solved

1. Jeanne is a 48-year-old with dissociative identity disorder who was admitted to the crisis unit for a short-term stay after a suicide threat. On the unit, she has repeated the statement that she will kill herself to get rid of “all the others,” meaning her alters.
a. How do you think that staff reacts to working with patients such as Jeanne?
b. What do you believe needs to be done to protect Jeanne?
2. John, a 24-year-old, returned from the Iraq War last month. Since then he has become increasingly irritable, isolated, and depressed. His wife says he does not want to go anywhere and won’t leave his home for days at a time. In the interview with the nurse at the clinic, he indicates that he feels helpless and anxious and jumpy.
a. Identify priorities in providing care for this patient.
b. What type of medication would you anticipate being ordered for John?
Chapter 17:
1. A patient with suspected somatic symptom disorder has been admitted to the medical-surgical unit after an episode of chest pain with possible electrocardiographic changes. While on the unit, she frequently complains of palpitations, asks the nurse to check her vital signs, and begs staff to stay with her. Some nurses take her pulse and blood pressure when she asks. Others evade her requests. Most of the staff tries to avoid spending time with her.
a. Consider why staff wish to avoid her. How would you feel as a nurse in this situation?
b. Design interventions to cope with the patient’s behaviors. Give rationales for your interventions.
Chapter 18
1. Logan, a 19-year-old male model, has experienced a rapid decrease in weight over the past 4 months after his agent told him he would have to lose some weight or lose a coveted account. Logan is 6 feet 2 inches tall and weighs 132 pounds, down from his usual 176 pounds. He is brought to the emergency department with a pulse of 40 beats per minute and severe arrhythmias. His laboratory workup reveals severe hypokalemia. He has become extremely depressed, saying, “I’m too fat… I don’t want anything to eat… If I gain weight, my life will be ruined. There is nothing to live for if I can’t model.” Logan’s parents are startled and confused, and his best friend is worried and feels powerless to help Logan. “I tell Logan he needs to eat or he will die… I tell him he is a skeleton, but he refuses to listen to me. I don’t know what to do.”
a. Which physical and psychiatric criteria suggest that Logan should be immediately hospitalized?
b. What are some of the questions you would eventually ask Logan when evaluating his biopsychosocial functioning?
c. What are your feelings toward someone with anorexia? Can you make a distinction between your thoughts and feelings toward women with anorexia and toward men with anorexia?
d. What are some things you could do for Logan’s parents and friend in terms of offering them information, support, and referrals? Identify specific referrals.
e. Identify at least five criteria that, if met, would indicate that Logan was improving.
Chapter 19:
1- Anthony is a 46-year-old who complains of waking frequently at night. Consequently, he is tired all day and knows that he has not been functioning as well as he should. Whenever he can manage it, he goes out to his car at lunchtime to take a 60-minute nap, because he has fallen asleep at his desk and been given a disciplinary warning. He is drinking 2 to 3 cups of coffee in the afternoon so that he does not feel sleepy while driving home.
a. What questions would you ask to determine if Anthony might have a sleep disorder?
b. What recommendations will you make to improve his sleep hygiene?
c. What instructions and education should you give this patient regarding personal and community safety?
2. Your patient, Vivian, has been using temazepam (Restoril) for several years to treat insomnia. She has been reading that long-term use of hypnotics is not healthy or productive and wants to quit taking them. However, she is focused on needing 9 hours of sleep each night and is extremely worried about what will happen when she discontinues the temazepam.
a. What instructions would you provide to Vivian regarding stimulus control, sleep restriction, and cognitive restructuring of her sleep complaint?
b. Identify alternative pharmacological therapies.
Chapter 20:
1. As a nurse on an adolescent psychiatric-mental health nursing unit, you often encounter teenagers who are misinformed about growth and development, as well as sexuality. What information would you include in a series of teaching sessions that would help these adolescents acquire a greater understanding of the developmental changes they are going through?
2. To understand your own beliefs, answer these questions:
a. Are you comfortable with your own sexuality? With that of others?
b. Are you judgmental?
c. Could you be helpful to someone who has a sexual disorder?
d. What factors have influenced your beliefs and values regarding sexuality?
e. What do you think is the impact of sexually explicit television, music videos, and movies on your sexual attitudes, values, and beliefs?
Chapter 21:
1. Jacob is a 14-year-old adolescent who has been diagnosed with conduct disorder.
a. Explain to one of your classmates his probable behaviors in terms of (1) aggression toward others, (2) destruction of property, (3) deceitfulness, and (4) violation of rules.
b. What are the outcomes for this disorder?
c. List at least seven ways you could support Jacob’s parents. What are some community referrals you could give them in your own locale?
2. Mallory is a 17-year-old female being admitted to the adolescent psychiatric unit after several weeks of impulsive behaviors such as extensive cutting and running away from home.
a. Put the following areas of assessment in order of priority and provide the rationale for your choices:
1. Suicide risk
2. Current coping skills
3. Skin integrity/risk for infection
4. Childhood development
5. Current family relationships
b. Identify at least three appropriate nursing diagnoses for Mallory based on the previously provided information.
c. Name three nursing interventions to support the nursing diagnosis of ineffective coping.
Chapter 22:
1. Write a paragraph describing your possible reactions to a drug-dependent patient to whom you are assigned.
a. Would your response be different depending on the substance (e.g., alcohol versus heroin or marijuana versus cocaine)? Give reasons for your answers.
b. Would your response be different if the substance-dependent person were a professional colleague? How?
2. Rosetta Seymour is a 15-year-old who has started using heroin nasally.
a. Briefly discuss the trend in heroin use among teenagers.
b. When Ms. Seymour asks you why she needs to take more and more to get “high,” how would you explain to her the concept of tolerance?
c. If she had just taken heroin, what would you find on assessment of physical and behavioral-psychological signs and symptoms?
d. If she came into the emergency department with an overdose of heroin, what would be the emergency care? What might be effective long-term care?
Chapter 23:
1. Mrs. Kendel is an 82-year-old woman who has Alzheimer’s disease. She lives with her husband, who has been trying to care for her in their home. Mrs. Kendel is having trouble dressing. She has put her blouse on backward and sometimes puts her bra on over her blouse. She often forgets where things are. She makes an effort to cook but has recently attempted to “put out” the electric burners of the stove with pitchers of water. Once in a while, she cannot find the bathroom in time, often mistaking it for a closet. At times, she cries because she is aware that she is losing her sense of her place in the world. She and her husband have always been close loving companions, and he wants to keep her at home as long as possible.
a. Assist Mr. Kendel by writing out a list of suggestions that he can try at home that might help facilitate (a) communication, (b) activities of daily living, and (c) maintenance of a safe home environment.
b. Identify at least three interventions appropriate to this situation for each of the areas previously cited.
c. Identify resources available for maintaining Mrs. Kendel in her home for as long as possible. Provide the name of a self-help group that you would urge Mr. Kendel to join.
Chapter 24:

1. Cherie is brought to the emergency department after slashing her wrist with a razor. She has previously been in the emergency department for drug overdose and has a history of addictions. Cherie can be sarcastic, belittling, and aggressive to those who try to care for her. When the psychiatric triage nurse comes in to see her, Cherie is initially adoring and compliant, telling him, “You are the best nurse I’ve ever had, and I truly want to change.” But when he refuses to support her request for diazepam (Valium) and meperidine (Demerol) for “pain,” she yells at him, “You are a stupid excuse for a nurse. I want to see the doctor immediately.” Cherie has borderline personality disorder.
a. What defense mechanism is Cherie using?
b. How could the nurse handle this situation while setting limits and demonstrating concern?

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