A voluntary client on a psychiatric inpatient unit asks the nurse ...

[strangeaffliction]

A voluntary client on a psychiatric inpatient unit asks the nurse to get her the forms for discharge
  against medical advice so she can leave immediately. The best response for the nurse to make would
  be
 
  a. I can't give you those forms without your physician's knowledge..
  b. I'll get the forms for you and bring them to your room..
  c. Your lawyer must get the forms for you from your doctor..
  d. Please tell me how you came to the decision to leave treatment..

Question 2

To establish a relationship with a severely withdrawn schizophrenic client being cared for at home
  by a supportive family, the most realistic plan would be for the community mental health nurse to
 
  a. visit daily for 4 days, then every other day for 1 week; stay with client for 20
  minutes, accept silence; state when the nurse will return.
  b. arrange to spend 1 hour each day with the client, with the focus on asking
  questions about what the client is thinking or experiencing; avoid silences.
  c. visit twice daily; sit beside the client with hand on the client's arm; leave if the
  client does not respond within 10 minutes.
  d. visit every other day; remind the client of the nurse's identity; tell the client he
  may use the time to talk or the nurse will work on reports.

[mcabuhat]

Answer to Question 1

ANS: D
A client who has been voluntarily admitted as a psychiatric inpatient has the right to demand and
obtain release in most states. However, as a client advocate, the nurse is responsible for weighing
factors related to the client's wishes and best interests. By asking for information, the nurse may be
able to help the client reconsider the decision. Option A is not a true statement. Option B:
Facilitating discharge without consent is not in the client's best interests before exploring the reason
for the request.

Answer to Question 2

A
Severe constraints on the community mental health nurse's time will probably not allow more time
than what is mentioned in option A, yet important principles can be used. A severely withdrawn
client should be met at the client's own level, with silence accepted. Short periods of contact are
helpful to minimize both the client's and the nurse's anxiety. Predictability in returning as stated will
help build trust. Option B: An hour may be too long to sustain a home visit with a withdrawn client,
especially if the nurse persists in leveling a barrage of questions at the client. Option C: Twice-daily
visits are probably not possible, and leaving after 10 minutes would be premature. Touch may be
threatening. Option D: Working on reports suggests the nurse is not interested in the client.

[strangeaffliction]

TYSM

[ttt030911]

Gracias!