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Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises?
- A. Resolve behavioral crises using the least restrictive intervention possible.
- B. Rights of the majority of patients supersede the rights of individual patients.
- C. Swift intervention is justified to maintain the integrity of the therapeutic milieu.
- D. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.
Correct Answer: A
Rationale: The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patient's legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.
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A student nurse prepares to administer oral medication to a patient diagnosed with major depressive disorder. What should the student nurse do when the patient refuses the medication?
- A. Share with the patient, 'I'll get an unsatisfactory grade if I don't give you the medication.'
- B. Tell the patient, 'Refusing your medication is not permitted. You are required to take it.'
- C. Attempt to discuss the patient's concerns about the medication, and report to the staff nurse.
- D. Document the patient's refusal of the medication without further comment.
Correct Answer: C
Rationale: The patient has the right to refuse medication in most cases. The patient's reason for refusing should be ascertained, and the refusal should be reported to a unit nurse. Sometimes refusals are based on unpleasant side effects that can be ameliorated. Threats and manipulation are inappropriate. Medication refusal should be reported to permit appropriate intervention.
Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for a patient presenting with what characteristic?
- A. Presents a clear danger to self or others.
- B. Consistently noncompliant with medications at home.
- C. Has no reliable support systems in the local community.
- D. Develops new symptoms during the course of an illness.
Correct Answer: A
Rationale: Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The incorrect options do not necessarily describe patients for whom less restrictive treatment is indicated.
A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, 'Only a traitor would make me go to the hospital.' Which solution is best?
- A. Arrange a bed in a local homeless shelter with nightly onsite supervision.
- B. Negotiate a way to provide medication so the patient can remain at home.
- C. Hospitalize the patient until the symptoms have stabilized.
- D. Seek inpatient hospitalization for up to 1 week.
Correct Answer: B
Rationale: Hospitalization may damage the nurse-patient relationship even if it provides an opportunity for rapid stabilization. If medication can be obtained and restarted, the patient can possibly be stabilized in the home setting, even if it takes a little longer. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first because the patient is not dangerous.
A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, 'I'm willing to take my medicine, but I forgot to get my prescription refilled.' Which outcome should the nurse add to the plan of care?
- A. Nurse will obtain prescription refills every 90 days and deliver them to the patient.
- B. Patient's spouse will mark dates for prescription refills on the family calendar.
- C. Patient will report to the hospital for medication follow-up every week.
- D. Patient will call the nurse weekly to discuss medication-related issues.
Correct Answer: B
Rationale: The nurse should use the patient's support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary if the patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as he or she continues to take the medications as prescribed. No patient issues except failure to obtain medication refills were identified.
A nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following?
- A. Housing adequacy and stability
- B. Income adequacy and stability
- C. Family and other support systems
- D. Early psychosocial development
- E. Substance abuse history and current use
Correct Answer: A,B,C,E
Rationale: Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment.