NR 607 Week 2: Questions & Answers: Latest Updated A+ Guide Solution

Art is a 52-year-old who presents to the clinic for a routine follow-up appointment. He has a history of schizophrenia with a lack of insight, impulsivity, and previous violent behavior. As the interview begins, Art states that he has had homicidal ideations toward his brother and nephew. He states that the two men have "disrupted his thinking" by "creating a new theory of family," and he is worried that the only solution is to kill them both. Currently, Art is calm and cooperative with disorganized thought content and fixed delusions; his appearance is slightly disheveled. He denies substance use and does not appear inebriated. He denies a specific plan to kill his brother and nephew and denies access to firearms. He endorses that he stopped taking his medications two weeks ago because he no longer needs them and does not think he needs additional assistance at this time. Which of the following is the most a (Ans - begin the involuntary admission process Rationale: The most appropriate management strategy for Art is to begin the involuntary admission process. Art has homicidal ideations and a history of impulsivity and prior violence. He does not recognize the need for treatment. Therefore, the process for involuntary admission should be implemented. Consideration should also be made as to whether Art's family should be notified of his threats. Because Art is currently calm and cooperative, de-escalation techniques are not necessary. Amir is a 28-year-old who was brought to the ED by law enforcement after his mother called 911 due to his bizarre behaviors. When the police arrived, Amir was agitated and wandering the street naked. He refused to follow directions and became combative with officers when approached. He was handcuffed and transported by a squad car. Before transfer, his mother told police that Amir had a history of schizophrenia with treatment nonadherence and marijuana use. During the ride to the ED, Amir was calm and cooperative. He was transferred to a gurney in the triage area without incident, but after transfer to an exam room, Amir began screaming and threatening the PMHNP and staff member. Amir tried to punch and spit at them when they approached the bedside. Which of the following are the most appropriate management strategies for Amir? Select all that apply. -begin the involuntary admission process -use de-escalation technician (Ans – -use de-escalation techniques -request additional staff support -medicate with intramuscular lorazepam 0.5 mg -remove objects from the room, such as monitors, tray tables, or other equipment, that the client may use to injure himself or others Rationale: Amir presents a risk of harm to self and others due to his combative behavior; therefore, the most appropriate management strategies for Amir include the use of de-escalation techniques, request for additional staff support, intramuscular lorazepam 0.5 mg, and the removal of objects from the room, such as monitors, tray tables, or other equipment, that he may use to injure himself or others. Chemical restraint may be necessary. Additional staff should be requested to provide support, and de-escalation techniques should be attempted. Items the client may be used to injure himself or others should be secured or removed. Physical restraints may be necessary and should be applied by the emergency department team, not law enforcement