After signing a contract that he will no longer smoke in his ...

[bio_gurl]

After signing a contract that he will no longer smoke in his room, the patient violates the contract. The contract consequences include confiscation of smoking materials and mandatory supervision for future smoke breaks.
 
  How should the nurse appropriately address the patient's behavior?
  a. Why are you smoking in your room when you know it is not allowed?
  b. The contract states that if you smoke in your room, you must give me your smok-ing materials. Let me have them, please.
  c. Okay, Larry, give me your cigarettes and lighter now.
  d. I am going to give you one more chance, Larry. Let's see if you can live up to the contract.

Question 2

The nurse observes a withdrawn schizophrenic. The patient is sitting alone and moving her lips as if she is talking, but there is no audible sound. The nurse speaks to the patient by name, but the patient does not seem to hear.
 
  What should the nurse do first?
  a. Hug the patient's shoulders, refer to the patient by name, and ask if she's praying.
  b. Document the patient's nonresponsiveness and continued detached behavior.
  c. Sit down in the chair next to the patient, touch her arm, and speak softly.
  d. Touch the patient's shoulder and then join another group of patients.

[scottmt]

Answer to Question 1

B
Reminding the patient of contract violation and the penalty attached should be done before tak-ing the cigarettes. This approach is fair and puts the blame for the consequence on the offender. Providing the patient with the opportunity to explain the actions does not conform to the agreed-on contract. Providing additional opportunities for compliance does not support the con-tract and may encourage manipulative behavior.

Answer to Question 2

C
Sitting with the patient and touching her presents the reality of the nurse's presence. Continued attention will make the patient feel safe. Feelings of safety are needed in the beginning of the nursepatient relationship. Hugging the patient may invade the patient's personal space. The nurse's assessment will be documented but it is most appropriate to attempt an interaction with the patient.

[bio_gurl]

Excellent

[kusterl]

TYSM