FULLY SOLVED MATERIAL
◉ Which situation requires priority intervention on an inpatient
psychiatric unit?
1. A client is threatening to throw the television at another client.
2. A male client wants to use the phone to call his spouse.
3. A client sitting in a chair is delusional and hallucinating
4. A client has refused to eat anything for the last 2 days. Answer:
Answer:
1. A client is threatening to throw the television at another client.
◉ The client diagnosed with bipolar disorder and who is prescribed
lithium, an anti mania medication, is admitted to the psychiatric unit
in an acute manic state. Which intervention should the nurse
implement first?
1. Have the laboratory draw a STAT serum lithium level.
2. Evaluate what behavior prompted the psychiatric admission.
3. Assess and treat the client's physiological needs.
4. Administer STAT dose of lithium to the client.. Answer: Answer:
3. Assess and treat the client's physiological needs.
,◉ The psychiatric unit staff is upset about the new female charge
nurse who just sits in her office all day. One of the staff members
informs the clinical manager indicates a laissez-faire leadership
style?
1. "I will schedule a meeting to discuss the concerns of the charge
nurse."
2. "I hired the new charge nurse and she is doing what I told her to
do."
3. "You and the staff really should take care of this situation on your
own."
4. "I will talk to the charge nurse about your concerns and get back
to you.". Answer: Answer:
3. "You and the staff really should take care of this situation on your
own."
(laissez-faire attitude is an "everybody is driving their own train"
attitude, you guys take care of it)(option 1. is democratic. 2. is an
autocratic style. authoritarian approach. 4. is taking charge of the
situation.)
◉ The mental health worker reports that one of the nurses
threatened to force-fed the male client diagnosed with
schizophrenia if the client did not eat the meal on the lunch tray.
Which action should the charge nurse take first?
1. Tell the MHW that this intervention is part of the client's care plan.
2. Request the nurse to come to the office and discuss the MHW
allegation.
,3. Ask the client what happened between him and the nurse during
lunch.
4. Ask the MHW to write down the situation to submit to the head
nurse.. Answer: Answer:
2. Request the nurse to come to the office and discuss the MHW
allegation.
(never choose an answer like 4. where it suggests you "pass it up" so
that you don't have to deal with the problem. it will be wrong)
◉ The client diagnosed with paranoid schizophrenia is imminently
aggressive and is dangerous to himself, the other clients, and the
psychiatric staff members. The client is placed in a seclusion room.
Which interventions should the psychiatric nurse implement? Select
all that apply.
1. Assess the client every 2 hours for side effects of medication.
2. Tell the client what behavior will prompt the release from
seclusion.
3. Do not notify the client's family of the initiation of seclusion.
4. Explain that the client will be in seclusion room for 24 hours.
5. Instruct the MHW to check the client every 10-15 minutes..
Answer: Answer:
1. Assess the client every 2 hours for side effects of the medication.,
2. Tell the client what behavior will prompt the release from
seclusion., 5. Instruct the MHW to check the client every 10-15
minutes.
, ◉ The psychiatric nurse overhears a MHW arguing with a client
diagnosed with paranoid schizophrenia. Which action should the
nurse implement?
1. Ask the MHW to go to the nurse's station.
2. Tell the MHW to quit arguing with the client.
3. Notify the clinical manager of the psychiatric unit.
4. Report the behavior to the client abuse committee.. Answer:
Answer:
1. Ask the MHW to go to the nurse's station. (first thing you are
going to do is assess situation with the MHW.)
◉ The psychiatric nurse has taken 15 minutes extra for the lunch
break two times in the last week. Which action should the female
clinical manager implement?
1. Take no action and continue to watch the nurse's behavior.
2. Document the behavior in writing and place in the nurse's file.
3. Tell the nurse to check in and out with her when taking lunch.
4. Talk to the nurse informally about taking 45 minutes for lunch..
Answer: Answer:
4. Talk to the nurse informally about taking 45 minutes for lunch.
(Assess)