Chapter 10, The Interview and Assessment Process Video Solutions, Psychiatric-Mental Health Nursing: Evidence-Based Concepts, Skills, and Practices

Problem 1

Which of the following statements by the client is an example of a precipitating factor?
a. "I had a fight with my husband and said I was going to kill myself."
b. "My father left us when I was 3."
c. "I go to a special classroom in school for the 'troublemakers." "
d. "My husband is an alcoholic."

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Problem 2

A client reports to the emergency department with complaints of depression and an increase in obsessive hand washing since he filed for bankruptcy. His hands appear reddened with some areas of broken skin. He appears tremulous, diaphoretic, and agitated. He denies taking any prescription medication for anxiety or depression. He admits to drinking a gallon of wine daily for the past 10 years but states he never gets drunk. His last alcohol consumption was about 24 hours ago. Which of these assessment findings requires immediate intervention?
a. Complaints of depression
b. Impaired skin integrity
c. Bankruptcy
d. Alcohol withdrawal

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Problem 3

A client is admitted to the inpatient psychiatric unit after a suicide attempt in which she cut both wrists and required sutures. When the nurse approaches her to conduct an initial assessment, her husband states, "I need to be in the room during the assessment because my wife gets very upset and won't be able to answer your questions." His wife is slouched over and not making eye contact with the nurse or her husband. Which of these is the best response by the nurse?
a. "That's fine; thanks for being so supportive."
b. "Please come in but let your wife answer the questions."
c. "I'll need to conduct this part of the assessment with only your wife. Perhaps we can talk after that."
d. "T'm not allowed to talk to you."

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Problem 4

An 80-year-old man is admitted to the gero-psychiatry unit after his daughter brings him to the emergency department reporting that he is confused and having trouble remembering things. She adds that he has been having trouble ever since his wife of 60 years died 3 months ago. Which of the following facts should the nurse consider while conducting an assessment?
a. Depression may mimic signs of dementia in the elderly.
b. Based on the client's age, he is suffering from dementia.
c. It is normal for people of the client's age to experience confusion and memory loss.
d. Confusion and memory loss are normal components of grief and mourning.

Asma Venkitta

Numerade Educator

Problem 5

A client reports during assessment, "I don't feel like living anymore now that my husband left me. I feel so ugly and small. His new girlfriend is half my age." Which is the best response by the nurse?
a. "Tell me about why your husband left you."
b. "You're not ugly or small."
c. "Are you having thoughts of killing yourself?"
d. "Tell me about your feelings."

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