Test Bank: Variables Affecting the Therapeutic Environment: Violence and Suicide Keltner: Psychiatric Nursing, 8th Edition,100% CORRECT

Document Content and Description Below

Test Bank: Variables Affecting the Therapeutic Environment: Violence and Suicide Keltner: Psychiatric Nursing, 8th Edition MULTIPLE CHOICE 1. A student tells the school nurse, “My friend thr... eatened to take an overdose of pills.” The nurse talks to the friend who verbalized the suicidal threat. What is the most critical question for the nurse to ask? a. “Why do you want to kill yourself?” b. “Do you have access to medications?” c. “Have you been taking drugs and alcohol?” d. “Did something happen with your parents?” ANS: B The nurse must assess the patient’s access to a means to carry out the plan and, if there is access, alert the parents to remove the medications from the home. The information in the other questions is important to ask, but it is not the most critical. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 2. A tearful patient at the mental health center says, “I should be dead.” What is the most important first task for the nurse in assessing this patient? a. Ascertain the lethality of the suicide plan. b. Establish a rapport with the patient. c. Determine the risk factorNs foRr suIicidGe. B.C M d. Encourage expression of feUelinSgs. N T O ANS: B Establishing rapport will allow the nurse to obtain relevant assessment data such as the presence of a suicide plan, lethality of plan, and presence of risk factors for suicide. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 3. A patient being treated at the mental health center says, “I am having thoughts about suicide.” What is the nurse’s most therapeutic response? a. “Thank you for telling me, but there’s nothing to worry about. We will handle it together.” b. “Telling me about these feelings is a very positive action on your part.” c. “It’s important for you to be hospitalized as soon as possible.” d. “Let’s talk about the things you have to live for.” ANS: B This response gives the patient reinforcement and validation for making a positive response rather than acting out a suicidal impulse. It gives neither advice nor false reassurance, and it does not imply stereotypes such as “You have a lot to live for.” It uses the patient’s ambivalence and sets the stage for more realistic problem-solving. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 4. Select the most appropriate comment by the nurse when a depressed patient says, “What’s the use in going on?” a. “Are you thinking about suicide?” b. “I am not sure I understand what you are saying.” c. “Keep your hope alive. It’s always darkest just before light.” d. “Tell me more about your activities before you got depressed.” ANS: A The possibility of suicide must be openly addressed. The patient often feels relieved to be able to talk about suicidal ideation. The subject must be addressed directly. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 5. A nurse counsels a patient who made a suicide attempt 3 days ago. What is the nurse’s most therapeutic response? a. “I’m glad you voluntarily admitted yourself to the hospital. We can help you here.” b. “When you have bad feelings, try to remember the good things about your life.” c. “You must take control of your problems and try to find solutions.” d. “Let’s discuss some ways to solve your most important problem.” ANS: D The nurse helps the patient to develop effective coping skills. Assist the patient to reduce the overwhelming effects of problems by generating and testing ways to solve them. The distracters present overwhelming approaches to problem-solving. DIF: Cognitive level: ApplyinNg R I GTOBP:.CNursMing process: Implementation MSC: Client Needs: Psychosocial Integrity 6. When assessing a patient’s plan for suicide, what aspect has priority? a. Patient’s cultural heritage b. Patient’s insight into suicidal motivation c. Availability of means and lethality of method d. Quality and access to an intact social support system ANS: C If a person has definite plans that include choosing a method of suicide readily available to the person, and if the method is one that is lethal (i.e., will cause the person to die with little probability for intervention), the suicide risk is considered high. These areas provide a better indication of risk than the areas mentioned in the other options. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity 7. Which emotion experienced by a patient should be assessed by the nurse as most predictive of an increased suicide risk? a. Anger b. Elation c. Sadness d. Hopelessness ANS: D Of the feelings listed, hopelessness is most closely associated with increased suicide risk. Depression, aggression, impulsivity, and shame are other feelings noted as risk factors for suicide. