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When leading a therapeutic group, the nurse demonstrates an understanding of the need to act as the group’s executive when:
- A. Restating rules when a new member joins
- B. Being available to orient the new members
- C. Helping a member defuse the anger they are experiencing
- D. Offering personal opinions on group topics
Correct Answer: A
Rationale: When leading a therapeutic group, the nurse's role as the group's executive involves setting and maintaining boundaries, ensuring adherence to the group's rules, and creating a safe and structured environment for all members. Restating rules when a new member joins helps to establish expectations and maintain consistency within the group. It allows the nurse to assert authority and guide the group in a direction that is conducive to therapeutic progress. By upholding the rules and boundaries of the group, the nurse helps to create a sense of safety and trust among the members, allowing for open and productive communication and shared growth.
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Which strategy will the nurse include in the plan of care for a 6-year-old child for whom operant conditioning has been recommended?
- A. Periodically asking the child to attempt increasingly difficult puzzles
- B. Consistently offering praiseace their dirty dishes in the sink
- C. Expecting the child to rinse and place their dirty dishes in the sink
- D. Conditioning the child to expect punishment when misbehaving
Correct Answer: B
Rationale: Operant conditioning, based on Skinner’s theory, involves reinforcing desired behaviors. Positive reinforcement (praise) encourages repetition of the behavior.
A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a client’s electroconvulsive therapy (ECT) procedure. What is the rationale for administering this medication?
- A. Robinul decreases anxiety during the ECT procedure.
- B. Robinul induces an unconscious state to prevent pain during the ECT procedure
- C. Robinul prevents severe muscle contractions during the ECT procedure.
- D. Robinul decreases secretions to prevent aspiration during the ECT procedure.
Correct Answer: D
Rationale: Glycopyrrolate is an anticholinergic that reduces salivation and other secretions, which helps to prevent aspiration during ECT, where muscle relaxants are used.
A new nurse asks the mentor, “How can I be sure I’m developing a therapeutic environment for my unit?” The mentor uses as a basis for the response the fact that a therapeutic milieu is characterized by:
- A. Rigid adherence to timelines and unit routine
- B. Relaxation of boundaries when doing so is accepted by all
- C. Working with a member to help improve their communication skill
- D. The focus of the staff is directed to the most critically disturbed patients
Correct Answer: D
Rationale: A therapeutic milieu is characterized by focusing on the needs and goals of the patients. By establishing specific patient-centered goals that are agreed upon mutually by the patient and the staff, it ensures that the care provided is individualized and tailored to the patient's needs. This approach fosters a collaborative and empowering environment where the patient feels heard and supported in their recovery journey. It also promotes a sense of ownership and accountability for both the patient and the staff in working towards these goals together. In contrast, rigid adherence to timelines and unit routine (option A) may not always take into account the unique needs of each patient, and relaxation of boundaries (option B) can potentially compromise the therapeutic process by blurring professional boundaries. Therefore, establishing patient-centered goals is a key component of creating a therapeutic environment on a nursing unit.
The community health nurse is visiting a patient diagnosed with dysfunctional grieving since the death of his wife and child over a year ago. Which actions should the nurse implement first?
- A. Promote interaction with others.
- B. Assess risk of self-directed violence.
- C. Facilitate expression of feelings related to the loss.
Correct Answer: B
Rationale: Assessing the risk of self-directed violence is the priority when dealing with a patient diagnosed with dysfunctional grieving. Individuals experiencing complicated grief may be at an increased risk for self-harm or suicidal ideation. By assessing the risk of self-directed violence first, the nurse can ensure the patient's safety and provide appropriate interventions if necessary. Once the risk is assessed and managed, the nurse can then proceed with other interventions such as promoting interaction with others and facilitating the expression of feelings related to the loss.
A 19-year-old patient with undifferentiated schizophrenia is acutely psychotic. The nurse assesses the primary deficit as:
- A. Social isolation
- B. Disturbed thinking
- C. Altered mood states
- D. Poor impulse control
Correct Answer: B
Rationale: Acute psychosis primarily affects thought processes, evidenced by delusions or disorganized thinking.