A client states I'm pretty fed up with my wife. I'm thinking I ...

[ishan]

A client states I'm pretty fed up with my wife. I'm thinking I should just get a divorce, but I worry
  about how that will affect my kids.
 
  What do you think I should do? The psychiatric mental health
  nurse responds Tell me what is happening between you and your wife.. Which basic nursing
  intervention does this interchange characterize?
  a. Advocacy
  b. Counseling
  c. Health teaching
  d. Milieu management

Question 2

A client standing in the dining room is experiencing auditory hallucinations commanding him to
  strangle someone.
 
  His behavior and verbalizations indicate he is experiencing severe to panic level
  anxiety. Put each of the nursing interventions in the order they should be undertaken.
  A. Send another staff member to report the situation and obtain a prn medication.
  B. Assure the client that staff will help him resist the command.
  C. Take the client to a quiet, secure environment.
  D. Clear the dining room of other clients.
  E. Explain that the medication will stop the voices, then administer the drug.

[shaquita]

Answer to Question 1

ANS: B
The nurse is intervening to assist the client to clarify his thoughts and feelings, which is an activity
related to counseling. Option A: Advocacy is taking the client's side. Option B: Health teaching
involves imparting information to the client. Option D: Milieu therapy involves using the
environment to influence behavior.

Answer to Question 2

B, D, A, C, E
Rationale: This sequence supports client self-control to resist the command, protects other clients
from potential harm, secures help from another while allowing the nurse to remain with the client to
provide structure and set limits, removes client to a safer, less confusing environment, explains
therapeutic use of medication, and limits the possibility of the client perceiving the medication as
punishment.

[ishan]

Thank you

[shaquita]

Happy to help you