27 31 St Louis Mosby Varcarolis E Halter M 2009 Essentials of psychiatric

27 31 st louis mosby varcarolis e halter m 2009

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27-31). St. Louis: Mosby. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 480). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Giddens Concepts: Cognition, Clinical Judgment HESI Concepts: Clinical Decision-Making/Clinical Judgment 22.ID: 9476891495 A schizophrenic client is seen seemingly talking to someone who isn’t there. Which nursing statement would be mosttherapeutic initially? ·“You need to wash up and get ready to go to supper in the cafeteria with the other clients now.” ·“I’ve noticed your eyes darting back and forth, and I wondered whether you mightbe hearing voices.” Correct ·“You were telling me yesterday that your mother died last June of cancer. Can youtell me more about that?” ·“Today is my birthday. Would you like to go on an outing with my family?” Rationale: The most therapeutic nursing statement is the one in which the nurse addresses the client’s behavior and asks whether the client is hearing voices. With this statement, the nurse also assesses the client’s behavior. If the client is hearing voices, the nurse prevents reinforcement of the hallucinatory thinking by telling the client that he or she does not hear them. In asking, “Today is my birthday. Would you like to go on an outing with my family?” the nurse nontherapeutically changes the focus from the client. In stating, “You need to wash up and get ready to go to supper in the cafeteria with the other clients now,” the nurse ignores the client’s obvious psychotic behavior and directs the client to socialize with others. Such an intervention is not usually positive, because it floods the client with stimuli that may contribute to an escalation of psychotic behavior. In asking, “You were telling me yesterday that your mother died last June of cancer. Can you tell me more about that?” the nurse uses distraction, summarization, and refocusing.Test-Taking Strategy: Note the strategic words “most” and “initially” and eliminate the options that are unrelated to the client’s behavior. Also, focus on the data in the question. The correct option is the only one that addresses the client’s behavior. Review: care of theclient who is hallucinating .Reference: Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care(pp. 287, 288). St. Louis: Saunders.Cognitive Ability: ApplyingClient Needs: Psychosocial IntegrityIntegrated Process: Communication and DocumentationContent Area: Mental Health Giddens Concepts: Communication, Psychosis
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HESI Concepts: Cognition—Psychosis, Communication Awarded 1.0 points out of 1.0 possible points.
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