A community mental health nurse has worked for months to ...

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A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications.
 
  The patient says, Only a traitor would make me go to the hospital. Select the nurse's best initial intervention.
 
  a. With the patient's consent, contact resources to provide medications without charge temporarily.
  b. Arrange a bed in a local homeless shelter with nightly on-site supervision.
  c. Hospitalize the patient until the symptoms have stabilized.
  d. Ask the patient, Do you feel like I am a traitor?

Question 2

A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient's spouse calls the nurse to report the patient has not taken prescribed medication and is having disorganized thinking.
 
  The patient forgot to refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care.
 
  a. The patient's spouse will mark dates for prescription refills on the family calendar.
  b. The nurse will obtain prescription refills every 90 days and deliver to the patient.
  c. The patient will call the nurse weekly to discuss medication-related issues.
  d. The patient will report to the clinic for medication follow-up every week.

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Answer to Question 1

ANS: A
Hospitalization may damage the nurse-patient relationship, even if it provides an opportunity for rapid stabilization. If medication is restarted, the patient may possibly be stabilized in the home setting, even if it takes a little longer. Programs are available to help patients who are unable to afford their medications. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first, since the patient is not dangerous. A yes/no question is non-therapeutic communication.

Answer to Question 2

ANS: A
The nurse should use the patient's support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary for the nurse to do if patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as medication is taken as prescribed.

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Excellent

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TYSM