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The nurse is assessing a group of patients on an inpatient psychiatric unit. The patient?s history for which of the following would the nurse identify as the strongest indicator of risk for violence?
- A. Panic disorder
- B. Problematic anxiety
- C. Somatoform disorder
- D. Violent behavior
Correct Answer: D
Rationale: A history of violent behavior is the strongest indicator of future violence risk, as past behavior is a reliable predictor of future actions in psychiatric assessments. Panic disorder, problematic anxiety, and somatoform disorder may contribute to emotional distress but are not as directly correlated with violent behavior.
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The nurse is caring for an older patient in a residential care facility. The patient has been extremely irritable the entire day. When modifying the patient?s plan of care, which of the following would be an appropriate snack to offer the patient to decrease the irritability?
- A. Chocolate candy bar
- B. Handful of raisins
- C. Granola bar
- D. Glass of milk
Correct Answer: D
Rationale: A glass of milk is an appropriate snack for an older patient experiencing irritability. Milk contains tryptophan, which can promote calmness by aiding serotonin production. Chocolate candy bars and granola bars may contain high sugar, potentially worsening irritability, while raisins, though healthy, lack the calming nutrients found in milk.
A unit in an inpatient psychiatric facility is experiencing an increase in violence episodes by patients. A group of nurses working on this unit is developing a plan to address this issue. When developing this plan which of the following would the nurses most likely address as the problem areas? Select all that apply.
- A. Inconsistent unit activities
- B. Medication power struggles
- C. Empathetic staff response
- D. Clear set boundaries
- E. Little patient participation in treatment plan
Correct Answer: A,B,E
Rationale: Inconsistent unit activities, medication power struggles, and little patient participation in treatment plans can contribute to increased violence by creating uncertainty, conflict, or disengagement. Empathetic staff responses and clear boundaries are protective factors, not problem areas.
A son brings his father to the clinic and tells the nurse that his father has begun to act strangely in the past few days and has unprovoked outbursts of anger. After the incidents, the father expresses remorse for his outburst. The son says, I?ve never seen him act this way. Which question would be most appropriate for the nurse to ask next?
- A. Does your father have a history of an anxiety disorder such as panic disorder?
- B. Has your father exhibited previous problems expressing anger appropriately?
- C. Has your father suffered any traumatic injury to his brain recently?
- D. Has your father injured the back of his head or neck in the past week?
Correct Answer: C
Rationale: Asking about recent traumatic brain injury is most appropriate, as sudden behavioral changes, such as unprovoked anger outbursts in an older adult with no prior history, may indicate a neurological issue, such as a brain injury. The other options are less likely to explain the sudden onset of symptoms.
While interviewing a patient, a nurse asks, What do you do when you get angry? Which patient response would indicate to the nurse that the patient engages in anger suppression?
- A. I?ve been known to fly off the handle when I?m angry.
- B. People say I withdraw and pout about the problem.
- C. I usually approach the person directly to talk about it.
- D. I try to discuss how I?m feeling about it with a close friend.
Correct Answer: B
Rationale: Withdrawing and pouting indicate anger suppression, as the patient avoids expressing anger directly. Flying off the handle suggests explosive anger, while direct discussion or confiding in a friend indicates healthier anger expression.
An advanced practice psychiatric nurse is preparing to conduct a support group for psychiatric-mental health nurses who have been assaulted by patients. Which of the following would the nurse need to keep in mind with this group?
- A. Nurses experience a conflict between the role of caregiver and victim.
- B. Nurses who are victims often go on to prosecute the patient attackers.
- C. Nurses actively express the feelings associated with patient assaults.
- D. Nurses as victims of patient assaults rarely experience guilt or shame.
Correct Answer: A
Rationale: Nurses assaulted by patients often experience a conflict between their caregiver role and victim status, leading to emotional distress. Prosecution is uncommon, feelings may not always be actively expressed, and guilt or shame are common, making A the most accurate.