based on unpleasant side effects that can be ameliorated. Threats and manipulation are inappropriate. Medication refusal should be reported to permit appropriate intervention.
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.
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.
A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, 'Only a traitor would make me go to the hospital.' Which solution is best?
- A. Arrange a bed in a local homeless shelter with nightly onsite supervision.
- B. Negotiate a way to provide medication so the patient can remain at home.
- C. Hospitalize the patient until the symptoms have stabilized.
- D. Seek inpatient hospitalization for up to 1 week.
Correct Answer: B
Rationale: Hospitalization may damage the nurse-patient relationship even if it provides an opportunity for rapid stabilization. If medication can be obtained and restarted, the patient can possibly be stabilized in the home setting, even if it takes a little longer. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first because the patient is not dangerous.
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.