What is the most important reason the nurse should avoid making ...

[leilurhhh]

What is the most important reason the nurse should avoid making promises or agreeing to keep secrets for psychiatric clients?
 
  1. It is a legal rule that all information must be shared with the treatment team.
  2. Trust is destroyed when the information must be shared with the treatment team.
  3. The client cannot be allowed to manipulate the nurse.
  4. The nurse should not bear the burden of the secret.

Question 2

The nurse identifies the following client problems: ataxia and falling due to intoxication, skin le-sions associated with psoriasis, shyness of long-standing duration, hearing voices saying pleasant things for 3 months.
 
  Which problem should take priority during the 12 hours immediately following admission?
  1. Ataxia and falling
  2. Psoriatic skin lesions
  3. Shyness
  4. Hearing voices

[Edwyer]

Answer to Question 1

ANS: 2
When a promise is broken or a secret told, trust in the individual and the system is disrupted. It is more difficult for the client to understand why the promise could not be kept after the fact than when it is explained initially. Option 1 is untrue. Options 3 and 4 are irrelevant.

Answer to Question 2

ANS: 1
The condition that presents the greatest threat to the client's physical safety (option 1) is of prior-ity importance. The order of importance of intervention is placed in the following sequence: safety, health, intrapersonal problems and needs, and interpersonal problems and needs.