A nurse is working with a psychiatric client who was admitted to the inpatient facility and is being discharged. The client asks the nurse what he should do when he goes home to promote getting adequate sleep. Which response by the nurse would be most appropriate?

Correct Answer: B

Rationale: The correct answer is B: Save your bedroom for sleeping; that means no work and no TV in the bedroom. Rationale: 1. The bedroom should be associated with sleep to promote better sleep hygiene. 2. Removing work and TV from the bedroom helps to create a sleep-conducive environment. 3. This approach helps the client establish a bedtime routine that signals the brain it is time to sleep. 4. It discourages activities that may interfere with falling asleep or staying asleep. 5. It aligns with evidence-based recommendations for improving sleep quality. Summary: A: Going to bed at the same time every night is beneficial, but watching TV before bed can disrupt sleep. C: Prescribing sleeping pills should be a last resort and not the initial recommendation. D: Keeping the bedroom warm is not as critical as creating a sleep-friendly environment.

Correct Answer: C

Rationale: The correct answer is C because it demonstrates active listening, empathy, and encourages further exploration of the patient's experience without dismissing or invalidating their feelings. By asking James to share more about his experience, it shows that you are engaged, caring, and willing to understand his perspective. This approach can help build trust and rapport with the patient, which is important in therapeutic communication. Option A is incorrect because it denies the patient's experience and may lead to feelings of invalidation. Option B is incorrect as it dismisses the patient's feelings of fear and may come across as patronizing. Option D is incorrect as it focuses more on reassurance rather than addressing the patient's emotional distress and exploring their experience.

Correct Answer: B

Rationale: The correct answer is B: Case manager. The nurse acted as a case manager by coordinating and scheduling activities for the patient based on the input from different professionals involved in the patient's care. The nurse's role in this scenario was to ensure that all aspects of the patient's care were organized and managed effectively. A: Advocate - While the nurse may advocate for the patient's needs, in this scenario, the nurse's primary role was to coordinate care rather than advocate for a specific outcome. C: Milieu manager - This role involves managing the therapeutic environment, which is not directly related to scheduling activities for the patient. D: Provider of care - In this scenario, the nurse was not providing direct care to the patient but rather coordinating care provided by other healthcare professionals.

Correct Answer: A

Rationale: The correct answer is A because it demonstrates empathy by acknowledging the client's emotions and inviting them to express their feelings. By saying "I can see that you are upset. Tell me how you feel," the nurse shows understanding and validates the client's experience. This response focuses on the client's perspective and emotions, fostering a supportive and empathetic connection. Choice B focuses more on the nurse's emotions rather than the client's, which may not fully address the client's needs. Choice C shifts the focus to the nurse's past experiences, which may not resonate with the client or address their current feelings. Choice D reflects the nurse's emotions without directly addressing the client's experience, lacking the focus on the client's feelings that is central to empathy.

Correct Answer: D

Rationale: The correct answer is D because it demonstrates empathy, respect, and collaboration. By acknowledging the patient's feelings and involving them in the decision-making process, the nurse shows understanding and promotes a sense of control. This approach can help diffuse the patient's anger and improve cooperation during the procedure. A: This option may escalate the patient's anger by implying they are incapable, leading to further resistance. B: Blaming the patient for their injuries can worsen the situation and create a hostile environment. C: Leaving the room without addressing the patient's emotions may exacerbate their feelings of abandonment and escalate the situation.

Correct Answer: B

Rationale: The correct answer is B because interacting with others in the environment is a key indicator of mental health and wellness in older adults. Social interaction promotes cognitive function, emotional well-being, and overall quality of life. It helps prevent isolation and depression. Choice A is incorrect as minimal social contacts can lead to feelings of loneliness and isolation. Choice C is incorrect because relying solely on family for assistance may indicate limited social support network. Choice D is incorrect because experiencing bereavement is a normal part of life and does not necessarily indicate mental health and wellness.

Correct Answer: C

Rationale: The correct response is C: "What's happening around you when this occurs?" This question is appropriate because it helps the nurse gather more information about the client's experiences during the spacing out episodes, which can provide insights into triggers or patterns. It allows the client to describe the context of the episodes, aiding in the assessment and potential identification of stressors or environmental factors contributing to the dissociative experiences. Incorrect answers: A: "Do you feel stressed most of the time?" This answer assumes stress as the primary cause without exploring other potential triggers. B: "Does this frighten you when it happens?" This answer focuses on the emotional response rather than the environmental context, which may not be as helpful in understanding the situation. D: "Do you feel as if you are out of your body?" This answer is more specific and may jump to conclusions about depersonalization, which may not necessarily be the client's experience.

Correct Answer: D

Rationale: The correct answer is D: Integrating mental and physical health in one setting. This approach ensures that individuals with SMI receive holistic care addressing both their mental and physical health needs simultaneously. By having mental health professionals collaborate with medical providers in one setting, communication barriers are reduced, leading to more effective treatment. This integrated approach also helps in better coordination of care and ensures that all aspects of the individual's health are considered. Choice A (Seeking medical attention at the emergency department) is incorrect because it does not address the long-term need for integrated care for individuals with SMI. Choice B (Having a community clinic in the area where the SMI live) might help with accessibility but does not guarantee the integration of mental and physical health services. Choice C (Medicating the patient before a medical examination) is inappropriate as it does not address the underlying issue of healthcare disparity for individuals with SMI.

Correct Answer: D

Rationale: The correct answer is D: Agranulocytosis. Clozapine is known to cause agranulocytosis, a serious condition characterized by a decrease in white blood cells, leading to increased susceptibility to infections. The symptoms of fever, sore throat, and mouth sores are indicative of an infection, which could be a result of agranulocytosis. The physician should be notified immediately for further evaluation and management. A: Severe anemia is not typically associated with the symptoms described and is not a common side effect of clozapine. B: Neuroleptic malignant syndrome presents with symptoms such as muscle rigidity, fever, and altered mental status, which are different from the symptoms described. C: Encephalitis is inflammation of the brain and is not directly related to the symptoms reported by the patient.