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The nurse manager of the psychiatric unit plans the biweekly, unit-wide interdisciplinary team case conference focused on one particular client. Which client is most important for the manager to select for discussion?
- A. A client who was admitted after a second serious suicide attempt and refuses to talk.
- B. A client toward whom the staff have sharply conflicting attitudes and actions.
- C. A client who experiences hallucinations, takes possessions from other clients, and paces continually.
- D. A client, well known and well liked by staff, whose diagnostic testing reveals a brain tumor.
Correct Answer: A
Rationale: A client with a recent serious suicide attempt who refuses to talk is at high risk for self-harm and requires urgent interdisciplinary discussion to coordinate safety and treatment plans. Other cases, while significant, are less immediately life-threatening.
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The nurse is preparing a plan of care for a client demonstrating mania. Which interventions should be included in the plan of care?
- A. Place the client in seclusion.
- B. Ignore any client complaints.
- C. Use a firm and calm approach.
- D. Use short and concise explanations and statements.
- E. Remain neutral and avoid power struggles and value judgments.
- F. Firmly redirect energy into more appropriate and constructive channels.
Correct Answer: C,D,E,F
Rationale: A client with mania will be extremely restless, disorganized, and chaotic. Grandiose plans are extremely out of touch with reality, and judgment is poor. Interventions for the client in acute mania include using a firm and calm approach to provide structure and control, using short and concise explanations or statements because of the client's short attention span, remaining neutral and avoiding power struggles and value judgments, being consistent in approach and expectations and having frequent staff meetings to plan consistent approaches and to set agreed-on limits to avoid manipulation by the client, hearing and acting on legitimate client complaints, and redirecting energy into more appropriate and constructive channels.
The nurse is caring for a client in the psychiatric unit who has issues with coping and defense mechanisms. The nurse understands that which is true regarding coping and defense mechanisms? Select all that apply.
- A. Coping mechanisms are destructive ways to avoid dealing with reality.
- B. Physical symptoms, general irritability, and self-destructive behaviors are some of the signs of inadequate coping.
- C. Criticizing ineffective defense mechanisms will guide the client toward better coping techniques.
- D. Ineffective coping mechanisms allow anxiety to increase, triggering the client to utilize defense mechanisms in order to protect himself from the anxiety.
- E. The inability to cope can be caused by a lack of an adequate support system, a serious medical diagnosis, situational crises, or a lack of psychological resources.
Correct Answer: B,D,E
Rationale: Coping mechanisms are constructive, not destructive, making A incorrect. Criticizing defense mechanisms is nontherapeutic, making C incorrect. Signs of inadequate coping, anxiety escalation, and causes of poor coping are accurate.
During the nursing assessment, the client states, 'My surgeon just told me that my cancer has spread, and I have less than 6 months to live.' Which nursing response would be the most therapeutic?
- A. I am sorry. Would you like to discuss this with me some more?'
- B. I am sorry. There are no easy answers in times like this, are there?'
- C. I hope you'll focus on the fact that your doctor says you have 6 months to live and that you'll think of how you'd like to live.'
- D. I know it seems desperate, but there have been a lot of breakthroughs. Something might come along in a month or so to change your status drastically.'
Correct Answer: A
Rationale: The client has received very distressing news and is most likely still experiencing shock and denial. In option 1, the nurse invites the client to ventilate feelings. Option 2 is social and expresses the nurse's feelings rather than the client's feelings. Option 3 is patronizing and stereotypical. Option 4 provides social communication and false hope.
A client who has a history of depression has been prescribed nadolol for the management of angina pectoris. Which consideration is most important when the nurse plans to counsel this client about the effects of this medication?
- A. Risk of tachycardia
- B. Probability of fatigue
- C. High incidence of hypoglycemia
- D. Possible exacerbation of depression
Correct Answer: D
Rationale: Clients with depression or a history of depression have experienced an exacerbation of depression after beginning therapy with beta-adrenergic blocking agents. These clients should be monitored carefully if these agents are prescribed. The medication would cause bradycardia rather than tachycardia. Fatigue is a possible side effect, but it is not the most important item. Hypoglycemia is a sign that is masked with beta blockers.
The client angrily tells the nurse that the primary health care provider (HCP) purposefully provided incorrect information. Which responses by the nurse to the client support therapeutic communication?
- A. I'm certain that the HCP would not lie to you.
- B. I'm not sure what you mean by that statement.
- C. Can you describe the information that you are referring to?
- D. Do you think it would be helpful to talk to your doctor about this?
- E. You can check the information on lots of websites on the Internet.
Correct Answer: B,C,D
Rationale: Options 2 and 3 attempt to clarify the information to which the client is referring. Option 4 attempts to explore whether the client is comfortable talking to the HCP about this issue and encourages direct confrontation. Options 1 and 5 hinder communication by disagreeing with the client and referring the client to the Internet instead of his HCP for clarification. This technique could make the client defensive and block further communication.