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity 8. Four individuals have suicide plans. Which plan evidences the highest risk for completed suicide? a. Drinking dishwashing detergent before a family meal b. Jumping from a suspension bridge in a rural location late at night c. Cutting the wrists in the bathroom while a patient’s spouse reads in the next room d. Overdosing on acetaminophen 1 hour before the patient’s spouse is expected home from work ANS: B The correct response presents a highly lethal method with little opportunity for rescue. The other options are lower lethality methods with higher rescue potential. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity 9. A novice nurse on an inpatient psychiatric unit says to a colleague, “My newest patient has been diagnosed with schizophrenia. At least I won’t have to monitor for a suicide risk.” Select the colleague’s most accurate response. a. “Our structured milieu provides a safe environment for all patients, regardless of their suicide risk.” NURSINGTB.COM b. “Delusions usually protect a patient with schizophrenia from thinking about suicide.” c. “Suicide is a higher risk for adolescents than for patients with schizophrenia.” d. “Any mental illness substantially increases the risk of suicide.” ANS: D Up to 15% of patients with schizophrenia and other mental illnesses die from suicide, more than adolescents or older adults. Delusions offer no protection. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. A depressed patient admitted following a suicide attempt by overdose of sedatives states, “I don’t feel like signing your papers. My partner should have let me die.” What level of suicide precautions should the nurse apply? a. No precautions because the patient is in a secure setting b. Routine observation that is appropriate for all patients c. One-to-one continuous supervision by staff members d. Observation by staff members every 15 minutes ANS: C One-to-one constant supervision is appropriate for suicidal patients who are considered at high risk—those who still have suicidal ideation, those who are angry that an attempt failed, or those who refuse to participate in their own care by agreeing to talk with staff before harming themselves. The other options are not appropriate for a patient whose suicide risk is high. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 11. A suicide crisis line caller states, “I called to say goodbye to someone.” What is the nurse’s best response? a. “You seem ambivalent about committing suicide. Let’s talk about that.” b. “You must be feeling a lot of pain. What are you planning to do?” c. “I hope you realize how much you have to live for.” d. “I think I can help you, if you’ll let me.” ANS: B Expressing empathy and genuine concern while offering to work with the patient is a good beginning. Asking about the plan is appropriate and enables the nurse to assess risk. The other options fail to offer both empathy and help. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 12. How does the social-psychological models describe aggression? a. Intentional harm toward others b. An unhealthy way of managing anxiety c. A conflict with others expNrUesRseSdIagNgGreTssBiv.elCyOM d. A response to frustration in the social environment ANS: D Social-psychological models of aggression focus on the interaction of individuals with their environment and locate the source of anger in interpersonal requirements and frustrations. The other options are not consistent with this model. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity 13. A patient is shouting loudly and is verbally aggressive. What analysis should the nurse make about this behavior? a. It is acceptable if directed toward staff but not toward another patient. b. It is not harmful and might prevent the patient from physically acting out. c. It is a significant warning sign that the patient may become physically aggressive. d. It allows the patient to vent frustration and alleviate stress without hurting anyone. ANS: C Research findings indicate that verbally aggressive attacks on others are among the major warning signs of assault and battery, making the other answers mutually exclusive. Verbal aggression is part of the assault cycle. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: Client Needs: Psychosocial Integrity 14. The nurse cares for a patient who was verbally aggressive upon admission. Three days later the patient says, “My family put me here. They wanted to get rid of me.” When should the nurse be most vigilant for signs of escalating aggression? a. During one-on-one sessions b. During group activities c. During visiting hours d. In the early morning ANS: C Patients are more likely to become aggressive at admission, at shift change, at mealtimes, during visiting hours, during the evening, when being transported, and during periods of change. In this case the patient will probably be increasingly upset if the family does not visit, because it will reinforce her thinking that they are against her. She is also likely to become increasingly upset if they do visit, because she accuses them of unfairly hospitalizing her. The other times are possible, but research has not supported them as being exceptionally high risk. