A nurse is admitting a client to the psychiatrist unit after attacking a neighbor. The nurse should know that the client can be kept in the hospital after the 72 hours hold is over when which of the following conditions is met?

The client is unwilling to accept the treatment being oﬀered.

The client states that they will never attack the neighbor again.

The client plans to move out of state immediately upon discharge from the hospital.

The client is a threat to himself and others.

Answer and Explanation

The Correct Answer is D

A client can be kept in the hospital after the initial 72-hour hold if they are deemed to be a threat to themselves or others. This determination is typically made by a mental health professional who evaluates the client’s behavior and mental state. If the client is considered to be a danger, they may be held involuntarily for further treatment and observation.

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Correct Answer is B

Explanation

The client's statement about losing faith in God and not understanding how God could allow bad things to happen to her suggests that she is experiencing spiritual distress. This can be common among individuals experiencing depression and anxiety, as they may struggle to find meaning or purpose in their lives.

Option a, Risk for lack of faith, is not a recognized nursing diagnosis.

Option c, Risk for impaired religiosity, may be more appropriate for a client who has experienced a significant change in their religious practices or beliefs but does not necessarily indicate distress.

Option d, Risk for impaired spirituality, could be appropriate but may be too broad and not specific enough to the client's situation.

A. "I feel angry when I hear that tone of voice." B. “You make me so angry when you talk to me that way.' C. “Are you trying to make me angry?" D. “Why do you use that condescending tone of voice with me?"

Correct Answer is D

Explanation

This response is open-ended and non-judgmental, allowing the client to reﬂect on their behavior and share their thoughts and feelings. It also avoids blaming the client or making assumptions about their intentions, which could escalate the situation and damage the therapeutic relationship.

Option A, “I feel angry when I hear that tone of voice,” focuses on the nurse's own feelings and could be perceived as confrontational or defensive.

Option B, “You make me so angry when you talk to me that way,” places blame on the client and may trigger a defensive response.

Option C, “Are you trying to make me angry?” is also confrontational and may be interpreted as accusing the client of intentionally provoking the nurse.

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A nurse is admitting a client to the psychiatrist unit after attacking a neighbor. The nurse should know that the client can be kept in the hospital after the 72 hours hold is over when which of the following conditions is met?

Nursing Test Bank

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Correct Answer is B

Explanation

A nurse is working with a client who used a condescending tone of voice in the conversation. Which response by the nurse is most therapeutic?

Correct Answer is D

Explanation

A client was involuntarily admitted to a behavioral health facility after trying to harm himself. Which statement by the client would indicate further education is needed regarding his rights?

The nurse places a client In the seclusion room until he admits responsibility for the fight In the day room. The nurse's action could be viewed as which of the following?

A female client asks about her male nurse's girlfriend and social activities. Which of the following is the best response by the nurse?

The client expresses the loneliness she feels to the nurse. Which response by the nurse demonstrates the existence of a therapeutic relationship?

Some cultures are likely to engage in self-treatment using healing processes and may diﬀer from Western medicine. The nurse is caring for a client who uses these healing practices. What is the best action by the nurse?

Who initiated psychoanalytical therapy as a treatment to assist in understanding the defense mechanism?

Which of the following is an example of an Intentional Tort?

When the local newspaper calls to inquire why the mayor has been admitted to the hospital, the nurse replies,” He is here because he's an alcoholic.” What possible legal action may the nurse be charged?