1. the psychiatric nurse on an inpatient acute unit notices a patient pacing the floor looking side-to-side quickly. what should the psychiatric nurse do first?
A. call the practitioners.
B. Medicate the patient.
c. use therapeutic communication.
D. Place the patient in the seclusion room.
2. a 53-year-old female patient is nearing discharge from an inpatient acute unit.
the patient was admitted 15 days ago for chronic depression following 2 months of noncompliance with medication. the patient lives alone in an apart- ment that is subsidized by social services. the social worker wants the patient to move to a group home where she can have assisted living and socialize with her peers. the patient approaches the psychiatric nurse and asks what she should do. how should the psychiatric nurse respond?
A. Tell the patient that she will enjoy living in the group home because others will be there to help her.
B. Tell the patient that she should live independently but needs to take her med- ication as prescribed by the practitioner.
c. Tell the patient to speak with the social worker.
D. help the patient process her options, letting the patient make the final decision.
3. a 73-year-old male patient is wandering the hallway in the dementia unit dur- ing dinner time. the hallway is lined with many doors, some opening to patient rooms and others to closets. all doors are clearly marked. what should the psy- chiatric nurse do first?
A. Take the patient to the dining room.
B. Ask the patient if he needs to use the bathroom.
c. Ask if he is a little confused.
D. Medicate the patient.
4. a 34-year-old man is admitted to the acute inpatient unit with a diagnosis of schizophrenia paranoid type. he arrives in a wheelchair, and then stands at the nurse’s station staring in all directions. the psychiatric nurse introduces herself and the patient stares silently in her direction. what should the psychiatric nurse do first?
A. Medicate the patient.
B. call the practitioner.
c. calmly walk the patient into the seclusion room.
D. Maintain a friendly tone and calmly explain the admission process and explain any activity that the patient may be seeing around the nurse’s station.
5. a 63-year-old divorced woman and mother of four adult children is admitted voluntarily to an acute inpatient unit for detoxing from Xanax. the patient says,
“i get a little anxious since all my kids moved out of the house 4 years ago. My doctor prescribed me Xanax to help me.” according to the report from the emer- gency department, the patient was prescribed a 30-day supply of Xanax and she used the entire supply in 3 days. the patient has six practitioners each pre- scribing Xanax unbeknown to the others. the patient is careful to have prescrip- tions filled in different pharmacies throughout the county to prevent pharmacists from discovering her plan. the patient tells the psychiatric nurse,
“i don’t know why they put me here with all these drug addicts. i’m not one of them. My doctor prescribed me my medication.” what is the best explanation for the patient’s statement?
A. The patient is displaying the distorted defense mechanism.
B. The high dose of Xanax has made the patient delusional.
c. The patient is displaying dissociation defense mechanism.
D. The patient is displaying the undoing defense mechanism.
6. a 20-year-old man brought to the acute inpatient unit was diagnosed with major depression disorder. two days before admission to the unit, the patient told his mother that he did not want to live anymore since his girlfriend broke up with him over the weekend. the patient’s mother called the police who convinced the patient to go to the emergency department for medication.
the patient calmly told the er psychiatrist that he had no suicide plan and really had no intention to kill himself. with some arm twisting, the patient agreed to be admitted for overnight observation. early the next morning the patient tells the psychiatric nurse that he is ready to go home. what is the best response?
A. i’ll get your paperwork ready now. you’ll be discharge in a couple of hours.
B. Talk to the psychiatrist.
c. you cannot be discharged for 48 hours.
D. Speak with the psychiatrist. The psychiatrist can discharge you or ask you to stay for further observation or treatment. if you disagree with the psychiatrist, you can sign a 48-hour notice that informs the psychiatrist that you want to be discharged within the next 48 hours. According to our state law, the psychiatrist must discharge you at the end of the 48 hours if the psychiatrist does not feel you are a danger to yourself or others.
the patient had been noncompliant with medication for 2 months. the patient was committed to the acute involuntary unit of the hospital. Four weeks after being medicated the patient showed normal behavior but remained involun- tary. the charge psychiatric nurse asked a new psychiatric nurse to have the patient sign consent forms. what is the best response?
A. The new psychiatric nurse should explain the consent form to the patient and ask the patient to sign the form.
B. The new psychiatric nurse should tell the charge psychiatric nurse that the pa- tient is not competent to sign the form because she is an involuntary patient.
c. The new psychiatric nurse should assess the patient to determine if the patient is competent. if so, then the nurse should explain the consent form to the pa- tient and ask the patient to sign the form.
D. The new psychiatric nurse should tell the charge psychiatric nurse that she is not comfortable asking the patient to sign the document.
8. a 33-year-old male patient admitted to an acute inpatient unit for anxiety dis- order had a verbal altercation with another patient over selection of a television program for evening viewing. the psychiatric nurse separated the patients. the 33-year-old male patient walked the hallway shouting and flaring his arms.
what is the psychiatric nurse’s first response?
A. Medicate the patient.
B. Place the patient in the seclusion room in four-point restraints.
c. Place the patient in the seclusion room.
D. use active listening and therapeutic communication to de-escalate the patient.
9. a new psychiatric nurse is conducting the admission assessment with a 24-year- old female patient diagnosed with bipolar i disorder and borderline personal- ity. the patient is calm and cooperative. on report the new psychiatric nurse learns that the patient stopped taking medication 1 month ago and voluntarily took herself to the hospital to have her medication adjusted. the only inter- viewing area available was in a vacant social worker’s office down the hallway from the nurse’s station. the new psychiatric nurse sat at the desk located in the center of the room and the patient sat in a chair near the door. the door was open during the interview. all the other patients were in group therapy while the interview was being conducted. upon learning of the assessment, the charge psychiatric nurse reprimanded the new psychiatric nurse. why was it necessary to reprimand the new psychiatric nurse?
A. The new psychiatric nurse was using the social worker’s office for the assessment.
B. The new psychiatric nurse placed herself at risk.
c. The new psychiatric nurse violated hiPAA law.
D. The charge psychiatric nurse had no cause to reprimand the new psychiatric nurse.
10. a 42-year-old single woman, living alone, was brought to the emergency department by her sister. her sister received a call from the patient’s employer saying that the patient had missed work for the past week and he was con- cerned about her safety. her sister found the patient lying in bed, the apart- ment was in disarray, dishes were unwashed in the sink, and the patient had poor hygiene. the patient told her sister that she had lost interest in everything over the past several months. all she wanted to do was sleep. what should the psychiatric nurse in the emergency department do first?
A. Place the patient on constant observation knowing that a patient with depres- sion may attempt suicide.
B. Ask the practitioner if she wants to order a thyroid test panel.
c. Ask the practitioner if she wants to order a cT scan of the brain.
D. Prepare the paperwork so the practitioner can commit the patient.