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 15. A patient is becoming increasingly tense, pacing the hall, alternately whispering, and shouting. Other patients receive hostile, suspicious glares as they walk by. Which phase of the assault cycle is the patient demonstrating? a. Crisis phase b. Triggering phase c. Escalation phase d. Depression phase ANS: B NURSINGTB.COM The triggering phase is characterized by increased tension, readiness to retaliate, pacing, irritability, suspiciousness, glaring, breathing changes, and diaphoresis. The other stages are defined by behaviors specific to the stage and are not described in the scenario. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity 16. A patient is increasingly tense, pacing the hall and glaring angrily at others. What is the nurse’s best response to this patient’s behavior? a. “It looks as though you are feeling upset. Please tell me what’s concerning you.” b. “I can see you are on the verge of losing control. What can I do to help you?” c. “You must maintain control of your feelings even if you are feeling angry.” d. “I’m going to give you an injection of your medication to prevent loss of control.” ANS: A In the triggering phase the patient’s behaviors are nonviolent and present no immediate danger to others. The nurse should convey empathic support and encourage ventilation using clear, calm, and simple statements. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 17. A patient has entered the escalation phase of the assault cycle. What is the most appropriate nursing intervention in order to manage the situation? a. Direct the patient to the quiet room. b. Process the incident with the patient. c. Encourage ventilation of feelings. d. Place the patient in seclusion. ANS: A During the escalation phase the patient is still capable of cooperation when the nurse takes charge and gives calm, firm directions. This intervention observes the principle of using the least restrictive alternative. Oral PRN medication might be used if the least restrictive alternative is not effective. Ventilation of feelings would have been used in the triggering phase. Processing the incident occurs in the recovery and depression phases. Seclusion is necessary in the crisis phase. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 18. Which principle guides nursing intervention in the assault cycle? a. Contagiousness of violence b. Least restrictive alternative c. Containment d. Control ANS: B It is a regulatory requirement to care for patients using the least restrictive alternatives. These efforts at treatment should be documented. Only when less restrictive alternatives prove ineffective can more restrictiNveUaRltSerInaNtiGveTs Bbe.uCseOdM. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 19. A patient’s behavior has continued to escalate despite nursing interventions designed to achieve de-escalation. The patient begins to kick and strike at staff. This behavior evidences which phase of the assault cycle? a. Triggering b. Depression c. Escalation d. Crisis ANS: D The crisis phase is characterized by a patient’s loss of self-control with fighting, hitting, kicking, scratching, biting, and throwing things. Each of the other phases has selected characteristics, none of which were described in the scenario. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: Client Needs: Safe, Effective Care Environment 20. A patient whose behavior has continued to escalate despite nursing interventions begins to kick and strike out at the nurse. What is the priority nursing intervention? a. Offering an oral PRN medication b. Having staff stand by at a distance c. Physically controlling the patient’s behavior d. Allowing the behavior until the patient de-escalates ANS: C When a patient loses control, staff must take physical control to prevent injury to the patient or others. A determination must then be made as what measures are necessary (intramuscular medication, involuntary seclusion, or restraint), keeping in mind the importance of using the least restrictive alternatives that will achieve the goal of safety. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 21. The nurse in charge of a crisis team determines that a patient who has lost control requires restraint. What is the most important factor in the safe and effective use of physical restraint? a. A calm, well-trained staff b. Taking the patient off guard c. Administering an antipsychotic drug d. Talking to the patient throughout the procedure ANS: A Six to eight staff members are required. Each must know his or her role. With training, staff can carry out the various functions smoothly and calmly. Calmness helps ensure that physical contact is protective, rather than aggressive. Hospital protocols and legal requirements must be observed. The other options are either less important elements or inappropriate. 22. 22. