A patient who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The patient continues to need routine psychiatric services. The nurse anticipates that this patient will most likely be referred to which of the following?

Correct Answer: C

Rationale: The correct answer is C: Intensive outpatient program. This option is most appropriate as the patient still requires ongoing psychiatric services but does not need the level of care provided in a partial hospitalization program. In-home mental health care may not provide the structured support needed. Crisis center in the community is more for immediate intervention, not ongoing care. The intensive outpatient program offers a balance of support and independence for the patient transitioning back to school.

Correct Answer: B

Rationale: The correct answer is B: The client performs the ritual to relieve anxiety temporarily. In obsessive-compulsive disorder, repetitive behaviors such as checking are done to alleviate distress or anxiety, providing temporary relief. This behavior is a coping mechanism to manage overwhelming feelings of anxiety. The husband's observation of the wife's constant checking behavior indicates that she is engaging in this ritual to reduce her anxiety. Understanding this aspect is crucial for the nurse to provide appropriate support and interventions to help the client manage her symptoms effectively. Choice A (The client is attempting to exert control over the situation) is incorrect because the primary motivation behind compulsive behaviors in OCD is not about exerting control but rather reducing anxiety. Choice C (The woman's behavior reflects a need for safety) is incorrect as the main driver behind OCD behaviors is not necessarily related to safety concerns but rather to managing anxiety. Choice D (The woman is attempting to use thought stopping to decrease her behavior) is incorrect because thought stopping is a cognitive technique that is

Correct Answer: D

Rationale: Reaction formation is a defense mechanism where a person behaves in a way that is opposite to their true feelings or impulses. In this scenario, choice D demonstrates reaction formation because the client is expressing a belief that people who steal are lazy and should earn money honestly, which is opposite to their own behavior of stealing. This behavior helps the client deny their true feelings of guilt or shame about their actions. Choices A, B, and C do not exhibit reaction formation as they do not involve expressing beliefs or behaviors opposite to their true feelings or impulses.

Correct Answer: B

Rationale: Rationale: 1. Choice B is correct as it addresses the misconception by stating that only a very few clients with mental illness exhibit violent behaviors, helping the student understand that violence is not a common trait among all clients with mental illness. 2. Choice A is incorrect as it perpetuates the misconception by suggesting that most clients with mental illness are violent, even though de-escalation techniques can be used. 3. Choice C is incorrect as it implies that medications are the sole solution to prevent violent behaviors, which is not always the case. 4. Choice D is incorrect as it oversimplifies the issue by suggesting that only paranoid clients exhibit violent behaviors, which is not true for all clients with mental illness.

Correct Answer: D

Rationale: The correct answer is D because the patient's action of pulling out a knife and making a threat demonstrated a clear and present danger to others. The patient's behavior posed an immediate risk to the safety of those around them, necessitating urgent intervention for the protection of others. A: While the patient was indeed threatening to others, the severity of the threat, involving a weapon, indicated a higher level of danger. B: Psychosis alone may not always indicate an immediate danger to others unless accompanied by specific threatening behavior. C: While escape risk is a consideration, the primary concern in this scenario was the patient's potential harm to others, justifying seclusion for safety reasons.

Correct Answer: B

Rationale: The correct answer is B because assessing alcohol and tobacco use in a pregnant client with depression is crucial for providing comprehensive care. First, substance use can exacerbate mental health symptoms and impact treatment effectiveness. Second, substance use during pregnancy can harm both the mother and the unborn child, leading to adverse health outcomes. Third, this information is vital for developing a holistic care plan that considers both the mental health needs of the client and the safety of the unborn child. Choices A, C, and D are incorrect because: A: Failing to assess alcohol and tobacco use neglects essential information that can impact the client's well-being and treatment. C: Substance use during pregnancy can have significant long-term effects on the unborn child's health and development. D: Assessing alcohol and tobacco use is not optional, as it directly influences the client's mental health and the well-being of the unborn child.

Correct Answer: B

Rationale: The correct answer is B: Assessment. In the Calgary Family Model, the Assessment stage involves identifying and understanding the problems within the family system. This is where the nurse gathers information about the family's strengths, resources, and challenges. The nurse assesses the family's structure, communication patterns, roles, and interactions to develop a comprehensive understanding of the family dynamics. Engaging with the family (Choice A) occurs before the Assessment stage. Intervention (Choice C) comes after the Assessment stage when specific strategies are implemented. Termination (Choice D) is the final stage when the nurse concludes their work with the family.

Correct Answer: D

Rationale: The correct answer is D: transition of care. Transition of care refers to clients moving between treatment settings, ensuring continuity and coordination of care. Rehospitalization (A) specifically refers to clients being admitted back to the hospital. Adverse event (B) refers to harm resulting from medical care. Readmission (C) is similar to rehospitalization, specifically indicating clients being admitted back to a hospital after a previous discharge. Transition of care (D) is the most appropriate term as it encompasses the movement of clients between various healthcare settings beyond just hospitals.

Correct Answer: A

Rationale: The correct answer is A: Disturbed Body Image. This is the priority nursing diagnosis for a client with body dysmorphic disorder because it directly addresses the client's preoccupation and distress related to perceived flaws in appearance. By addressing the disturbed body image, the nurse can help the client work through these feelings and improve self-perception. Choice B: Ineffective Coping may be relevant but addressing the underlying body image distortion is crucial. Choice C: Low Self-Esteem is a common issue with body dysmorphic disorder but improving body image perception is more specific. Choice D: Risk for Other-Directed Violence is not directly related to body dysmorphic disorder symptoms. In summary, addressing the core issue of distorted body image is the priority in caring for a client with body dysmorphic disorder.