Which is the priority inpatient care for people with severe mental illness?

Symptom management

Family issues

Insight into illness

Social skills

Answer and Explanation

The Correct Answer is A

Inpatient psychiatric care is designed for the acute stabilization of individuals experiencing severe exacerbations of mental illness. The primary goal of this setting is to manage life-threatening symptoms and return the client to a functional baseline that allows for a safe transition to community-based care. The priority is the immediate containment and reduction of symptoms that pose a risk to the client’s safety or their ability to perform basic self-care.

Rationale:

A. Symptom management is the priority because acute symptoms, such as active psychosis, suicidal ideation, or extreme aggression, are the reasons for admission. Until these symptoms are stabilized through pharmacological and therapeutic interventions, the client cannot safely engage in other aspects of recovery. Managing the crisis is the foundation of inpatient treatment.

B. Although family issues are important, they are considered secondary concerns in an acute inpatient environment. Family therapy and resolving interpersonal conflicts are typically addressed once the client is stable enough to communicate effectively. These issues are often better managed in long-term outpatient or residential settings.

C. Gaining insight into an illness is a long-term goal of psychiatric rehabilitation. During an acute phase of severe mental illness, cognitive distortions or hallucinations often prevent a client from having the capacity for insight. Forcing insight during a crisis is often ineffective; the immediate focus must remain on physiological and behavioral stability.

D. Social skills training is a component of psychosocial rehabilitation. While inpatient units provide a structured milieu to practice social interaction, the primary focus is not skill-building but safety and stabilization. Extensive social skills development usually occurs in day treatment programs or halfway houses after the acute symptoms have been successfully managed.

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Correct Answer is C

Explanation

Self-monitoring in the context of eating disorders like bulimia nervosa is a cornerstone of Cognitive Behavioral Therapy (CBT). It goes beyond simple food logging; it is a specialized technique designed to help the client identify the antecedents (triggers) of their behavior, the behavior itself (bingeing/purging), and the consequences (emotional or physical) that follow, thereby breaking the cycle of disordered eating.

Rationale:

A. Keeping a record of food intake is a component of self-monitoring, but this statement is incomplete. Monitoring food alone does not address the behavioral connection between emotions and the urge to purge. This answer describes a food diary rather than a comprehensive therapeutic self-monitoring strategy.

B. Confronting conflict relates to interpersonal therapy and assertiveness training. Although improved communication can reduce stress, it is not a direct measure of the effectiveness of self-monitoring techniques, which are specifically focused on tracking the client’s internal and external cues for eating behaviors.

C. It demonstrates that the client has moved beyond passive recording to active analysis. The client identifies the link between emotions (the "why") and the binge (the "what"), and is actively developing healthy alternative responses. This shows the self-monitoring has successfully increased the client's self-awareness and functional coping.

D. This statement is non-therapeutic and reflects a shame-based view of the disorder. Bulimia is not a lack of self-control but a complex psychological illness. Adopting a mindset of self-blame is likely to increase anxiety and trigger further binge-purge cycles rather than foster recovery.

A. Defiant B. Careless C. Outspoken D. Eager to please

Correct Answer is D

Explanation

Eating disorders, particularly Anorexia Nervosa and Bulimia Nervosa, are often associated with specific personality clusters that influence how the client interacts with the world and healthcare providers. These traits frequently include high levels of perfectionism, harm avoidance, and a significant preoccupation with social approval. Understanding these underlying characteristics allows the nurse to tailor their approach to address the client's need for control and their fear of judgment or failure.

Rationale:

A. Clients with eating disorders are rarely overtly defiant in their general personality. While they may be resistant to treatment changes regarding food and weight, their overall interpersonal style is usually characterized by compliance and a desire to avoid conflict. Defiance is more commonly associated with Oppositional Defiant Disorder or certain conduct disturbances.

B. Carelessness is the opposite of the typical presentation. These clients are usually meticulous and detail-oriented, especially concerning caloric intake, exercise regimens, and academic or professional performance. This high level of conscientiousness is a driving force behind the rigid behaviors seen in the disorder.

C. Outspokenness is uncommon, as these clients often struggle with assertiveness and the expression of negative emotions. They frequently bottle up their feelings to maintain a façade of being in control or perfect. This inability to verbally express distress often leads to the physical manifestation of their anxiety through disordered eating.

D. Being eager to please is a hallmark characteristic. Many clients have a history of being the perfect child who seeks validation through achievement and meeting the expectations of others. In a clinical setting, this may manifest as the client being exceptionally cooperative with non-food-related tasks while internally struggling with profound self-criticism and a fear of disappointing the treatment team.

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Which is the priority inpatient care for people with severe mental illness?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective?

Correct Answer is C

Explanation

The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client?

Correct Answer is D

Explanation

When a psychiatrist prescribes alprazolam for acute anxiety experienced by a client with agoraphobia, health teaching should include which instructions?

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on what?

Which is believed to be a risk factor specific to the development of delirium?

When working with a client with post traumatic stress disorder (PTSD), who has frequent flashbacks, the nurse should include which intervention?

Which client would most likely be mandated outpatient treatment?

A client with dependent personality disorder has a goal to increase problem-solving skills. Which client behavior would indicate progress toward meeting that goal?

Which is possible with somatization? Select all that apply.

Which statements about anger, hostility, and aggression are accurate? Select all that apply.