A patient who was responding to auditory hallucinations earlier in the morning now approaches the nurse shaking a fist and shouts, 'Back off!' and then goes to the dayroom. While following the patient into the dayroom, the nurse should

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Question 1 of 5

A patient who was responding to auditory hallucinations earlier in the morning now approaches the nurse shaking a fist and shouts, 'Back off!' and then goes to the dayroom. While following the patient into the dayroom, the nurse should

Correct Answer: A

Rationale: The correct answer is A, as it prioritizes safety by ensuring physical space between the nurse and the patient, reducing the risk of potential harm. By creating distance, the nurse can prevent escalation and maintain a safe environment for both parties. This approach allows for de-escalation and assessment of the situation without provoking further agitation. Choice B is incorrect as it may trap the patient and limit their options, potentially increasing their distress. Choice C is incorrect as maintaining a fixed distance may not be sufficient if the patient becomes physically aggressive. Choice D is incorrect as immediately engaging in conversation may exacerbate the situation and lead to further agitation.

Question 2 of 5

The nurse is assessing an Asian American patient. During the interview, the nurse determines that the patient likely follows Taoism based on which statement?

Correct Answer: B

Rationale: The correct answer is B because Taoism emphasizes harmony with nature and living in balance. This statement reflects Taoist principles of aligning oneself with the natural order and finding contentment in living in harmony with the world. Explanation: - A: While purity and balance are important concepts in Taoism, this statement does not directly relate to Taoist beliefs about harmony with nature. - C: Respecting nature's powers is a general concept that may align with various belief systems, but it does not specifically indicate Taoism. - D: This statement about worshipping God out of love is more characteristic of monotheistic religions like Christianity or Islam, not Taoism which does not focus on a personal God.

Question 3 of 5

A patient is referred to a psychosocial rehabilitation program. When explaining this type of care to the patient, the nurse would emphasize which of the following?

Correct Answer: B

Rationale: The correct answer is B: Services that promote the patient's reintegration into the community. This option is correct because psychosocial rehabilitation programs focus on providing support and services that help individuals with mental health conditions to reintegrate into the community and improve their quality of life. These programs aim to help patients develop skills for independent living, social relationships, and vocational functioning. A: Intensive treatment that prepares the patient to live in the community - This option is not the best answer as psychosocial rehabilitation programs focus more on promoting reintegration rather than intensive treatment. C: Detoxification services for alcohol and drugs in an outpatient setting - This option is incorrect as psychosocial rehabilitation programs do not primarily focus on detoxification services but rather on broader aspects of recovery. D: Frequent monitoring within a therapeutic milieu for relapse prevention - While relapse prevention is important, it is not the primary focus of psychosocial rehabilitation programs, making this option less relevant compared to promoting community reintegration.

Question 4 of 5

A group of nursing students are reviewing information about counseling interventions. The students demonstrate a need for additional review when they identify counseling interventions as involving which of the following?

Correct Answer: C

Rationale: The correct answer is C: Goal of regaining functional abilities. Counseling interventions typically focus on emotional and psychological support rather than physical rehabilitation or regaining functional abilities. This choice is incorrect because counseling is not aimed at improving physical abilities but rather at addressing emotional and mental health issues. Choices A, B, and D are correct as they align with common counseling interventions, which are often specific, time-limited, focus on coping improvement, and aim to prevent disability by addressing mental health concerns.

Question 5 of 5

A nursing instructor is teaching a class on the pharmacodynamics of psychiatric medications. The instructor determines that additional teaching is needed when the students identify which of the following as a site of action?

Correct Answer: C

Rationale: The correct answer is C: Neurotransmitters. In pharmacodynamics, the site of action refers to where a drug exerts its effects in the body. Neurotransmitters are not a site of action; they are the chemical messengers that transmit signals between neurons. Drugs act on receptors, ion channels, and enzymes to produce their pharmacological effects. Receptors are proteins on cell surfaces or within cells that bind to specific drugs and initiate a response. Ion channels are proteins that regulate the flow of ions across cell membranes, affecting cell function. Enzymes are proteins that catalyze biochemical reactions. Therefore, neurotransmitters do not serve as the primary site of action for psychiatric medications.

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