The nurse is caring for a client in an acute mental health unit. The client states, “I believe my food is poisoned.” Which of the following should be an appropriate action by the nurse?

Taking steps to prevent the client from verbalizing the delusional thoughts.

Allowing the client to select food from vending machines.

Explaining that others eat the same food and feel safe.

Encouraging the client to discuss why someone would poison the food.

Answer and Explanation

The Correct Answer is B

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.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A reason:
While a mental health unit that includes milieu therapy may focus on stabilizing clients, it is not limited to those in an acute phase of mental illness. Milieu therapy is a comprehensive approach that can benefit individuals at various stages of their treatment.

Choice B reason:
Milieu therapy is not necessarily less intensive nor does it focus solely on one psychiatric illness or substance abuse disorder. It is a versatile treatment method that can be applied to a range of conditions and is integrated into the daily life of the unit.

Choice C reason:
This choice accurately reflects the essence of milieu therapy. It is a therapeutic approach where the environment is used as an integral part of treatment. The goal is to create a stable, adaptive reality through routines, boundaries, and open communication, fostering a sense of safety and support for therapeutic change.

Choice D reason:
Milieu therapy is not exclusively focused on long-term care but is adaptable to the needs of clients, whether they require short-term stabilization or long-term treatment. It is designed to help individuals learn healthier ways of thinking and behaving within a supportive community setting.

A. "You should call your boss and ask if you can have your job back." B. "There really isn't much you can do about that until you are discharged." C. "I don't understand why your partner would upset you with news like that." D. "You must feel very concerned and disappointed by that information."

Correct Answer is D

Explanation

Choice A reason:
Telling the client to call their boss and ask for their job back may not be the most supportive response. It could add stress by suggesting immediate action when the client may not be in a position to address the issue effectively due to their hospitalization.

Choice B reason:
This response might come across as dismissive, implying that the client's concerns are not valid or important. It does not offer emotional support or acknowledge the client's feelings about the situation.

Choice C reason:
Questioning why the partner would share such upsetting news does not provide comfort or support to the client. It could potentially create additional stress by introducing doubts about the partner's intentions.

Choice D reason:
This empathetic response acknowledges the client's likely emotional reaction to the news. It validates the client's feelings without making assumptions or judgments about the situation, which is an important aspect of nurse-client communication.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is caring for a client in an acute mental health unit. The client states, “I believe my food is poisoned.” Which of the following should be an appropriate action by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse has described the behavioral health unit being based on milieu therapy to a client. The client asks, "How is a unit that has milieu therapy different from other hospital units?" Which of the following responses should the nurse make?

Correct Answer is C

Explanation

A nurse is caring for a client who is hospitalized and says to the nurse, "My partner called and told me my boss hired someone to take my place." Which of the following responses should the nurse make?

Correct Answer is D

Explanation

The nurse is caring for a newly admitted client diagnosed with catatonic schizophrenia. Which of the following behaviors should the nurse document to be consistent with catatonic schizophrenia? The client:

A nurse in a mental health facility is caring for a client who is upset about the loss of privileges due to repetitive negative behavior. Which of the following statements by the nurse demonstrates the effective use of assertive communication?

A nurse is teaching about physiological responses to stress with a group of clients. The nurse should identify that which of the following changes reflect long-term physiological responses to stress? (Select all that apply)

A charge nurse is providing an in-service to a group of nurses about the benefits of an interprofessional team. Which of the following information should the nurse include?

A nurse is caring for a client diagnosed with severe manifestations of schizophrenia and is prescribed haloperidol (Haldol) PRN for agitation. The nurse should recognize which of the following as adverse effects of haloperidol (Haldol)?

A nurse overhears a client diagnosed with schizophrenia talking to herself. The client keeps stating, "The flakalas are here. The flakalas are here." The nurse should recognize the client's use of the word "flakala" as an example of which of the following alterations in speech?

A nurse is leading a group therapy session for clients who are newly diagnosed with cancer. Which of the following statements should the nurse make?

A charge nurse overhears another nurse talking with a client who has schizophrenia. Suddenly the client yells, "I am the devil! I am God! Open the gate for me!" Which of the following replies by the nurse requires intervention?