Psychiatric Nursing Degree Questions - Violent Behavior (11-17)

Psychiatric Nursing Degree Questions

Situation: B. a 50-year old stockbroker, is transferred to the psychiatric unit after treatment for a self-inflicted gunshot wound to the chest. Although he has recovered from the physical injury, he continues to express suicidal ideation. B. was recently divorced by his wife of 25 years, and he is estranged from his 24 year old son and 22 year old daughter.

11. Which action is the nurse's highest priority during the initial patient interview?

a) asking B. about the nature of his suicide attempt and whether he still has an active plan for it
b) allowing B. to talk about his son and daughter
c) encouraging B. to discuss his medical and psychiatric history
d) persuading B. to use more appropriate coping mechanisms

12. B. asks the nurse, "What do I have to live for? My wife left me and my children hate me. I'm all alone." Which response is most therapeutic?

a) you are a successful businessman. Don't you get satisfaction from your work?
b) have you tried to contact your family since your accident?
c) what do you think you have to live for?
d) you sound so hopeless. Are you saying you think suicide is your only option?

13. B. is on constant one-to-one observation. He complains that he cannot sleep with someone sitting next to him, looking at him every minute. How should the nurse reply?

a) you are on strict suicide precautions and must be observed at all times
b) why don't you discuss this with your physician? Maybe he can assign someone to sit outside your room
c) your treatment plan requires constant observation for your safety. Where in your room would you prefer the staff member to sit?
d) I can appreciate what are you saying. I would be uncomfortable in that situation too

14. B. tells the nursing assistant assigned to one-to-one duty that he is having severe stomach pains, and he asks her to get the nurse quickly. The assistant leaves B. and goes to the nurse's station. How should the nurse respond?

a) remind the assistant that constant observation means just that, and send her back to B. immediately
b) go with the assistant to B.'s room immediately
c) question the assistant's judgment about leaving B. unattended even for a brief time
d) call the physician to check on B. immediately

15. Later the same afternoon, the nurse speaks with the nursing assistant about leaving B. alone. The best teaching approach is to:

a) ask the assistant how the situation could have been handled better
b) demonstrate how to palpate the abdomen to assess for tenderness and pain
c) review the procedures for constant observation and explore ways to handle similar situations
d) discuss the seriousness and legal ramifications of such a lapse in security

16. B. is taken off one-to-one observation and placed on 15 minute checks. One afternoon, he is found hanging in the shower. Attempts to resuscitate him are ineffective. When the staff meets to discuss B.'s suicide, the focus should be on:

a) determining who is responsible for the lapse in security
b) preparing B.'s chart for review by hospital officials
c) deciding who will speak with the patient's family
d) ventilating feelings and thoroughly reviewing the case

17. Staff members meet with the patients to discuss B.'s suicide. The chief rationale for such a meeting is to:

a) dispel rumors regarding B.'s death
b) detect other patient's suicidal ideation
c) help the patients to ventilate their feelings about B
d) reassure the patients about their own safety and protection





Psychiatric Nursing Degree Questions:
ANSWERS AND RATIONALE

11) A
- the nurse's highest priority during the initial interview is determining whether the patient still has an active plan to commit suicide so that she can assess the likelihood of another suicide attempt. After evaluating this information, the nurse should explore the patient's feelings of inadequacy in coping with the immediate and chronic stresses in his life, his level of hope, and his view of the intolerableness of the situation. Such exploration enables the nurse to formulate nursing diagnoses and an effective plan of care.

12) D
- when a patient expresses hopelessness and suicidal intentions, the nurse must ask him directly about possible suicidal plans. Such questioning enables the nurse to assess the patient's level of suicide risk and to tell the patient that she recognizes his distress and wants to help. Even more important, it lets the patient know that talk about his feelings is acceptable. Denying the patient's feelings by commenting on his success as businessman is nontherapeutic and distances the nurse from the patient. Referring to the suicide attempt as an "accident" is nontherapeutic because it denies the patient's desperate situation. A despondent patient would find it too difficult to identify what he has to live for.

13) C
- the nurse should respond honestly and emphatically to B.'s complaint. She can accomplish both objectives by explaining the reason for constant observation and working with the patient to identify a place for the staff member to sit that will meet the patient's protection and comfort needs. Telling the patient that he is on suicide precautions and must be observed at all times places blame on the patient for his situation and is not an empathic response. Because constant observation means that the patient must always be in clear view, having the staff member sit outside the room is unacceptable. Mere acknowledgment of the patient's feelings is nontherapeutic because it offers no solution to the problem.

14) B
- because B. should not be left alone at any time while on one-to-one constant observation, the nurse should accompany the nursing assistant immediately to B.'s room to assess the situation and ensure his safety. The nurse should not waste time reviewing constant observation procedures, discussing the assistant's judgment, or calling the physician. Such actions may be done after she has had time to assess the patient's status.

15) C
- the most effective teaching method in this situation would incorporate a review of the procedures and rationale for constant observation of a suicidal patient. After reinforcing previous learning, the nurse can help the nursing assistant to identify more appropriate responses that could be taken in a similar situation, such as calling for assistance from the patient's room, bringing the patient to the nurse, using the call system or phone, or asking another patient to summon help. Asking the assistant to identify alternative ways of handling the situation may be helpful but would not ensure her understanding of critical aspects associated with institutional procedures, including the legal ramifications of leaving a patient unattended. Teaching abdominal palpation would be inappropriate, since performing a physical assessment is part of the nurse's, not assistant's responsibility.

16) D
- after a patient commits suicide, staff members must meet to discuss the event and to ventilate their feelings, which may range from grief, guilt, and anger to failure and inadequacy. Meeting together provides an opportunity to give and receive support. A thorough and careful case review may identify missed clues or errors of judgment in the patient's treatment, which could help protect other patients in the future. Hospital authorities will conduct an indepth case review to determine any liability on the part of staff members. Every patient's chart is an important legal document and should be kept up to date and ready for review at all times. The patient's physician, not a nursing staff member, is responsible for talking with the patient's family.

17) D
- when a patient attempts or commits suicide on the unit, staff members must hold a meeting with the patients to discuss the event. Many patients become frightened and believe that their safety is compromised or that they are in danger. They may be afraid that he staff cannot protect them from their own dangerous thoughts and impulses. Therefore, the chief reason for the meeting is to reassure the patients that the staff members can and will protect them. The meeting also can serve to dispel rumors about B.'s death and may lead to discussion of other patient's self-destructive thoughts. Patients also may express their feelings about B. and his death. Regardless of the tone the meeting takes, staff members must send a clear message that the patients will be protected.


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