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Mental Health EVOLVE FOUNDATIONS AND MODES OF CARE QUESTIONS1.A primary gain is always the reduction of anxiety. Gaining benefits from others is related to asecondary gain. Fulfillment of unconscious desires is unrelated to primary gains. Control ofunacceptable impulses is unrelated to primary gains.2.Mental healthy person SATAOne who accepts agingOne who engages available strengthsOne who sustains positive relationships3.A mother and her three young children arrive at the mental health clinic. The woman saysthat she is seeking help in leaving her husband. She reports that he has been beating her foryears but just started hitting the children. What is thebestinitial action by the nurse?
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4.A nurse counseling a client on the inpatient psychiatric unit responds to a statement made bythe client by stating, "I'm confused about exactly what is upsetting you. Would you go overthat again, please?" What is the nurse using?
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6.A nurse working in a crisis center understands that a crisis can best be defined as what?
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7.What does a psychiatric nurse identify as theprimarypurpose of theDiagnostic and
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What is Psychology?: Foundations, Applications, and Integration
Pastorino
A: Provide a classification of types of mental disorders and guidelines to aid in making adiagnosis.
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What is Psychology?: Foundations, Applications, and Integration
Pastorino
Expert Verified
development of partnerships to achieve best possible outcomes that reflect needs of the client, family, or community, requiring an understanding of what others have to offer
collaboration
___ involves a joint responsibility for client outcomes
collaboration
what is shared governance?
-type of collaboration
-when a decision is to be made, the nurse manager asks for staff opinion
-transition from traditional hierarchy to nursing staff being more involved
what are 4 overarching categories of collaboration?
1. Nurse-Patient
2. Nurse-Nurse
3. Interorganizational
4. Interprofessional
What are examples Nurse-Patient collaboration?
-goals for their plan of care
-teach how to dress wounds
What are examples Nurse-Nurse collaboration?
(Intraprofessional)
-hands-off reporting, mentoring)
What are examples Interprofessional collaboration?
-nurses, physical therapists, x-ray techs work together
What are examples Interorganizational collaboration?
-what is our presence in the community
-make an impact on others
-sponsor a 5k charity
what are the four attributes necessary for effective interprofessional collaboration?
interprofessional collaboration: nurses, physical therapists, x-ray techs work together
-values and ethics
-roles and responsibilities
-communication
-teams and teamwork
the four attributes of collaboration are necessary for effective ____ collaboration
interprofessional (nurses, physical therapists, x-ray techs work together )
who is the team leader?
nurse
How does collaboration aid in nursing and healthcare?
-we are required to collaborate
-positively impacts client outcomes and quality of care (CPR, surgery)
-helps prevent client safety concerns/incidents
-promotes job retention and improves communication skills
-decreases client length of stay and increases economic benefits to healthcare organizations
-moving toward collaborative model represented by interprofessional collaborators
-many
ways for students from various disciplines to learn from one another
what is delegation?
Transfers responsibility while remaining accountable for outcomes
should you delegate a task you don't like doing to another nurse or a CNA?
NO
What is the nurse responsible for in terms of delegation? What are the outcomes of delegation when done properly?
-requires knowing which skills are transferable (refer to State's Nursing Practice Act)--> certain things you can and can't delegate
-nurse is responsible for documenting delegated tasks
-results in improved quality, safety, improved efficiency, increased productivity, an empowered staff, and skill development of others
should you delegate a task to someone else when your patient is unstable?
NO
What are the 5 rights of delegation?
1. Right task- can it be delegated
2. Right Circumstance- Should it be delegated
3. Right person- can this person do the task
4. Right direction/ communication- is the task being conveyed in a clear manner
5. Right supervision- is the task being followed up on
once complete.
What are the steps to effective delegation?
-Assess the knowledge and skills of the delegatee.
-Match tasks to the delegatee's skills.
-Communicate clearly: Task, outcome, time
-Listen attentively.
-Provide feedback.
Which member of the interprofessional team in a palliative care setting serves as the client advocate, evaluating the physical, emotional, and spiritual needs of the client?
Nurse
Pharmacist
Music therapist
Primary healthcare provider
Nurse
A client is scheduled for an adrenalectomy. What does the nurse expect that the plan of care will include?
