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Rasmussen: Mental Health Exam 2.
1) A patient with schizophrenia begins to discuss "volmers" hiding in the warehouse at
work. The term "Volmers" should be documented as follows:
a. neologism
b. Concrete thought.
c. Thought Insertion
d. notion of reference - CORRECT ANSWERS
- A neologism is a newly coined word with a special meaning for the patient. "Volmer" is
not an
recognized common noun.
- Concrete thinking is the incapacity to think abstractly.
- Thought insertion is the process of implanting thoughts from others into one's own mind.
- An concept of reference is a form of illusion in which banal events are made personal.
significance.
,2) A patient who has suicidal thoughts is placed on the highest level of suicide prevention.
Which
What steps should the nurse in charge of the patient's care put into the care plan? (More
More than one answer is correct.
a. Keep an arm's length, one-on-one nursing surveillance around the clock. b. Allow
There is no glass or metal on the lunch trays.
c. Keep the patient in visual range while awake. Check every 15-30 minutes as the patient
is asleep.
d. Check the patient's whereabouts every 15 minutes and maintain frequent verbal
contact.
e. Check your location every hour. Make verbal contact at least three times per shift. f.
Remove any potentially hazardous objects from the patient's possession. - That is correct.
ANSWERS: A, B, F.
Individualized observation is required for anyone with limited control over suicidal
thoughts.
- Placing plastic plates on trays and removing possibly dangerous objects from patients'
Possession measures are covered in all levels of suicide prevention.
The following alternatives are used to implement less strict suicide prevention measures.
,3) A patient with schizophrenia urgently states, "I can see the left side of my body.
melding with the wall, then my face appears and fades in the mirror.
The nurse should:
a. Sit close to the sufferer.
b. Place a protective arm around the patient's shoulders. c.
Place one hand on the patient's arm and apply mild pressure.
d. Maintain an appropriate social interaction distance from the patient. - That is correct.
ANSWERS: D Rasmussen: Mental Health Exam 2.
The patient describes experiences that suggest personal boundary issues. A nurse
Maintain an acceptable social distance and do not touch the patient, because the patient is
Concerned about the incapacity to preserve ego boundaries and merging with or being
consumed by
The environment. Physical closeness or touch can cause panic.
4) Which statement suggests a patient with serious depression's most likely attitude on
life?
During the acute stage of the illness? - CORRECT ANSWERS Throughout an
During the acute phase of serious depression, the client may feel worthless and deserving
of negative outcomes.
, personally.
5) A patient with bipolar disorder is currently in the maintenance phase of treatment. The
The patient inquires: "Do I have to keep taking this lithium even though my mood is stable
now?"
Choose the nurse's proper response.
a. "You will be able to stop the medication in about 1 month."
b. "Taking the medication every day helps reduce the risk of a relapse."
c. "Usually patients take medication for approximately 6 months after discharge."
d. "It's unusual that the health care provider hasn't already stopped your medication." -
Correct answers are: B.
Patients diagnosed with bipolar illness may be prescribed lithium continuously to prevent
recurrences. Helping the patient comprehend this requirement will improve drug
adherence.
6) A person has had problems maintaining a job due to clashing with coworkers and
accusing
They are accused of conspiring. Today, the individual exclaims, "They're all trying to
destroy me. Isn't that
True?" Choose the nurse's most therapeutic response.