The doctor ordered a lithium level to be drawn on a patient who ...

[schs14]

The doctor ordered a lithium level to be drawn on a patient who is suspected to be toxic. The patient, although bipolar, is also experiencing hallucinations. The lab technician enters the patient's room to draw the specimen. The patient begins to shout,
 
  I am going to be sucked dry. The nurse enters the patient's room and states the following:
  A.
  The technician must draw your blood now.
  B.
  Don't worry, we will leave enough for you to live.
  C.
  I'll stay with you awhile and we can go over today's activities.
  D.
  The technician is here to help you and needs to take your blood in order to assist you.

Question 2

You are one of the nurses monitoring the dining room during dinner. A male patient who has schizophrenia asks a table mate to please pass the pepper. When the table mate does so, the first patient throws the pepper shaker at you.
 
  He or she screams, Now look what you've done There are spiders all over my food I can't eat this Get the spiders out of there Your best response is:
  A.
  Those aren't spiders; that is the pepper you asked for
  B.
  I don't see any spiders. Let's go to the game room for a little while before you try eating again.
  C.
  Where are the spiders? I am also afraid of them
  D.
  It is inappropriate for you to throw things; you need to go to the locked unit now.

[amit]

Answer to Question 1

ANS: C
Reduce the patient's anxiety first. Then proceed with attempting the blood draw.

Answer to Question 2

ANS: B
This response acknowledges the patient's distress, describes reality, and then focuses on other behaviors. Response A is reality based, but it devalues the patient's view of reality. Response C is reinforcing the presence of spiders. Response D is punishing the patient for his psychosis.

[schs14]

Thanks for the timely response, appreciate it

[kusterl]

Gracias!