Test-Taking Strategy: The subject of the question specifically relates to safety. Use the process of elimination to answer the question. Thinking about the purpose of seclusion will assist in directing you to the correct option. Review seclusion procedures if you had difficulty with this question. Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 587, 588). St. Louis: Mosby. Cognitive Ability: Evaluating Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Evaluation Content Area: Mental Health Question 54 1 / 1 pts A nurse is preparing a discharge plan for a client who has attempted suicide. The nurse understands that the plan of care should focus on: Contracts and immediate available crisis resources
Follow-up appointments Encouraging the family to always be with the client Providing the hospital phone number Rationale: Crises may occur between appointments. Contracts help make clients feel responsible for keeping their promises, giving them a feeling of control. Encouraging the family to always be with the client is unrealistic. Follow-up appointments and providing phone numbers will not ensure immediate crisis intervention. Test-Taking Strategy: The subject of the question is the availability of immediate resources for the client when needed. Eliminate the option that contains the close- ended word “always.” Next, eliminate the options that will not necessarily provide immediate resources. Also note the word “immediate” in the correct option. Review discharge planning for a client who has attempted suicide if you had difficulty with this question. Reference: Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 418). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Planning Content Area: Mental Health Question 55 1 / 1 pts
A nurse observes that a client is pacing back and forth. The nurse asks the client how she is feeling, and the client responds by telling the nurse that she feels out of control! Which intervention is most appropriate initially to maintain a safe environment? Continuing to monitor the client Restraining the client Placing the client in seclusion Moving the client to a quiet room and talking about her feelings Rationale: The anxiety symptoms demonstrated by this client require some form of intervention. Moving the client to a quiet place decreases environmental stimuli, and talking gives the nurse an opportunity to identify the cause of the client s feelings and determine the appropriate interventions. Seclusion or restraint is not appropriate. Test-Taking Strategy: Use the process of elimination. Eliminate the options that are comparable or alike (restraint and seclusion). From the remaining options, select the option that addresses the client s feelings. Additionally, note that the final incorrect
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- Fall '15
- mental health, Saunders, Stuart