Nokea
Which intervention does the nurse include in the plan of care for a client from a different culture?
- A. Being respectful of the client's needs.
- B. Expecting non-adherent behavior.
- C. Monitoring for difficulty with dietary restrictions.
- D. Offering a firm handshake upon leaving the client.
Correct Answer: A
Rationale: Respecting the client's cultural needs promotes trust and effective care, ensuring culturally sensitive interventions. Expecting non-adherence is biased, monitoring dietary restrictions is too specific, and a handshake may not be culturally appropriate.
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When developing Jerry's plan of care, which of the following would NOT be helpful to include?
- A. Limiting choices
- B. Providing structure
- C. Encouraging patient input
- D. Ensuring availability of PRN medications
Correct Answer: A
Rationale: Limiting choices would not be helpful in Jerry's plan of care. Providing options, even if among limited choices, offers the patient a sense of independence rather than imposing control. Providing structure is crucial, especially in transitioning from a psychiatric to a medical-surgical unit. Encouraging patient input in identifying triggers and effective methods for managing aggressive impulses is essential for empowerment and individualized care. Ensuring the availability and prompt delivery of PRN medications gives the patient a sense of control and security, assuring access to necessary medication when needed.
Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper"? for no reason, starts "ranting"? and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes?
- A. Schizophrenia
- B. Post-traumatic stress disorder (PTSD)
- C. Bipolar disorder
- D. Delusional disorder
Correct Answer: C
Rationale: Bipolar disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes. This disorder is highly co-morbid with substance use, which can worsen the prognosis. While schizophrenia may involve aggression, it is not typically associated with mood episodes like mania that characterize bipolar disorder. Post-traumatic stress disorder (PTSD) is primarily characterized by re-experiencing traumatic events, avoidance behaviors, and hyperarousal, but not the distinct mood episodes seen in bipolar disorder. Delusional disorder is characterized by fixed false beliefs without the mood changes seen in bipolar disorder. Therefore, the correct answer is Bipolar disorder.
Identify the type of 'trigger' with the correct 'trigger' that can possibly lead to disturbed behavior.
- A. Emotional: room coldness
- B. Environmental: boredom
- C. Physical: pain
- D. Communication: silence
Correct Answer: C
Rationale: Physical pain is a common trigger that can lead to disturbed behavior in individuals, especially when they are unable to communicate their pain effectively. Choices A, B, and D are incorrect. Room coldness falls under environmental triggers, boredom is associated with emotional triggers, and silence is a communication aspect rather than a direct trigger for disturbed behavior.
The best way for a healthcare provider and a healthcare facility to control the effects of poor and disruptive patient behavior is to _________________.
- A. prevent it
- B. restrain the patient
- C. medicate the patient
- D. isolate the patient
Correct Answer: A
Rationale: The most effective approach to managing poor and disruptive patient behavior is by preventing it proactively. This involves implementing strategies, communication techniques, and environmental modifications that address the underlying causes of the behavior. Restraint, medication, and isolation should only be used as a last resort when the patient or others are at risk of harm. Restraint and isolation are primarily used to ensure safety, while medication, especially when used solely to control behavior, can have adverse effects and is considered a measure of last resort. Therefore, prevention is crucial in promoting a therapeutic environment and fostering positive patient outcomes.
Why might a nurse manager suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions?
- A. Individuals with this disorder respond well to small therapeutic groups.
- B. Therapeutic group work tends to be threatening to individuals who are suspicious.
- C. Compliance with unit rules and medication regimens increases as therapeutic group involvement increases.
- D. Involvement in small therapeutic groups may decrease the regression and dependency associated with institutionalization.
Correct Answer: B
Rationale: The nurse manager would suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions because individuals who are suspicious find group settings threatening. Paranoid individuals struggle in groups as they may not trust others enough to engage effectively and tolerate the necessary interactions for group therapy. Therefore, the correct answer is that therapeutic group work tends to be threatening to individuals who are suspicious. Choices A, C, and D are incorrect. While some individuals with schizophrenia may respond well to small therapeutic groups, those with paranoid delusions may find them threatening. Compliance with unit rules and medication regimens may not necessarily increase with group therapy, especially for acutely ill psychiatric clients not ready to accept reality. Involvement in small therapeutic groups is not primarily aimed at decreasing regression and dependency associated with institutionalization, making it an inappropriate option for the client's specific needs.