Patty is admitted to the inpatient unit after she has cut her wrists. Which is the most important nursing intervention?

Building a trusting relationship

Searching her belongings

Orienting her to the unit

Helping her settle into her room

Answer and Explanation

The Correct Answer is B

A. Building a trusting relationship: Establishing trust is essential in therapeutic relationships, especially with clients at risk for self-harm. However, ensuring the client’s immediate safety by searching belongings takes precedence to protect the client from further harm.

B. Searching her belongings: This is the first priority to ensure Patty’s immediate safety and prevent access to any objects she could use to harm herself. This action addresses the immediate risk and creates a safer environment for her.

C. Orienting her to the unit. Orientation to the unit helps the client feel more comfortable and understand the rules and layout of the facility, but it is not as urgent as ensuring her safety upon admission.

D. Helping her settle into her room: Assisting Patty in getting comfortable is important for her overall well-being but is secondary to securing her environment by removing any potentially harmful items.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A Reason:

Coordinating the implementation of the nursing care plan and documents is inappropriate. This choice is more related to general nursing responsibilities and care coordination. Milieu therapy specifically focuses on creating a therapeutic environment rather than coordinating care plans and documents.

Choice B Reason:

Providing and maintaining a safe and therapeutic environment in collaboration with others is appropriate. Milieu therapy involves creating a therapeutic environment that promotes the patient's mental health and well-being. This includes ensuring safety, providing structure, and creating a supportive atmosphere for patients. The nurse, in collaboration with the healthcare team, is responsible for establishing and maintaining this therapeutic milieu.

Choice C Reason:

Applying current knowledge to assess the patient's response to medication is inappropriate.

Assessing the patient's response to medication is an important nursing responsibility, but it is not the primary focus of milieu therapy. Milieu therapy is more concerned with the overall environment and its impact on the patient's mental health.

Choice D Reason:

Giving anticipatory guidance to prevent or reduce mental illness and enhance mental health is inappropriate. While anticipatory guidance is important in nursing care, it may not capture the essence of creating and maintaining a therapeutic environment, which is the core of milieu therapy. This choice is more related to health education and preventive measures rather than the overall therapeutic environment.

A. Monitor nutrition and self-care. B. Provide round-the-clock supervision. C. Offer structured socialization activities. D. Establish a long-term therapeutic relationship. E. Assist patients in self-assessment

Correct Answer is ["A","B","C","E"]

Explanation

Choice A Reason:

Monitoring nutrition and self-care is correct. Ensuring patients are maintaining proper nutrition and engaging in self-care activities is an essential part of psychiatric nursing care.

Choice B Reason:

Providing round-the-clock supervision is correct. In an inpatient psychiatric unit, especially for patients at risk of harm to themselves or others, providing continuous supervision is often necessary to ensure safety.

Choice C Reason:

Offering structured socialization activities is correct. Structured socialization activities can contribute to patients' well-being and help create a therapeutic and supportive environment.

Choice D Reason:

Establishing a long-term therapeutic relationship is incorrect. While building therapeutic relationships is important, establishing a "long-term" therapeutic relationship might be more applicable in outpatient or community settings. In an inpatient unit, the focus may be on immediate care needs and stabilization.

Choice E Reason:

Assisting patients in self-assessment is correct. Helping patients in self-assessment is a crucial aspect of psychiatric nursing, as it fosters self-awareness and empowers individuals to actively participate in their treatment.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Patty is admitted to the inpatient unit after she has cut her wrists. Which is the most important nursing intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse working in a psychiatric unit plans to apply milieu therapy on a patient. Which intervention would the nurse include in the therapy?

Correct Answer is B

Explanation

Which activity would a nurse perform in an inpatient psychiatric unit? Select all that apply. (Select All that Apply.)

Correct Answer is ["A","B","C","E"]

Explanation

Which stage of Maslow's hierarchy of needs is most threatened when a patient faces a possible layoff from work and witnesses intimate partner violence at home?

Which factor promoting patient growth describes the ability to view another person as worthy of caring about and as someone who has strengths and achievement potential?

A nurse is caring for a client who has cancer and is scheduled for immediate chemotherapy. The client tells the nurse that she wants to try nontraditional treatments first. Which of the following responses should the nurse make?

Which action would the nurse include when beginning a relationship with a new patient? Select all that apply. (Select All that Apply.)

Which statement reflects an accurate understanding of when termination would first be discussed as part of the nurse-patient relationship?

Which patient statement best captures the helpfulness of the nurse-patient relationship? Select one:

Peplau's Interpersonal Theory of Nursing: Select one:

Which cause is responsible for a patient reacting to the nurse by saying, "You are indifferent and cold, just like my mother"?