NUR 2459 / NUR2459 Exam 2: Mental and Behavioral Health Nursing Exam 2 Questions and Answers 100% Correct with Rationales

NUR 2459 / NUR2459 Exam 2: Mental and Behavioral Health Nursing Exam 2 Questions and Answers 100% Correct with Rationales A patient with schizophrenia begins to talks about "volmers" hiding in the warehouse at work. The term "volmers" should be documented as: a. neologism b. concrete thinking c. thought insertion d. idea of reference ANS: A - A neologism is a newly coined word having special meaning to the patient. "Volmer" is not a known common noun. - Concrete thinking refers to the inability to think abstractly. - Thought insertion refers to thoughts of others that are implanted in one's mind. - An idea of reference is a type of delusion in which trivial events are given personal significance. • A patient with suicidal impulses is placed on the highest level of suicide precautions. Which measures should be incorporated into the plan of care by the nurse caring for the patient? (More than one answer is correct.) a. Maintain arm's-length, one-on-one nursing observation around the clock. b. Allow no glass or metal on meal trays. c. Keep patient within visual range while awake. Check every 15 to 30 minutes while the patient is sleeping. d. Check the patient's whereabouts every 15 minutes and make frequent verbal contacts. e. Check whereabouts every hour. Make verbal contact at least three times each shift. f. Remove all potentially harmful objects from the patient's possession. ANS: A, B, F 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 suicide precautions. The remaining options are used in less stringent levels of suicide precautions. • A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears