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While sitting in the day room of the mental health unit, a male adolescent avoids eye contact, looks at the floor, and talks softly when interacting verbally with the RN. The two trade places, and the RN demonstrates the client’s behaviors. What is the main goal of this therapeutic technique?
- A. Initiate a non-threatening conversation with the client.
- B. Dialog about the ineffectiveness of his interactions.
- C. Allow the client to identify the way he interacts.
- D. Discuss the client’s feelings when he responds.
Correct Answer: C
Rationale: The main goal of the therapeutic technique demonstrated by the RN is to allow the client to identify the way he interacts (Choice C). By mirroring the client's behaviors, the RN provides a reflection of the client's own actions, which can help the client become more self-aware of how he presents himself. This can lead to insight into his own behavior and communication style, facilitating personal growth and potential behavior change.
Choice A is incorrect because the main goal is not just to initiate conversation, but to promote self-awareness. Choice B is incorrect as the focus is not on discussing the ineffectiveness of interactions but rather on self-identification. Choice D is incorrect as the main focus is not on discussing the client's feelings but on allowing the client to recognize his own behavior patterns.
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A mental health worker is caring for a client with escalating aggressive behavior. Which action by the mental health worker warrants immediate intervention by the RN?
- A. Is attempting the physically restrain the patient.
- B. Remains at a distance of 4 feet from the client.
- C. Tells the client to go to the quiet area of the unit.
- D. Is using a loud voice to talk to the client.
Correct Answer: A
Rationale: The correct answer is A because attempting to physically restrain a client with escalating aggressive behavior can escalate the situation further, leading to potential harm to both the client and the mental health worker. Physical restraint should only be used as a last resort and under the guidance of a registered nurse to ensure safety and prevent harm. Choices B, C, and D are not immediate interventions for managing escalating aggressive behavior. Remaining at a distance of 4 feet, telling the client to go to a quiet area, or using a loud voice are not effective strategies to de-escalate the situation and may not address the root cause of the aggression.
When preparing to administer to domestic violence screening tool to a female client, which statement should the RN provide?
- A. If your partner is abusing you, I need to ask these questions.
- B. State law mandates that I ask if you are a victim of domestic violence.
- C. The HCP provider needs to know if you are experiencing any domestic abuse.
- D. All clients are screened for domestic abuse because it is common in our society.
Correct Answer: D
Rationale: The correct answer is D. By stating that all clients are screened for domestic abuse because it is common in society, the nurse normalizes the screening process and reduces stigma. This approach can help the client feel more comfortable disclosing abuse. Choice A may inadvertently imply that the client's partner is abusing them, potentially leading to a defensive response. Choice B may make the client feel obligated to disclose abuse due to legal reasons, which can feel coercive. Choice C is vague and may not convey the importance of screening for domestic violence.
A nurse is caring for a client who was admitted for alcohol disorder. which one of the following require follow uo by the nurse? select all that apply
- A. Cardiac assessment
- B. Smoking history
- C. Genitourinary assessment
- D. Neurological assessment
- F. Client's recent loss
- G. Gastrointestinal assess,ment
Correct Answer: B
Rationale: The correct answer is B: Smoking history. This requires follow-up by the nurse because smoking can exacerbate alcohol-related health issues. The nurse needs to assess smoking habits to provide comprehensive care and address potential risks.
A: Cardiac assessment is important but not specifically related to alcohol disorder.
C: Genitourinary assessment may be important but is not a priority in this case.
D: Neurological assessment is crucial in alcohol disorder but is not the focus of the question.
F: Client's recent loss is important but not directly related to the client's alcohol disorder.
G: Gastrointestinal assessment is relevant but not a priority in this scenario.
During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.
- A. Auditory
- B. Visual
- C. Written
- D. Tactile
Correct Answer: A
Rationale: The correct answer is A: Auditory. During an admission assessment and interview, monitoring auditory communication channels is crucial for gathering information through spoken words, tone, and non-verbal cues like sighs or hesitations. This helps the nurse assess the patient's mental state, emotions, and communication effectiveness. Visual (B), written (C), and tactile (D) channels are not typically monitored during a standard interview, as they may not provide relevant information for the assessment process. Visual cues like body language can be important but are not as essential as auditory cues in this context. Written communication is not typically used in a face-to-face interview, and tactile communication is usually unnecessary unless specific procedures are being performed.
The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:
- A. Lithium (Eskalith)
- B. Clozapine (Clozaril)
- C. Diazepam (Valium)
- D. Amitriptyline
Correct Answer: A
Rationale: The correct answer is A: Lithium (Eskalith). Lithium is known to cause nephrogenic diabetes insipidus, leading to excessive urination and potential dehydration. Therefore, the patient receiving lithium should be carefully assessed for fluid and electrolyte imbalances. Clozapine (B), Diazepam (C), and Amitriptyline (D) do not have a significant impact on fluid and electrolyte balance compared to lithium.