11.6 Learning Activities: All
Flashcards
Click the Turn button to flip each card and see the answer, then use the arrow to move to the next card. Continue through the set and revisit cards as needed until you can recall the answers on your own.
Drag and Drop
Read each description carefully. Drag each answer choice into the box that matches the correct description. When all boxes are filled, select Check to submit your answers. If any answers are incorrect, select Retry to try again.
Knowledge Check
Read each question carefully. Select the answer you think is correct. Then select Check to submit your answer. If your answer is incorrect, select Retry to try again. Use the arrow buttons to move between questions.
NCLEX Next Generation-Style Questions
Test your clinical judgment with these NCLEX Next Generation-style questions.
- Open the activity: NCLEX Next Generation-style question 1
- Open the activity: NCLEX Next Generation-style question 2
Case Study
Nurse Handoff Report
Situation
Parker Allen, a 28-year-old man, was admitted to a locked behavioral health unit today for paranoia, psychosis, and violent behavior after an altercation with his landlord. Parker threw a table at the landlord when she came to his apartment to address a noise complaint made by another tenant. The landlord called the police, who transported Parker to the emergency department.
Background
Parker has a three-year history of schizophrenia. He has a master’s degree in engineering and works as a software developer. He was diagnosed with schizophrenia shortly after completing graduate school, when he became increasingly isolated and paranoid of those around him.
Parker’s first psychiatric hospitalization occurred approximately one year after his diagnosis, when he experienced auditory hallucinations and paranoid delusions. He has tried several medications but reports that he does not like how they make him feel and that they interfere with his ability to concentrate at work.
His currently prescribed medications include the following:
- Olanzapine 10 mg daily
- Venlafaxine extended release (XR) 75 mg daily
Parker states that he recently stopped taking his medications.
Assessment
Since arriving on the behavioral health unit, Parker has been withdrawn. He states, “The nurses can see my thoughts,” and explains that this is why he has remained in his room with his head covered by a blanket.
Parker sometimes answers questions, but his responses are frequently inappropriate or unrelated. He tells the nurse, “I’m pretty sure you are all here to kill me, and you’re starting with the hospital food. I know how this is going to go down.”
The nursing staff can speak with Parker only for brief periods because he either refuses to talk or becomes easily distracted. He has a disheveled and unclean appearance and has refused to shower since arriving on the unit. His hair is unkempt, and his beard needs trimming.
The nursing assistant reports that Parker refused to eat dinner when he arrived on the unit but drank a few sips of water from a sealed bottle.
Vital Signs
- Temperature: 37.0°C
- Heart rate: 76 beats/minute
- Respiratory rate: 18 breaths/minute
- Blood pressure: 128/79 mm Hg
- Oxygen saturation: 95%
Behavioral and Mental Status Findings
When the nurse enters Parker’s room, he is sitting on the bed wrapped in a blanket, with most of his face covered. He is facing away from the nurse and looking toward the window. When greeted, Parker does not move or turn toward the nurse’s voice. He is mumbling quietly to himself.
The nurse moves to face Parker and greets him again. Parker responds quietly but does not make eye contact. His responses are apprehensive.
Parker appears guarded and suspicious. He keeps his arms wrapped around himself beneath the blanket. The nurse observes that he is wearing several layers of clothing and has noticeable body odor.
The nurse asks Parker whether he is experiencing suicidal thoughts. Parker repeats many of the nurse’s questions rather than answering them. He rarely provides direct responses and appears distracted throughout the interaction.
Parker becomes agitated when asked about hallucinations. He states that he is hearing voices telling him that the food provided by the hospital is poisoned. He reports that the voices have been constant since his arrival at the hospital. At home, he was sometimes able to make the voices go away by listening to music through headphones.
The nurse observes that Parker makes unusual statements, such as, “The bammerhoff got me,” and uses tangential speech.
Previous documentation in the electronic health record indicates that Parker’s landlord told police that several neighboring tenants had complained about loud, unusual music and noises coming from his apartment late at night.
Parker tolerates the assessment for approximately 15 minutes. He then refuses to answer additional questions and states, “You better find the cook. They are poisoning all of us.”
Parker lies down in bed and pulls the covers over his head. The nurse informs him that they will return soon with a snack and thanks him for participating in the assessment. Parker does not respond and continues mumbling quietly beneath the covers.
Reflective Questions
- What cues do you recognize as important when planning Parker’s care?
- What is your hypothesis regarding Parker’s condition based on the available information?
- Write a SMART goal for Parker based on his priority nursing problem.
- What are the priority nursing interventions for Parker?
- How will you evaluate whether the nursing interventions have been effective?
- What symptoms require continued monitoring?
