Chapter 05: Psychiatric Mental Health Nursing in Acute Care Settings Flashcards
Inpatient hospitalization for persons with mental illness is generally reserved for which of the following patients?
a. Patients who present a clear danger to self or others
b. Patients who are noncompliant with medication at home
c. Patients who have limited support systems in the community
d. Patients who develop new symptoms during the course of an illness
ANS: A
Hospitalization is justified when the patient is a danger to self or others, or is unable to meet his or her basic needs, placing the individual at imminent risk of harming self. The distracters do not necessarily describe patients who require inpatient treatment.
A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the nurse learned that the patient received a notice of eviction immediately prior to admission. Select the nurse’s most appropriate action.
a. Postpone the patient’s discharge from the hospital.
b. Contact the landlord who evicted the patient to further discuss the situation.
c. Arrange a temporary place for the patient to stay until new housing can be arranged.
d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.
ANS: C
Poverty, stigma, unemployment, and lack of appropriate housing are identified as major barriers to recovery of mental health. The nurse needs to consider these gaps when planning discharge for patients from acute care settings as the gaps can delay discharge and
increase the likelihood of readmission. None of the other options is a viable alternative.
A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was hospitalized for 5 days. The patient’s thoughts are now more organized, and discharge is planned. The patient’s family says, “It’s too soon for discharge. We will just go through all this again.” Which of the following should the nurse do?
a. Ask the case manager to arrange a transfer to a long-term care facility.
b. Notify hospital security to handle the disturbance and escort the family off the unit.
c. Explain that the patient will continue to improve if the medication is taken regularly.
d. Contact the health care provider to meet with the family and explain the discharge rationale.
ANS: C
Patients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to advocate for the patient’s right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. The nurse can handle this matter.
A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor’s closet is locked. These observations relate to which of the following?
a. Coordinating care of patients
b. Management of milieu safety
c. Management of the interpersonal climate
d. Use of therapeutic intervention strategies
ANS: B
Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse’s concerns, are unrelated to the observations cited.
The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted?
a. The patient who is feeling anxiety and a sad mood after separation from a spouse of 10 years.
b. The patient who self-inflicted a superficial cut on the forearm after a family argument.
c. The patient experiencing dry mouth and tremor related to taking haloperidol (Haldol).
d. The patient who is a new parent and hears voices saying, “Smother your baby.”
ANS: D
Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.
A nurse surveys medical records. Which finding signals a violation of patients’ rights?
a. A patient was not allowed to send letters to family.
b. A patient’s belongings were searched at admission.
c. A patient with suicidal ideation was placed on continuous observation.
d. Physical restraint was used after a patient was assaultive toward a staff member.
ANS: A
The patient has the right to send and receive communication. Inspecting patients’ belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self.
Which principle has the highest priority when addressing a behavioural crisis in an inpatient setting?
a. Suspend the patients’ rights until the crisis is resolved.
b. Swift intervention is justified to maintain the integrity of a therapeutic milieu.
c. Rights of an individual patient are superseded by the rights of the majority of patients.
d. Patients should have opportunities to regain control without intervention if the safety of others is not compromised.
ANS: A
A patient’s rights are suspended only in circumstances where protection of the patient or others is a priority. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.
Clinical pathways are used in managed care settings to do which of the following?
a. Stabilize aggressive patients
b. Identify obstacles to effective care
c. Relieve nurses of planning responsibilities
d. Streamline the care process and improve outcomes
ANS: D
Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and improve outcomes. Care pathways do not identify obstacles or stabilize aggressive patients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier.
Which aspect of direct care is an experienced, inpatient registered nurse most likely to provide for a patient?
a. Hygiene assistance
b. Diversional activities
c. Assistance with job hunting
d. Building assertiveness skills
ANS: D
Building assertiveness skills is provided by the psychoeducational skills of the nurse. Assistance with personal hygiene would usually be accomplished by a health care aide. Diversional activities are usually the province of recreational therapists. The patient would probably be assisted in job hunting by a social worker or occupational therapist.
Which of the following scenarios best depicts a behavioural crisis?
a. A patient is waving fists, cursing, and shouting threats at a nurse.
b. A patient is curled up in a corner of the bathroom, wrapped in a towel.
c. A patient is crying hysterically after receiving a phone call from a family member.
d. A patient is performing push-ups in the middle of the hall, forcing others to walk around.
ANS: A
This behaviour constitutes a behavioural crisis because the patient is threatening harm to another individual. Intervention is called for to defuse the situation. The other options speak of behaviors that may require intervention of a less urgent nature because the patients in question are not threatening harm to self or others.
A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, “I don’t know what to do with my free time.” Which member of the treatment team would be most helpful to this patient?
a. Psychologist
b. Social worker
c. Recreational therapist
d. Occupational therapist
ANS: C
Recreational therapists help patients use leisure time to benefit their mental health. Occupational therapists assist with a broad range of skills, including those for employment. Psychologists conduct testing and provide other patient services. Social workers focus on the patient’s support system.
A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated patients’ rights?
a. Prohibited a patient from using the telephone
b. In patient’s presence, opened a package mailed to patient
c. Remained within arm’s length of patient with homicidal ideation
d. Permitted a patient with psychosis to refuse oral psychotropic medication
ANS: A
The patient has a right to use the telephone for communication. The patient should be protected against possible harm to self or others. Patients have rights to send and receive mail and be present during package inspection. Patients have rights to refuse treatment.
The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be included in the final version of the admission policy? Select all that apply.
a. Clear risk of danger to self or others
b. Adjustment needed for doses of psychotropic medication
c. Detoxification from long-term heavy alcohol consumption needed
d. Respite for caregivers of persons with serious and persistent mental illness
e. Failure of community-based treatment, demonstrating need for intensive treatment
ANS: A, C, E
Medication doses can be adjusted on an outpatient basis. The goal of caregiver respite can be accomplished without hospitalizing the patient. The other options are acceptable, evidence-informed criteria for admission of a patient to an inpatient service.
A psychiatric nurse discusses rules of the therapeutic milieu and patients’ rights with a newly admitted patient. Which rights should be included? (Select all that apply.)
a. The right to vote
b. The right to confidentiality
c. The right to a private room
d. The right to complain about inadequate care
e. The right to select the nurse assigned to their care
ANS: A, B, D
Patients’ rights should be discussed shortly after admission. Patients have rights related to voting, confidentiality and filing complaints about inadequate care. Patients do not have a right to a private room or selecting which nurse will provide care.
