A nurse and patient construct a no-suicide contract. Select the preferable wording.

Correct Answer: C

Rationale: The correct answer is option C: "For the next 24 hours, I will not in any way attempt to harm or kill myself." This wording is preferable because it clearly states the patient's commitment to safety for a specific time frame and covers a broader range of self-harm behaviors compared to the other options. Option A is less preferable as it limits the timeframe to 24 hours and only addresses harm to oneself, not a broader spectrum of self-destructive behaviors. Option B focuses solely on the hospitalization period, which is restrictive and does not address the patient's safety beyond that specific timeframe. Option D introduces a conditional statement that may delay seeking help in a crisis by requiring the patient to contact specific individuals before taking any action to ensure safety. Educationally, it is essential for healthcare providers to understand the importance of clear and comprehensive safety contracts in managing psychiatric emergencies. This question highlights the significance of precise language in such contracts to ensure the patient's safety and well-being. By selecting option C, the patient's commitment to personal safety is clearly articulated, providing a more robust foundation for managing the patient's risk of self-harm.

Correct Answer: D

Rationale: The correct answer is D) The patient interpreted the UAP’s behavior as potentially harmful. In psychiatric emergencies, patients may exhibit behaviors that are a response to their perception of threat or harm. In this scenario, the patient's confusion could have led to misinterpretation of the UAP's actions, resulting in a defensive response. Option A is incorrect because it generalizes behavior in older adults and does not specifically address the situation at hand. Option B is incorrect as it makes a broad assumption about the relationship between crowding in facilities and violence without directly relating it to the patient's behavior. Option C is incorrect as it assumes the patient learned violent behavior from other patients without considering the individual circumstances of this particular case. Educationally, understanding the underlying reasons for behaviors in psychiatric emergencies is crucial for healthcare providers to effectively manage and de-escalate situations. By recognizing cues and triggers, providers can respond in a way that promotes safety and minimizes harm for both patients and staff.

Correct Answer: C

Rationale: In this scenario, option C, "A wish for revenge," poses the greatest barrier for the nurse. This response indicates a desire to seek retribution or harm towards the patient who assaulted them, which can lead to escalating the situation and compromising the nurse's ability to provide safe and effective care. Option A, "Startle reactions," is a common physiological response to trauma but may not necessarily pose the greatest barrier as it can be managed through coping strategies and support. Option B, "Difficulty sleeping," is a common symptom of post-traumatic stress but does not directly hinder the nurse's ability to respond effectively in the future. Option D, "Preoccupation with the incident," can impact the nurse's mental well-being but may not pose an immediate barrier to their ability to function in their role. Educationally, understanding the psychological impact of traumatic events on healthcare providers is crucial in addressing psychiatric emergencies. It is important to provide training on coping mechanisms, self-care strategies, and seeking professional help to manage the emotional aftermath of such incidents effectively. Developing a supportive work environment and access to mental health resources can help healthcare professionals navigate and overcome the challenges posed by psychiatric emergencies.

Correct Answer: B

Rationale: In psychiatric emergencies, identifying the factors that may lead to violent behavior is crucial for effective intervention. In this scenario, the correct answer is B) History of spousal abuse. This option presents the greatest risk for violent behavior directed at others because individuals with a history of spousal abuse may have a pattern of aggressive behavior and a lack of impulse control, posing a significant danger to others in stressful situations. Option A) Severe agoraphobia is less likely to result in violent behavior directed at others as individuals with agoraphobia tend to avoid situations that trigger their anxiety rather than lash out violently. Option C) Bizarre somatic delusions may lead to self-harm or erratic behavior but not necessarily violence towards others. Option D) Verbalized hopelessness and powerlessness indicate a risk of self-harm or suicide rather than outward aggression towards others. Educationally, understanding these distinctions is vital for healthcare professionals, especially those working in psychiatric settings or emergency departments. By recognizing the factors that contribute to violent behavior, professionals can implement appropriate de-escalation techniques, ensure safety for all individuals involved, and provide targeted interventions to address the underlying issues effectively.

Correct Answer: C

Rationale: In this scenario, the correct answer is option C: "You want to go home to prepare your husband’s dinner?" The rationale behind this choice lies in the principles of validation therapy, which is a person-centered approach used in dementia care. Validation therapy involves acknowledging and empathizing with the patient's emotions and feelings, rather than correcting their perceptions or trying to bring them back to reality. Option A: "You must come away from the door." This response is directive and dismissive, not aligning with the principles of validation therapy. It does not acknowledge the patient's emotional state or address the underlying need expressed by the patient's behavior. Option B: "You have been a widow for many years." This response brings up a past event that may not be relevant to the current situation. It does not validate the patient's emotions or address the immediate concern expressed by the patient. Option D: "Your husband gets angry if you do not have dinner ready on time?" This response introduces a negative emotion (anger) and may escalate the situation. It does not validate the patient's feelings or address the underlying need being expressed. Educationally, understanding the principles of validation therapy is crucial for healthcare professionals working with cognitively impaired patients, especially in psychiatric emergencies. By choosing response C, caregivers can effectively validate the patient's emotions, establish rapport, and address the underlying emotional need, which can help de-escalate the situation and provide person-centered care.