Low-protein diet
Parenteral corticosteroids
Preoperative 24-hour urine specimen
Withholding all medications 48 hours before surgery
Parenteral corticosteroids
After surgery for insertion of a coronary artery bypass graft (CABG), a client develops a temperature of 102° F (38.9° C). Which priority concern related to elevated temperatures does a nurse consider when notifying the healthcare provider about the client's temperature?
A fever may lead to diaphoresis.
A fever increases the cardiac workload.
An increased temperature indicates cerebral edema.
An increased temperature may be a sign of hemorrhage.
A fever increases the cardiac workload.
A 50-year-old male client has difficulty communicating because of expressive aphasia after a cerebrovascular accident (CVA, also known as a "brain attack"). When the nurse asks the client how he is feeling, his wife answers for him. How should the nurse address this behavior?
Ask the wife how she knows how the client feels.
Instruct the wife to let the client answer for himself.
When the wife leaves return to speak with the client.
Acknowledge the wife but look at the client for a response.
Acknowledge the wife but look at the client for a response.
Which response by the nurse during a client interview is an example of back channeling?
"All right, go on..."
"What else is bothering you?"
"Tell me what brought you here."
"How would you rate your pain on a scale of 0 to 10?"
"All right, go on..."
A parent and 3-month-old infant are visiting the well-baby clinic for a routine examination. What instruction should the nurse include in the accident-prevention teaching plan?
Remove small objects from the floor.
Cover electric outlets with safety plugs.
Test the temperature of water before bathing.
Remove toxic substances from accessible areas.
Test the temperature of water before bathing.
A client who is recovering from deep partial-thickness burns develops chills, fever, flank pain, and malaise. The primary healthcare provider makes a tentative diagnosis of urinary tract infection. Which diagnostic tests should the nurse expect the primary healthcare provider to prescribe to confirm this diagnosis?
Cystoscopy and bilirubin level
Specific gravity and pH of the urine
Urinalysis and urine culture and sensitivity
Creatinine clearance and albumin/globulin (A/G) ratio
Urinalysis and urine culture and sensitivity
What is the ultimate goal of delegation?
To deliver client care as a team
To maximize client care outcomes
To improve the working ability of the nurse
To maintain open lines of communication between delegator and the delegatee
To maximize client care outcomes
Four days after the client's total hip arthroplasty, the nurse is preparing to transfer the client to a rehabilitation center. Before admission the client took warfarin sodium daily for a history of pulmonary embolus. While hospitalized, the client received subcutaneous heparin two times a day. The nurse does not see any anticoagulant therapy listed on the client's transfer prescriptions. What should the nurse do?
Contact the healthcare provider to determine which anticoagulant therapy should be prescribed for this client.
Arrange for a supply of heparin for the client to take to the rehab center.
Explain to the client that anticoagulant therapy will no longer be needed.
Instruct the client to talk about anticoagulant needs with the healthcare provider at the rehabilitation center.
Contact the healthcare provider to determine which anticoagulant therapy should be prescribed for this client.
During group therapy, the working phase usually begins when the group displays what?
Cohesiveness
Confrontation
Imitative behavior
Corrective recapitulation
Cohesiveness
When the group becomes united (cohesive), the clients can feel accepted, valued, and part of the group; this is the optimal time for the working phase to begin. Confrontation, imitative behavior, and corrective recapitulation all occur later in the working phase of group process, not in the beginning.
Which description by the nurse is a correct explanation of delegation?
The transfer of responsibility for the performance of an activity
The person's responsibility and accountability for individual actions or omissions
The active process of directing, guiding, and influencing the outcome of an individual
The transfer of both the accountability and responsibility from one person to another
The transfer of responsibility for the performance of an activity
A client is receiving furosemide to help treat heart failure. Which laboratory result will cause the nurse to notify the primary healthcare provider?
Hematocrit 46%
Hemoglobin 14.1 g/dL (141 mmol/L)
Potassium 3.0 mEq/L (3.0 mmol/L)
White blood cell 9200/mm 3 (9.2 × 10 9/L)
Potassium 3.0 mEq/L (3.0 mmol/L)
While organizing a community health care program for polio vaccinations, the registered nurse delegates the task of administering vaccines to the members of the health care team. Who among the health care team is most suitable to carry out the task?
