A nurse working in a mental health facility is utilizing milieu therapy to provide a therapeutic environment for their clients. Which of the following steps of the nursing process is the nurse demonstrating?
Evaluation
Planning
Assessment
Implementation
The Correct Answer is D
Choice A reason:
Evaluation is the final step in the nursing process, where the nurse determines the effectiveness of the nursing care plan and whether the client's goals and outcomes have been met. In the context of milieu therapy, evaluation would involve assessing the client's progress within the therapeutic environment.
Choice B reason:
Planning involves setting goals and expected outcomes for the client's care and then determining the specific interventions that will be used to achieve those goals. In milieu therapy, planning would include designing the structure and activities of the therapeutic environment to meet the needs of the clients.
Choice C reason:
Assessment is the first step in the nursing process, where the nurse collects comprehensive data pertinent to the client's health and the situation. In milieu therapy, assessment would include understanding the client's mental health status, personal history, and specific needs within the therapeutic environment.
Choice D reason:
Implementation is the step where the nurse puts the care plan into action. In the context of milieu therapy, implementation refers to the nurse's role in actively creating and maintaining the therapeutic environment, facilitating group activities, and ensuring that the daily routine is therapeutic for all clients.
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Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Taking steps to prevent the client from verbalizing delusional thoughts is not therapeutic. It can lead to the client feeling misunderstood and unsupported. Nurses should provide a safe environment where clients feel comfortable expressing their thoughts and feelings.
Choice B Reason:
Allowing the client to select food from vending machines can be a temporary measure to address the immediate concern of the client’s fear of being poisoned. It provides a sense of control over their situation and may help to reduce anxiety related to eating.
Choice C Reason:
Simply explaining that others eat the same food and feel safe may not be effective for a client experiencing delusions. Delusions are fixed beliefs that are not easily changed by logical explanations or evidence to the contrary.
Choice D Reason:
Encouraging the client to discuss why someone would poison the food might validate the delusion and could reinforce the false belief. It’s important to acknowledge the client’s feelings without supporting the delusional content.
Correct Answer is B
Explanation
Choice A Reason:
The statement that clients can be hospitalized for as long as the provider deems necessary is not entirely accurate. Involuntary admission is regulated by law, and there are specific criteria and time frames that must be adhered to. For example, if a person is admitted involuntarily, they must either be discharged within a certain number of days or brought to a mental health court to request a longer commitment.
Choice B Reason:
This statement is correct. Clients who are involuntarily admitted retain their rights, including the right to informed consent. They should be informed about their condition, the proposed treatments, and the potential risks and benefits, and they should be involved in their care decisions as much as possible.
Choice C Reason:
Administering medications to clients who refuse them is a complex issue. While there are circumstances where treatment may be given against a client's wishes, particularly if they pose a danger to themselves or others, this must be done within the framework of the law, which includes respecting clients' rights and obtaining necessary legal orders.
Choice D Reason:
The laws regarding the use of restraints on involuntarily admitted clients are indeed different and often more stringent. These laws are designed to protect the rights of clients and ensure that restraints are used only when absolutely necessary and as a last resort.
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