Nokea
For which patient is the nurse most likely to need to schedule a pre-ECT workup and teaching?
- A. Patient A, who is newly diagnosed with dysthymic disorder
- B. Patient B, who has melancholic depression that responded well to ECT 2 years ago
- C. Patient C, who was unresponsive to a 6-week trial of SSRI antidepressant therapy
- D. Patient D, who has depression associated with diagnosis of inoperable
Correct Answer: D
Rationale: The nurse is most likely to need to schedule a pre-electroconvulsive therapy (ECT) workup and teaching for Patient D, who has depression associated with the diagnosis of an inoperable brain tumor. In such cases, ECT may be considered as a treatment option due to the severity of the depression and the limitations in using other treatments. Before ECT can be initiated in a patient with such complex medical conditions, it is crucial to conduct a thorough evaluation and preparation process, which includes obtaining informed consent, assessing the patient's medical history, conducting pre-ECT laboratory tests, and providing patient and family education about the procedure. Given the unique circumstances of Patient D's inoperable brain tumor, the nurse must ensure all necessary steps are taken to ensure the safety and efficacy of ECT as a treatment option.
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A friend says to a nurse, “I am not going to get vaccines for my baby. I hear that vaccines cause autism.” The nurse’s best reply is:
- A. The exact cause of autism is not really known
- B. It’s believed that autism is really a result of birth trauma
- C. There is no conclusive evidence to connect autism to vaccinations.
- D. Please tell me more about where you got that information about autism?
Correct Answer: C
Rationale: This response provides factual, evidence-based information to address the common misconception linking vaccines to autism. It is clear and reassuring for the parent.
An advance directive gives legally binding direction for health care interventions when a patient:
- A. Has a new diagnosis of cancer.
- B. Is diagnosed with Parkinson's disease
- C. Diagnosed with amyotrophic lateral sclerosis is unable to speak.
- D. Is unable to make decisions for self because of illness.
Correct Answer: D
Rationale: An advance directive is used when a patient is unable to make their own healthcare decisions, typically due to a serious illness or injury. This legal document outlines the patient’s wishes for treatment and care.
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.
A patient returned from attending the service memorializing his wife, who died after a sudden illness. Although those around him were visibly saddened, he smiled and remained in control. He refused support from friends, stating, “I can handle anything that comes my way.” The patient’s behavior is an example of grief.
- A. Inhibited
- B. Distorted
- C. Conflicted
- D. Normal
Correct Answer: B
Rationale: The patient's behavior of smiling and remaining in control while refusing support from friends, despite attending a service memorializing his wife's death, is indicative of distorted grief. In distorted grief, individuals may show seemingly inappropriate reactions or behaviors that do not align with the typical grieving process. The patient's avoidance of accepting support and expression of excessive self-reliance in the face of a significant loss suggest a distorted way of coping with grief. In normal grief, individuals may experience a range of emotions and accept support from others as they navigate through the grieving process.
A novice mental health nurse shares that, “I’ll never get used to playing cards or other games with patients. It seems like a poor use of scarce nursing time.” The best response for the nurse’s mentor would be:
- A. “Perhaps you’ll want to rethink your transfer to this unit if you’re really uncomfortable.”
- B. “Your comments make a point about scarce resources. I’ll ask the treatment team to review our position on activities.”
- C. “Activity co-leadership puts us in a position to help patients develop social skills and support them as they take small risks.”
- D. “Managed care has cost us activities therapists. Activities are
Correct Answer: C
Rationale: The best response for the nurse’s mentor would be to highlight the importance of activities in mental health nursing. Participating in activities such as playing cards or games with patients is not just about passing time, but it also serves a therapeutic purpose. Engaging in activities helps patients to develop social skills, build relationships, and take small risks in a safe environment. As mental health nurses, it is crucial to understand that these activities are not a waste of time but rather an essential part of the therapeutic process. By participating in activities with patients, nurses can actively support their mental well-being and contribute to their overall treatment and recovery.