A patient was arrested for breaking windows... Which nursing diagnosis has priority?

Correct Answer: D

Rationale: The correct answer is D) Risk for other-directed violence. In a situation where a patient has been arrested for breaking windows, the priority nursing diagnosis is identifying the risk for other-directed violence. This is crucial for ensuring the safety of not only the patient but also others around them. It is important to assess the potential for the patient to cause harm to others, especially considering their behavior of breaking windows, which could escalate to physical harm towards individuals. Option A) Risk for injury is not the priority in this scenario because the focus is on the risk the patient poses to others rather than self-injury. Option B) Ineffective coping may be relevant, but it is secondary to the immediate concern of potential violence towards others. Option C) Impaired social interaction is not the priority at this moment because the main concern is the safety and well-being of those around the patient. Educationally, understanding the prioritization of nursing diagnoses in psychiatric emergencies is vital for providing effective and timely care. Recognizing and addressing the risk for violence is crucial in ensuring the safety of all individuals involved and preventing potential harm. By prioritizing this nursing diagnosis, nurses can implement appropriate interventions to manage and mitigate the risk of other-directed violence.

Correct Answer: A

Rationale: In psychiatric emergencies, managing angry patients without resorting to violence is crucial for ensuring both patient and staff safety. Option A, which suggests helping the patient identify and challenge anger-inducing thoughts, is the correct choice. This intervention is rooted in cognitive-behavioral strategies, which aim to modify maladaptive thought patterns. By assisting the patient in evaluating and replacing irrational thoughts with more rational ones, nurses can help de-escalate the situation and promote self-awareness and self-regulation skills in the patient. Options B and C, advocating for negative reinforcement and aversive conditioning, respectively, are not appropriate in this context. These approaches can escalate aggression, violate ethical principles, and potentially lead to further distress or trauma for the patient. Restraint and seclusion should only be used as a last resort when imminent harm is likely. Aversive conditioning techniques are not recommended in mental health care due to their potential for harm and lack of evidence-based support. Option D, administering medication, may be necessary in some cases, but it should not be the first-line intervention for managing anger in psychiatric emergencies. Medications should be prescribed based on a thorough assessment by a qualified healthcare provider and in conjunction with other therapeutic interventions. Educationally, understanding the principles of de-escalation techniques, cognitive-behavioral strategies, and ethical considerations in psychiatric care is essential for nurses working in mental health settings. This question highlights the importance of using evidence-based, patient-centered approaches to manage challenging behaviors and promote positive outcomes for individuals experiencing psychiatric emergencies.

Correct Answer: C

Rationale: In a psychiatric emergency scenario involving a patient with multi-infarct dementia displaying aggression, the most appropriate initial intervention is option C) Saying to the patient, “This is a safe place.” This response acknowledges the patient's feelings of distress and helps create a sense of safety and security, potentially de-escalating the situation. Option A) Gently touching the patient’s arm could escalate the situation by invading their personal space and triggering a defensive response. Option B) Asking the patient, “What do you need?” may be too direct and overwhelming for a patient experiencing heightened agitation, potentially escalating the situation further. Option D) Directing the patient to cease the behavior is confrontational and may lead to increased aggression or resistance. Educationally, understanding the importance of creating a safe environment and using calming, reassuring language in managing psychiatric emergencies is crucial for healthcare providers. By prioritizing de-escalation techniques and communication skills, healthcare professionals can better address challenging behaviors in patients with psychiatric conditions, ensuring both patient and staff safety.

Correct Answer: C

Rationale: The correct answer is option C) Continue, saying, “This is needed so your wound will not get infected.” This intervention uses a cognitive technique by offering a rationale for the action being taken, which can help the patient understand the importance of the dressing change and potentially reduce their irritability. Option A is incorrect as abruptly stopping the dressing change without any explanation or communication can escalate the situation and lead to further distress for the patient. Option B is also incorrect as it puts the responsibility solely on the patient without providing any supportive or educational information, which may not be effective in calming an irritable patient in a psychiatric emergency. Option D is incorrect as it uses a directive approach without considering the patient's feelings or providing any rationale, which can further agitate the patient and hinder effective communication and cooperation. In an educational context, it is important for healthcare providers to use cognitive techniques such as providing explanations and rationales to help patients understand the reasons behind interventions, especially in psychiatric emergencies where patients may be experiencing heightened emotions or distress. Effective communication strategies can help de-escalate situations, build trust, and improve patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) A personality style that externalizes problems. This choice is the most likely explanation for the patient being described as difficult by family members in the context of psychiatric emergencies. Understanding this requires knowledge of personality styles and their impact on how individuals perceive and interact with the world around them. Option A) Poor childrearing that did not teach respect for others is less likely as it focuses on upbringing rather than the internal disposition of the individual. While upbringing can influence behavior, it is not the most suitable explanation in this case. Option B) Automatic thinking leading to cognitive distortions is also less likely as it pertains more to cognitive processes and distorted thinking patterns rather than personality styles that influence behavior consistently over time. Option D) Delusions that others wish to deliver harm is less likely as it suggests a specific psychotic symptom rather than a general personality style contributing to difficult interpersonal relationships. Educationally, this question highlights the importance of understanding personality styles in psychiatric emergencies, as they can significantly impact how individuals express distress and interact with others. By recognizing these patterns, healthcare providers can better assess and manage challenging behaviors in such situations.