A patient presents to the emergency department with mixed psychiatric symptoms. The admission nurse suspects the symptoms may be the result of a medical problem. Lab results show elevated BUN (blood urea nitrogen) and creatinine. What is the nurse's next best action?

Correct Answer: B

Rationale: In this scenario, option B) Assess the patient for a history of renal problems is the correct choice. Elevated BUN and creatinine levels indicate possible renal impairment, which can manifest as psychiatric symptoms. By assessing the patient for a history of renal problems, the nurse can gather crucial information to understand the underlying cause of the psychiatric symptoms and initiate appropriate interventions. Option A) Report the findings to the health care provider is not the best immediate action because further assessment is needed before involving the provider. Option C) Assess the patient's family history for cardiac problems is irrelevant to the current situation and does not address the elevated BUN and creatinine levels. Option D) Arrange for the patient's hospitalization on the psychiatric unit is premature without determining the root cause of the symptoms. Educationally, this question highlights the importance of a comprehensive assessment in nursing practice, especially in cases where physical and psychiatric symptoms overlap. It underscores the need for nurses to consider all possible contributing factors to provide holistic and patient-centered care. Understanding the connections between physical and mental health is essential in the field of behavioral health nursing.

Correct Answer: A

Rationale: In caring for a patient with bipolar disorder in the manic phase, the priority nursing intervention is to provide a quiet environment and limit stimulation (Option A). This is essential because individuals in a manic state are often overwhelmed by their own racing thoughts and heightened energy levels. Creating a calm and quiet space can help reduce external stimuli that may exacerbate their symptoms and promote a sense of grounding for the patient. Encouraging the patient to engage in social activities (Option B) may further escalate their symptoms due to the already heightened energy levels and impulsivity present during mania. Administering sedatives (Option C) should not be the initial approach as it may not address the underlying causes of the manic behavior and can have potential side effects. Offering medications to address the manic symptoms (Option D) is important, but creating a safe and calming environment is the immediate priority to ensure the patient's well-being and safety. From an educational perspective, understanding the principles of therapeutic communication, environmental management, and prioritization of care in mental health nursing is crucial for nurses caring for patients with bipolar disorder or other psychiatric conditions. By prioritizing non-pharmacological interventions like providing a quiet environment, nurses can help promote patient comfort, safety, and overall therapeutic outcomes.

Correct Answer: B

Rationale: The correct answer is B) Countertransference. Countertransference occurs when a healthcare provider projects their own feelings, attitudes, or unresolved issues onto a patient. In this scenario, the nurse is experiencing sadness and making a personal connection to the patient, which indicates countertransference. Option A) Transference involves the patient projecting feelings onto the nurse based on their past experiences. This is not occurring in the scenario provided. Option C) Catastrophic reaction involves an extreme response to stress or trauma, which is not evident in the nurse's feelings of sadness. Option D) Defensive coping reaction refers to strategies individuals use to protect themselves from unpleasant emotions or situations, which is not the case in the given scenario. In an educational context, understanding countertransference is crucial for healthcare providers, especially in behavioral health settings where emotional connections with patients are common. Recognizing and managing countertransference can help nurses maintain professional boundaries and provide effective care without letting personal emotions interfere with their judgment or care delivery. This scenario highlights the importance of self-awareness and emotional regulation in nursing practice.

Correct Answer: B

Rationale: In this scenario, the priority nursing action is option B) Ask the patient if they are having thoughts of suicide or self-harm. This is the correct answer because the patient's statement indicates a high risk for self-harm or suicide, which requires immediate assessment and intervention to ensure the patient's safety. Option A is incorrect because while encouraging the patient to talk about their feelings is important, assessing for suicidal ideation takes precedence in this situation. Option C is incorrect as providing reassurance without addressing the risk of self-harm may overlook the seriousness of the patient's statement. Option D is incorrect as engaging in physical activities may not address the immediate risk of self-harm that the patient is expressing. In an educational context, this question highlights the critical importance of recognizing and responding to suicide risk in patients with mental health disorders. Nurses must be trained to assess and address suicidal ideation promptly and effectively to ensure patient safety and provide appropriate care in behavioral health settings.

Correct Answer: A

Rationale: Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as 'Did you feel angry?' ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.