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The head nurse on a unit that serves persons with cognitive impairment is concerned about her staff, many of whom seem to be becoming 'burned out' by their challenging work. Which response by the head nurse is most likely to minimize staff frustration and burnout on the unit? Select all that apply.
- A. Educate staff regarding realistic expectations for this patient population.
- B. Arrange for 12-hour shifts so that staff can have more days off per week.
- C. Guide staff to use small, realistic goals as their measure of patient progress.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A because educating staff about realistic expectations for working with persons with cognitive impairment can help them understand the challenges they may face and develop appropriate coping strategies. This knowledge can reduce frustration and burnout by promoting a better understanding of the patients' needs and behaviors.
Choice B, arranging for 12-hour shifts, may actually increase staff burnout as longer shifts can be physically and mentally taxing. Choice C, guiding staff to use small, realistic goals, while helpful in patient care, may not directly address staff burnout. Therefore, the most effective approach to minimize staff frustration and burnout in this scenario is education on realistic expectations.
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A patient with schizophrenia tells the nurse 'I don't know, it's just all the same. You never know. It comes, it goes, it blows away. Get it?' The best response for the nurse to make would be:
- A. Nothing you are saying is clear; you are not making sense.'
- B. Yes, life can be like that sometimes, very confusing.'
- C. Try to organize your thoughts and then tell me again.'
- D. I am having difficulty understanding what you are saying.'
Correct Answer: D
Rationale: The correct answer is D because it reflects active listening and acknowledges the patient's communication difficulties without being dismissive. By stating difficulty in understanding, the nurse shows empathy and openness to further clarification. Choice A is incorrect as it may be perceived as judgmental. Choice B is incorrect as it does not address the patient's communication challenges. Choice C is incorrect as it places the responsibility solely on the patient without offering support.
A 32-year-old client with an admitting diagnosis of catatonic schizophrenia has been mute and motionless for 2 days. The priority nursing diagnosis is:
- A. Risk for deficient fluid volume
- B. Impaired physical mobility
- C. Impaired social interaction
- D. Ineffective coping
Correct Answer: A
Rationale: The correct answer is A: Risk for deficient fluid volume. The priority nursing diagnosis in this case is to address the client's physical needs to ensure their safety and well-being. The client's mutism and immobility put them at risk for dehydration and malnutrition. By prioritizing the risk for deficient fluid volume, the nurse can address the immediate physiological needs of the client.
Choice B: Impaired physical mobility is incorrect because while the client is motionless, the immediate concern is addressing the risk of dehydration.
Choice C: Impaired social interaction is incorrect as addressing social interaction is not the priority when the client's physical needs are not being met.
Choice D: Ineffective coping is incorrect because the client's presentation is indicative of a more urgent physical need for hydration and nutrition.
A client with anorexia nervosa has refused meal trays and supplemental feedings for 3 days following admission to the general hospital. The nurse can anticipate that intervention will include:
- A. IV infusions beginning immediately and continuing for 48 hours after client begins eating.
- B. Tube feedings until the client eats 90% of all meals for 1 day.
- C. Placing the client on suicide precautions and one-to-one observation.
- D. Limiting peer group visitors for 2 weeks.
Correct Answer: B
Rationale: The correct answer is B. Tube feedings until the client eats 90% of all meals for 1 day. This intervention is appropriate for a client with anorexia nervosa who is refusing to eat. Tube feedings ensure adequate nutrition while also encouraging the client to resume eating orally. It is a gradual approach that aims to transition the client back to regular eating habits.
Explanation for why other choices are incorrect:
A: IV infusions are not the first-line intervention for a client with anorexia nervosa refusing to eat. This choice does not address the underlying issue of the client's refusal to eat.
C: Placing the client on suicide precautions and one-to-one observation is not indicated solely based on refusal to eat. This choice does not address the nutritional needs of the client.
D: Limiting peer group visitors for 2 weeks does not address the client's refusal to eat and is not a relevant intervention in this situation.
A nurse cares for a rape victim who was given flunitrazepam (Rohypnol) by the assailant. Which intervention has priority? Monitoring for:
- A. Coma
- B. Seizures
- C. Hypotonia
- D. Respiratory depression
Correct Answer: D
Rationale: The correct answer is D: Respiratory depression. Flunitrazepam is a sedative-hypnotic drug that can cause central nervous system depression, leading to respiratory depression, which is life-threatening. Monitoring respiratory status is crucial to prevent respiratory failure.
A: Coma may occur but is a consequence of severe respiratory depression, hence monitoring respiratory status is more critical.
B: Seizures are not a common side effect of flunitrazepam and do not pose immediate life-threatening risks compared to respiratory depression.
C: Hypotonia (muscle weakness) is a potential side effect but does not require immediate intervention like respiratory depression.
In summary, monitoring for respiratory depression is the priority as it can lead to respiratory failure and death, while the other choices are not as immediately life-threatening.
Which of the following should the nurse consider when planning care for a client with antisocial personality disorder? Clients with antisocial personality disorder:
- A. Demand constant attention
- B. Tolerate frustration well
- C. Have well-developed superegos
- D. Are initially often charming
Correct Answer: D
Rationale: The correct answer is D: Are initially often charming. This is because individuals with antisocial personality disorder often exhibit charm and charisma to manipulate others for personal gain. This behavior is known as "charm offensive" and can be used to deceive and exploit others. This initial charm can make it difficult for others to recognize their true motives and manipulative nature.
Incorrect options:
A: Demand constant attention - Individuals with antisocial personality disorder may appear self-centered and manipulative but not necessarily demand constant attention.
B: Tolerate frustration well - Clients with antisocial personality disorder often have difficulty managing frustration and may resort to aggressive or impulsive behavior.
C: Have well-developed superegos - Individuals with antisocial personality disorder typically lack empathy and have a weak or underdeveloped superego, leading to a disregard for social norms and the rights of others.