A patient has sat in stony silence in the day room for 20 minutes ...

[HCHenry]

A patient has sat in stony silence in the day room for 20 minutes after her appointment with her psychiatrist. She appears tense and vigilant.
 
  The nurse sees the patient abruptly stand up and pace back and forth across the day room, clenching and unclenching her fists. She then stops and stares intently into the face of the psychiatric technician seated at a table. The priority assessment that should be made is that the patient is: a. working off the energy of angry feelings.
  b. attempting to use relaxation strategies.
  c. exhibiting clues to potential aggression.
  d. trying to work through her anger.

Question 2

A person in the community asks the nurse, People with mental illnesses went to state hospitals in earlier times. Why has that changed? Select the nurse's accurate response(s). (Select all that apply.)
 
  a. Science has made significant improvements in drugs for mental illness, so now many persons may live in their communities.
  b. There's now a better selection of less restrictive treatment options available in communities to care for people with mental illness.
  c. National rates of mental illness have declined significantly. There actually is not a need for state institutions anymore.
  d. Most psychiatric institutions were closed because of serious violations of patients' rights and unsafe conditions.
  e. Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings.

[efwsefaw]

Answer to Question 1

C
The description of the patient's behavior shows the classic signs of someone whose potential for aggression is increasing. The patient's pacing may reduce some of the urge to respond physically, but this would be a secondary assessment and not as important to safety as are the signs of impending aggression and violence. The patient's behavior and nonverbal indicators are inconsistent with relaxation. The data are inadequate to determine whether the patient is trying to work through her anger, but this too would be a secondary observation.

Answer to Question 2

A, B, E
The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. Funding for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved.