Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the
community with serious and persistent mental illness? Within 3 months, the patient will:
a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time.
B
Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role
performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of
meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect
options focus on the classic medical model rather than recovery.
A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce.
Select the nurse's most caring comment.
a. "Let's discuss some means of coping other than suicide when you have these feelings."
b. "I understand why you're so depressed. When I got divorced, I was devastated too."
c. "You should forget about your marriage and move on with your life."
d. "How did you get so depressed that hospitalization was necessary?"
A
The nurse's communication should evidence caring and a commitment to work with the patient. This
commitment lets the patient know the nurse will help. Probing and advice are not helpful or therapeutic
interventions.
In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which
comment by the nurse who receives the report best demonstrates advocacy?
a. “This is a psychiatric hospital. Craziness is what we are all about.”
b. “Let’s all show acceptance of this patient by wearing lots of makeup too.”
c. “Your comments are inconsiderate and inappropriate. Keep the report objective.”
d. “Our patients need our help to learn behaviors that will help them get along in society.”
D
Accepting patients' needs for self-expression and seeking to teach skills that will contribute to their well-
being demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take
,action to ensure that others are not prejudiced against the patient. Humor can be appropriate within the
privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a
critical way will create conflict. Nurses must show compassion for each other.
A nurse assesses a newly admitted patient with depression. Which statement is an example of
"attending"?
a. "We all have stress in life. Being in a psychiatric hospital isn't the end of the world."
b. "Tell me why you felt you had to be hospitalized to receive treatment for your depression."
c. "You will feel better after we get some antidepressant medication started for you."
d. "I'd like to sit with you a while so you may feel more comfortable talking with me."
D
Attending is a technique that demonstrates the nurse's commitment to the relationship and reduces
feelings of isolation. This technique shows respect for the patient and demonstrates caring.
Generalizations, probing, and false reassurances are nontherapeutic.
A patient shows the nurse an article from the Internet about a health problem. Which characteristic of
the web site's address most alerts the nurse that the site may have biased and prejudiced
information?
a. Address ends in ".org."
b. Address ends in ".com."
c. Address ends in ".gov."
d. Address ends in ".net."
B
Financial influences on a site are a clue that the information may be biased. ".com" at the end of the
address indicates that the site is a commercial one. ".gov" indicates that the site is maintained by a
government entity. ".org" indicates that the site is nonproprietary; the site may or may not have reliable
information, but it does not profit from its activities. ".net" can have multiple meanings.
A nurse says, "When I was in school I learned to call upset patients by name to get their attention, but
I read a descriptive research study that says that this approach doesn't work. I'm going stop calling
patients by name." Which statement is the best appraisal of this nurse's comment?
a. One descriptive research study rarely provides enough evidence to change practice.
b. Staff nurses apply new research findings only with the help from clinical nurse specialists.
c. New research findings should be incorporated into clinical algorithms before using them in practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
A
Descriptive research findings provide evidence for practice but must be viewed in relation to other
studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of
,evidence. Clinical algorithms use flow charts to manage problems and do not specify one response to a
clinical problem. Classic tenets of practice should change as research findings provide evidence for
change.
Two nursing students discuss career plans after graduation. One student wants to enter psychiatric
nursing. The other student asks, "Why would you want to be a psychiatric nurse? All they do is talk.
You'll lose your skills." Select the best response by the student interested in psychiatric nursing.
a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios
must be better because of the nature of patients' problems."
b. "Psychiatric nurses use complex communication skills, as well as critical thinking, to solve
multidimensional problems. I'm challenged by those situations."
c. "I think I'll be good in the mental health field. I do not like clinical rotations in school, so I don't want
to continue them after I graduate."
d. "Psychiatric nurses don't have to deal with as much pain and suffering as medical surgical nurses.
That appeals to me."
B
The practice of psychiatric nursing requires a different set of skills than medical surgical nursing,
although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical
and mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient
ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric
nursing involves clinical practice, not simply documentation. Psychosocial pain is real and can cause as
much suffering as physical pain.
Which research evidence would most influence a group of nurses to change their practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway
B
Research findings are graded using a hierarchy of evidence. A systematic review of randomized
controlled trials is Level A and provides the strongest evidence for changing practice. Expert committee
recommendations and descriptive studies lend less powerful and influential evidence. A critical pathway
is not evidence; it incorporates research findings after they have been analyzed.
A bill introduced in Congress would reduce funding for the care of people with mental illnesses. A
group of nurses write letters to their elected representatives in opposition to the legislation. Which
role have the nurses fulfilled?
a. Advocacy
b. Attending
, c. Recovery
d. Evidence-based practice
A
An advocate defends or asserts another's cause, particularly when the other person lacks the ability to
do that for him- or herself. Examples of individual advocacy include helping patients understand their
rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and
publication in the interest of improving the individuals with mental illness; the letter-writing campaign
advocates for that cause on behalf of patients who are unable to articulate their own needs.
An informal group of patients discuss their perceptions of nursing care. Which comment best indicates
a patient's perception that his or her nurse is caring?
a. "My nurse always asks me which type of juice I want to help me swallow my medication."
b. "My nurse explained my treatment plan to me and asked for my ideas about how to make it better."
c. "My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon."
d. "My nurse spends time listening to me talk about my problems. That helps me feel like I'm not
alone."
D
Caring evidences empathic understanding, as well as competency. It helps change pain and suffering into
a shared experience, creating a human connection that alleviates feelings of isolation. The remaining
options give examples of statements that demonstrate advocacy or giving advice.
A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The
patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource
should the treatment team consult for information on more effective medications for this patient?
a. Clinical algorithm
b. Clinical pathway
c. Clinical practice guideline
d. International Statistical Classification of Diseases and Related Health Problems (ICD)
A
A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from
large databases of information. These guidelines help the treatment team make decisions cognizant of
an individual patient's needs, such as ethnic origin, age, or gender. A clinical pathway is a map of
interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best
practices about specific health problems. The ICD classifies diseases.
Which historical nursing leader helped focus practice to recognize the importance of science in
psychiatric nursing?
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