Technician
Patient care associate
Certified nursing aide
Licensed practical nurse
Licensed practical nurse
The licensed practical nurse can be delegated the task of administering oral medications or vaccines. Technicians, patient care associates, and certified nursing aides are unlicensed assistive personnel who are not appropriate for delegation of tasks such as administering medication or vaccines as per the delegation rights. The scope of practice for unlicensed assistive personnel providing client care is limited to providing basic care, comfort, and hygiene.
Which team member acts as a liaison between the health care facility and the media?
Triage officer
Public information officer
Medical command physician
Hospital incident commander
Public information officer
A client who develops heart failure has a serum potassium level of 2.3 mEq/L (2.3 mmol/L). Digoxin and potassium chloride are prescribed. What action should the nurse take?
Double the dose of potassium chloride and administer it with the prescribed digoxin.
Hold the dose of digoxin, administer the potassium chloride, and call the primary healthcare provider immediately.
Give the digoxin and potassium chloride as prescribed and report the laboratory results to the primary healthcare provider.
Administer the prescribed digoxin and potassium chloride with a glass of orange juice and continue to monitor the client.
Hold the dose of digoxin, administer the potassium chloride, and call the primary healthcare provider immediately.
Which process involves transferring responsibility to multiple players, usually with varying degrees of education and experience, while retaining the ultimate accountability for providing the client care?
Leadership
Delegation
Supervision
Assignment
Delegation
The registered nurse (RN) is caring for a client who underwent a hysterectomy. Which tasks can be delegated to the unlicensed assistive personnel (UAP) to provide quality care to the client? Select all that apply.
Recording vital signs
Assisting the client with bathing
Administering oral medications
Preparing the care plan for the client
Administering intravenous antibiotics
Recording vital signs
Assisting the client with bathing
What does a psychiatric nurse identify as the primary purpose of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition ( DSM-5)?
Facilitate communication between researchers and clinicians.
Aid in teaching psychopathology to mental health professionals.
Assist in collecting accurate public health statistics through the use of diagnostic codes.
Provide a classification of types of mental disorders and guidelines to aid in making a diagnosis.
Provide a classification of types of mental disorders and guidelines to aid in making a diagnosis.
Which step in the nursing process would involve promoting a safe environment for the client?
Planning
Diagnosis
Assessment
Implementation
Implementation
The nurse promotes a safe environment during the implementation stage of the nursing process. During the planning stage, the nurse develops an individualized care plan for the client. The plan contains strategies and alternatives to achieve specific outcomes. During the diagnosis stage, the nurse analyzes the assessment data to determine the health care issues. The nurse collects comprehensive data pertinent to the client's health and situation during the assessment stage.
Three days after a cast is applied to a client's fractured tibia, the client reports that there is a burning pain over the ankle. The cast over the ankle feels warm to the touch, and the pain is not relieved when the client changes position. What is the nurse's priority action?
Obtain a prescription for an antibiotic.
Report the client's concern to the primary healthcare provider.
Administer the prescribed medication for pain.
Explain that this is typical after a cast is applied
Report the client's concern to the primary healthcare provider.
An older adult is returned to the surgical unit after having a subtotal gastrectomy. Which dietary modification should the nurse anticipate that the healthcare provider will most likely prescribe?
Increase intake of dietary roughage quickly
Avoid oral feedings for a prolonged period
Resume small, easily digested feedings gradually
Limit intake to self-selection of personally preferred foods
Resume small, easily digested feedings gradually
The nurse is caring for a client with ureteral colic. To prevent the development of renal calculi in the future, which strategy should be included in the client's plan of care?
Instructing the client to drink at least 3L of fluid daily
Interventions to decrease the serum creatinine level
A urinary output goal of 2000 mL per 24 hours
Excluding milk products from the diet
Instructing the client to drink at least 3L of fluid daily
Increasing fluid intake[1][2] dilutes the urine, and crystals are less likely to coalesce and form calculi. An elevated serum creatinine has no relationship to the formation of renal calculi. Calcium restriction is necessary only if calculi have a calcium phosphate basis. Producing only 2000 mL of urine per 24 hours is inadequate
Which generation of nursing professionals, being exposed to both terrorism and natural disasters, should be key members for disaster planning initiatives?
Veteran
Generation X
Generation Y
Baby Boomer
Generation Y
Which term refers to the nurse's ability to plan, direct, control, and evaluate others in different situations?
Delegation
Leadership
Followership
Management
Management