Nurse in Psychiatry Test Bank

Correct Answer: B

Rationale: The correct answer is B: Medications the patient has recently taken. This is crucial because certain medications can cause delirium in elderly patients. Step 1: Evaluate recent medication history. Step 2: Identify medications known to cause delirium. Step 3: Determine if the patient has taken any of these medications. Other choices are incorrect because: A: Evidence of spasticity or flaccidity is more related to neuromuscular conditions. C: Level of preoccupation with somatic symptoms is not specific to delirium assessment. D: The patient�s level of motor activity is not a key factor in distinguishing delirium from other problems.

Correct Answer: C

Rationale: The correct answer is C because reorienting the patient to time, place, and person is crucial in the immediate post-ECT period to help the patient regain orientation as consciousness improves. This intervention helps prevent confusion and disorientation commonly experienced after ECT. A: Continually stimulating the patient may be overwhelming and unnecessary. B: Continuing bagging is not relevant after ECT as the patient's respiratory function should have stabilized. D: Encouraging walking and eating can be unsafe immediately post-ECT due to potential disorientation and muscle weakness.

Correct Answer: C

Rationale: The correct answer is C because Lewy body disease can affect a patient's ability to communicate pain, making specialized pain assessment tools crucial. Special scales designed for patients with dementia can help in accurately assessing pain levels. These tools consider non-verbal cues and behavioral changes that may indicate pain. Asking the patient's family (A) may not always provide an accurate assessment of pain perception. Using a visual analog scale (B) may be challenging for a patient with cognitive impairment. Focusing solely on mental status (D) may overlook important indicators of pain in patients with Lewy body disease.

Correct Answer: B

Rationale: The correct answer is B: Medications the patient has recently taken. This is crucial because certain medications can cause delirium in elderly patients. Step 1: Evaluate recent medication history. Step 2: Identify medications known to cause delirium. Step 3: Determine if the patient has taken any of these medications. Other choices are incorrect because: A: Evidence of spasticity or flaccidity is more related to neuromuscular conditions. C: Level of preoccupation with somatic symptoms is not specific to delirium assessment. D: The patient�s level of motor activity is not a key factor in distinguishing delirium from other problems.

Correct Answer: A

Rationale: Rationale: The correct answer is A: Assisting the patient in accomplishing the activity. This is because the primary nursing role related to therapeutic activities is to support and facilitate the patient in engaging in the activity independently. By assisting the patient, the nurse promotes autonomy and empowerment, which are essential for therapeutic outcomes. Summary: - B: Ensuring that the patient will comply with the rules of the activity is incorrect as it focuses on compliance rather than empowering the patient. - C: Ensuring that the patient can accomplish the activity in a timely manner is incorrect as the focus should be on the patient's ability to engage in the activity, not just the speed. - D: Directing and controlling the activities to minimize patient anxiety and confusion is incorrect as it doesn't promote the patient's independence and may reinforce dependency.