chapters 1-4 PN MENTAL HEALTH NURSING fully solved

chapters 1-4 PN MENTAL HEALTH NURSING1.American Nurses Association American Psychiatric Nurses Associates 3.International Society of Psychiatric-Mental Health Nurses - correct answer Provision of Care to clients in mental health settings based on which standards? what various methods should nurses use to collect data from clients? - correct answer observation, interviewing, physical examinations and collaboration. psychosocial history includes - correct answer perception of own health, beliefs about illness and wellness-activity/leisure activities, how the client passes times- use of substances/substance use disorder- stress level and coping abilities- usual coping strategies, support systems. - cultural beliefs and practices level of consciences is described using the following terms and observed behavior included in documentation - correct answer alert, lethargy, stupor, coma( decorticate rigidity, decelerate rigidity) alert - correct answer the client is responsive and able to fully respond by opening her eyes and attending to a normal tone of voice and speech. The client answers questions spontaneously and appropriately. lethargy - correct answer the client is able to open her eyes and respond but is drowsy and falls asleep readily. stupor - correct answer the client requires vigorous or painful stimuli to elicit a brief response: example would be pinching a tendon or rubbing the sternum. coma - correct answer no response can be achieved from repeated painful stimuli abnormal posturing in the client who is comatose - correct answer two types: decorticate rigidity and decerebrate rigidity decorticate rigidity - correct answer flexion and internal rotation of upper-extremity joints and legs decelerate rigidity - correct answer neck and elbow extension, wrist and finger flexion physical appearance - correct answer examination includes observation of personal hygiene, grooming and clothing choice. Excepted findings are that the client is well-kept, clean, and dressed appropriately for the given environment. behavior - correct answer examination includes observation of voluntary and involuntary body movements, and eye contact. Mood and affect mood - correct answer a clients mood provides information about the emotion that she is feeling. affect - correct answer a clients affect is an objective expression of mood, such as a flat affect or a lack of facial expression . cognitive and intellectual abilities - correct answer *collect data regarding the clients orientation time, person and place. - immediate (( ask the client to repeat a series of numbers or a list of objects) -Recent(ask the client to recall recent events, such as visitors from the current day or the purpose of the current mental health appointment or admission) -remote( ask the client to state a fact from his past that is verifiable, such as his birth date or his mothers maiden name) *check the clients level of knowledge for example, ask him what he knows about his current illness or hospitalization *Perform an objective data collection regarding of the clients perception of his illness * check the clients judgment based on a hypothetical questions.