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment N R I G B.C M A patient has been placed in four-point leather restraints following a violent episode. The nurse establishing the care plan must ensure that the restraints are removed according to what guidelines? a. After a minimum of 4 hours of seclusion b. Every 2 hours, one restraint at a time, for 10 minutes c. To allow the patient to eat, drink, or use the bathroom d. After the patient is sedated with antipsychotropic medication ANS: B Restraints must be removed at intervals specified by agency protocol (in no case less often than 2 hours) to inspect for injuries, check circulation, and provide limb range of motion. The other options do not follow regulatory policies. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: Client Needs: Physiologic Integrity 23. Staff members take an aggressive patient to seclusion. Before leaving the patient in the room, what priority action should be implemented? a. Removing potentially harmful objects from the patient b. Requiring the patient to use the bathroom c. Having the patient lie on the bed d. Offering the patient fluids ANS: A Use of seclusion promotes safety, so removal of harmful objects is necessary. Seclusion is also designed to decrease stimulation. The patient might be asked if he or she needs to go to the bathroom but will not be forced to do so. In some facilities there is no bed in the room, only a mattress on the floor. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 24. A nurse who has worked on an acute psychiatric unit for 5 years has begun describing patients in insensitive ways and is less creative when dealing with patient problems. What is the most likely explanation for the nurse’s behavior? a. Marginalization b. Depersonalization c. Secondary traumatization d. Poor conflict management skills ANS: C Secondary traumatization occurs as a result of listening to and empathizing with other people’s traumas. Synonyms include compassion fatigue and helper stress. The individual becomes less able to help others. Clinical supervision is indicated. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: Client Needs: Psychosocial Integrity 25. Which management practice should the clinical nurse leader of a psychiatric unit implement to enhance the therapeutic environment? a. Encourage staff efficiency and time management. b. Emphasize timely and coNmUprRehSeInsNivGeTdoBc.umCeOnMtation. c. Prepare a comprehensive policy and procedure manual. d. Implement positive reinforcement for upholding professional standards. ANS: D Institutional constraints and bureaucracy affect the caring ethic of nurses. Positive reinforcement for upholding nursing’s professional standards is a management practice that supports nursing and will contribute positively to the therapeutic environment. The other options are not supportive of nursing. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 26. Which nursing intervention for an angry, hostile patient would best contribute to prevention and management of aggression? a. Loudly calling the patient by name b. Conveying personal interest in the patient c. Positioning oneself directly in front of the patient d. Firmly directing the patient to discontinue the behavior ANS: B Research has indicated that the nurse’s ability to be with the patient as a unique person in a unique situation is essential for dealing with potentially violent patients. De-escalation techniques include listening, empathizing, using a calm voice, offering alternatives rather than ultimatums, and conveying genuine interest in the patient and his or her well-being. The other options listed are not therapeutic. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 27. Which characteristic of an inpatient unit organizational culture predisposes the highest risk for patient violence and aggression? a. Staff behaving in an authoritarian manner b. High degree of structural flexibility c. Feeling of safety among patients d. Bland colors used in decor ANS: A An important variable affecting the risk of aggression is staff attitude. A higher risk for assault is present for staff with authoritarian attitudes. Such attitudes demean patients, who might act out in anger or defense against feeling depersonalized and powerless. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 28. For which situation would clinical supervision be most important in assuring safety? a. A patient asks to visit with the consumer advocate. b. A new clinical nurse leader is hired to reorganize the unit. c. A newly admitted patientNmUaRkeSsIa NneGaTrlyBl.etChaOl Msuicide attempt. d. The treatment model for the unit is changed by the psychiatrist in charge. ANS: C Clinical supervision for staff can be a tool to facilitate improved staff cohesion, morale, and ability to maintain therapeutic relationships with patients. During clinical supervision, nurses examine attitudes, reactions, and conflicts with patients on the unit and find ways of approaching problems. Nurses often require clinical supervision when working with suicidal patients. The distracters do not pose hazards to patients’ well-being. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 29. An experienced staff nurse describes feeling emotionally burdened and yet engages actively in gossip and spreading rumors about other staff members. The clinical nurse leader can assess these behaviors as consistent with what condition? a. Antisocial personality disorder b. Mild-to-moderate depression c. Depersonalization d. Burnout ANS: D Burnout often produces a clinical picture similar to the one described in this question. Depression cannot be diagnosed based on this information, nor can one suggest that the behavior is antisocial. Depersonalization is a symptom of burnout. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Safe, Effective Care Environment 30. A psychiatric nurse is demonstrating characteristics of burnout. What effect would be expected on patients under this nurse’s care? a. They will feel unsafe. b. They will feel empowered. c. They will feel a sense of impaired d. They will feel a sense of universality with the nurse. ANS: C A nurse who is burned out will not spend adequate time with patients, which reduces trust. Patients feel devalued, demoralized, and powerless, and they express low levels of satisfaction with care. The patient’s sense of safety and security is jeopardized. The patient looks to the nurse as a caregiver; universality is not desirable in this instance. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: Client Needs: Psychosocial Integrity 31. A staff nurse tells a peer, “I find it difficult to deal with patients who have personality disorders. They can control their behavior, whereas patients with depression truly need my services.” What is the peer’s most helpful response? a. “Even though it’s bothering you, the patients seem to like you.” b. “Our clinical nurse specialist is a good resource to help you explore those feelings.” c. “Fortunately, managed care has reduced inpatient services for people with personality disorders.” NURSINGTB.COM d. “Your comment tells me you have personal problems. Maybe psychiatric nursing is not the best practice arena for you.” ANS: B Clinical supervision can help nurses examine attitudes, reactions, and conflicts with patients on the unit and arrive at new ways of approaching patient problems. This option is the only one that recognizes that the nurse is voicing a legitimate problem for which help should be available. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Psychosocial Integrity 32. Which scenario presents a high risk for violence? a. A nurse empathizes with a patient who dislikes attending exercise class. b. A nurse enforces the rule that patients must attend all scheduled activities. c. A patient spends free time with a group of other patients talking about issues in their lives. d. A patient with high anxiety is allowed to remain in a quiet room instead of attending a community meeting. ANS: B Being forced into a treatment activity reduces trust in staff. Struggles over rules are control battles. Patients who do not feel that they have control over their lives might react violently, because they believe that they have little to lose. The other options do not exemplify control battles. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 33. Which expression of suicidality is most acute in nature? a. Threat b. Gesture c. Ideation d. Attempt e. Completion ANS: C Suicidality exists on a continuum, beginning with ideation and then progressing to threats, gestures, attempts, and finally completed suicide. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: Client Needs: Safe, Effective Care Environment MULTIPLE RESPONSE 1. What common themes apply to persons who have suicidal ideation? (Select all that apply.) a. Belief that life is meaningless b. Absolute intention to die c. Existence of cognitive impairment d. Experiencing hopelessness e. Feeling out of control ANS: A, D Hopelessness, meaninglessness, and feeling out of control are the most common themes underlying suicidal ideation. The other options reflect myths about suicide. Not all who attempt suicide are intent on dying. Not all are cognitively impaired. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity 2. A patient with suicidal impulses is placed on suicide precautions. Which measures will the nurse incorporate into the plan of care? (Select all that apply.) a. Allow no glass or metal on meal trays. b. Remove all potentially harmful objects. c. Maintain continuous one-on-one nursing observation. d. Check the patient’s whereabouts every 15 minutes, and make frequent verbal contacts. e. Keep the patient within visual range while he or she is awake, and check every 15 to 30 minutes while asleep. ANS: A, B, C One-on-one observation is necessary for anyone who has limited control over suicidal impulses. Plastic dishes on trays and the removal of potentially harmful objects from the patient’s possession are measures included in any level of suicide precautions. The distracters are insufficient to assure the patient’s safety. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment NURSINGTB.COM [Show More]

Last updated: 5 months ago

Preview 1 out of 23 pages