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- Ms. G, an 82-year old woman, has a history of dementia and depression. She has been admitted because her daughter feels that, “Mom is getting more depressed and confused.” She is oriented to self and believes it is 1985. She is continuously trying to “find my coat so I can go to work.” She is ambulatory with an unsteady gait and can perform self-care with step-by-step coaching. Her daughter would like her transferred to a long-term care geropsychiatric unit.
- Ms. B, a 32-year old woman, has a borderline personality disorder and a history of frequent admissions to the psychiatric unit. Five days ago she was admitted for suicidal gesture after self-infliction of cuts to the posterior forearm. She is extremely flirtatious with all males. She can independently perform all activities of daily living (ADLs), but will dress in an excessively provocative manner.
- Mr. D, a 58-year old man, has a long history of major depression. He appears lethargic and disinterested in the environment or others. He responds appropriately when asked a direct question, but does not initiate any social interaction. He requires verbal prompting for all ADLSs, which he can perform himself, however, he says, “I would rather not.”
- Mr. S, a 38-year-old homeless man, who was found wandering naked on a busy street. He has been in the unit for 7 weeks with minimal improvement, but he has not been aggressive towards anyone. He frequently giggles to himself, and if allowed, weaves bits of garbage into his hair. He demonstrates word salad (schizophrenia) and looseness of association. He requires repetitive coaching to perform all ADLs.
- Mr. V, a 62-year-old man, voluntarily committed himself 2 days previously for recurrent thoughts of suicide since the death of his wife several months ago. He reports frequently sitting at her graveside with a gun and a bottle of whiskey. He is alert and oriented x3 and answers questions appropriately, but he is preoccupied with thoughts of death. He is on one-to-one suicide precautions.
- Ms. M, a 40-year old woman was admitted after a verbal altercation in an expensive department store when her credit cards were declined because she was over the $10,000 limit. She is talkative, grandiose, and emotionally labile. She can accomplish ADLs, but will change her clothes repeatedly throughout the day.
- Mr. P, a 20-year old man, was admitted yesterday throughout the emergency department after causing a disturbance on a public bus. He appears disheveled and acts suspicious. He has been refusing to eat or sleep because he believes that “those guys have been trying to kill me because I know who they are.”
1. Which two of the seven patients would be best to assign to the nurse who has floated from the medical-surgical unit?
2. Which three of the seven patients would be best to experience to the experienced LPN?
3. Which two of the seven patients would be best to assign to the experienced male RN?
4. The nursing assistant tells you that his clinical assignment for the day is to obtain a patient history and perform a mental status examination that will take about 1 to 2 hours to complete. Which two patients would you assign to the student?
5. Which laboratory value causes you the most concern for Ms. M who is taking lithium?
A. Serum chloride level of 100 mmol/L
B. Serum sodium level of 125 mEq/L
C. Serum potassium level of 5 mEq/L
D. Serum glucose level of 140 mg/dL
6. Ms. B requests that you talk to her in private about a serious personal issue. You agree to spend 10 minutes with her, and during that time she tells you that her step-father has raped her several times in the past and she plans to “buy a gun and shoot him the next time I see him coming at me.” What is the best approach in repsonding to this information?
A. Recognize this is the patient’s attempt to manipulate you to gain sympathy and gently but firmly set limits.
B. Spend additional time with the patient and gather more information about the incident and her feelings.
C. Acknowledge that her underlying feelings of anger and powerlessness and say that you must report the conversation to the psychiatric team.
D. Assess the patient for any physical evidence of rape and offer to contact a rape crisis counselor.
7. Mr. P has a nursing diagnosis of Risk for Self Directed and Order-Directed Violence related to fear and paranoid behavior. Which task can be delegated to the mental health assistant?
A. Observing interactions and behavior towards other patients
B. Following him around the day room to prevent occurences of aggression toward other patients.
C. Serving his food tray and pointing out that all items are wrapped and sealed in original packaging.
D. Checking all his personal belongings for items that are potentially dangerous.
8. You are talking to Ms. S, who has disorganized schizophrenia with a thought disorder. The patient says, “I am God Jesus God. I will pray pray, say pray, say pray, say day a pray for you.” What is the best therapeutic response?
A. “Thank you, Jesus, I need all the prayers that I can get.”
B. “Praying is a good thing to do, but you are not Jesus.”
C. “Let’s talk about something else right now.”
D. “Your offer to pray for me is kind and generous.”
9. Ms. B says that the male nursing student was flirting and trying to kiss her and touch her breasts. The student denies the accusation, but says, “She asked me if I thought she was attractice, and I said yes.” What is the best way to handle this situation?
A. Advise the student that this type of behavior is typical for Ms. B, but suggest that he contact the instructor and fill out an incident report.
B. Tell the student that this is a learning experience, but he should remember to carefully consider the impact of casual comments when working with psychiatric patients.
C. Go with the student to confront Ms. B so that the details of the incident can be clarified and then write an incident report.
D. Tell the student that the incident will have to be reported to the board of nursing, but that nothing is likely to come of it.
10. Which end-of-shift tasks should be delegated to one of the mental health assistants? (Select ALL that apply)
A. Assisting Ms.G to change her soiled blouse before evening visitors arrive
B. Accompanying Ms. B to the bathroom to prevent her from repeating locking the door which she did earlier.
C. Encouraging Mr. D to finish a glass of water for the allotment of the shift.
D. Accomanying Mr. S to the gift shop before it closes.
E. Maintaining one0on-one observation with Mr. V until the oncoming shift takes over.
F. Explaining to Ms. M why she cannot independently go to take a smoke break.
G. Assisting Mr. P to straighten his room and pick up his belongings.