Answer questions completely and in your own words. This test is open book. Cite all references using APA formatting.
Scenario 1: This scenario and related questions (2) are worth 10 points.
Brian, a college sophomore with a grade-point average of 3.4 is brought to the emergency department after a suicide attempt. He has been extremely depressed since the death of his girlfriend 5 months previously when the car he was driving crashed. His parents are devastated, and they believe that taking one’s life prevents a person from going to heaven.
Brian has epilepsy and has had more seizures since the auto accident. He says he should be punished for his carelessness and does not care what happens to him. He has stopped going to classes and no longer shows up for his part-time job as a reading tutor.
What might be a possible DSM-5 diagnosis for Brian? (5 points)
What are some factors that you should assess regarding aspects of Brian’s overall health and other influences that can affect mental health? (5 points)
Scenario 2: This scenario and related questions (2) are worth 20 points.
Emma, a psychiatric nurse, is not having an easy time with her new client, Mrs. Rhodes, a young mother of three who is being hospitalized for depression. Her husband travels a great deal, and she feels isolated and overwhelmed by some of her children’s behaviors and other parenting challenges. She has become increasingly withdrawn and tearful.
Emma and her patient, Mrs. Rhodes, are scheduled to meet twice a day for one-on-one sessions. In their first session, Emma identifies roles and parameters, establishes their informal contract for these meetings, and sets mutual goals. She also encourages Mrs. Rhodes to take the lead in stating her goals. Things seem to go all right, although Mrs. Rhodes is, of course, very depressed.
However, the second session becomes much more challenging because, as Emma asks questions to establish rapport, and as Mrs. Rhodes begins to share some of her feelings, she starts to cry as she describes an argument with her sister. When the patient suddenly says, “I feel so alone, so lonely. That’s the real problem. What I need is a real friend, not a nurse. I like you. Can we just be friends?”
When Emma tries to explain that this is not the function of the nurse–patient relationship, Mrs. Rhodes smiles awkwardly and says, “I understand.”
They talk a little more, and Emma thinks that things are going well, but suddenly Mrs. Rhodes stands and says, “I’m sorry. I can’t do this. I’m going back to my room.”
1. Emma feels rejected by Mrs. Rhodes. “I thought we liked each other,” she tells you. “What did I do wrong? It is true that I had to explain the boundaries of the nurse-patient relationship, but she seemed to understand and handle it well. Does she hate me now?” Assuming that Mrs. Rhodes did understand, and assuming that Emma did nothing that particularly offended her, what might be the cause of Mrs. Rhodes’ suddenly leaving? (10 points)
2. Emma follows Mrs. Rhodes just into the hallway. When Mrs. Rhodes whispers, “Please, I just need to be alone,” Emma doesn’t know what to do. Should she let her go or insist she return? Discuss both options and provide a rationale. (10 points)
Scenario 3: This scenario and related questions (2) are worth 20 points.
Geoff Cranch, a psychiatric mental health nurse, walks into a conference room where Sylvie Waters, a patient who has been exhibiting signs of extreme depression, waits in a folding chair in front of a desk.
“Hi, Mrs. Waters,” he says. “Sorry to hear you’re not feeling well. I just want to ask you a few questions and kind of see where we’re at with things.” He takes a seat behind a desk and boots up the computer. “Sorry, this is going to take a minute to boot up. But let’s go ahead and start. I understand you’ve been feeling depressed. Can you tell me about that?”
Sylvie looks at the floor and takes several deep breaths, shaking her head. “I don’t even know where to begin,” she sighs.
“Take your time,” Geoff says. “I might need a new computer anyway. Sorry about that.”
“What’s the computer for?”
“Just so I can make notes in your record. It’s part of the EMR requirements we have to follow. It’s very standard. We should probably start now though, so we don’t run out of time. What’s been going on?”
“I don’t know,” Sylvie says.
Melanie from the IT department peeks through the glass door behind Geoff and taps on it softly and apologetically.
“Someone’s in the window,” Sylvie says.
Melanie cracks the door open, tiptoes into the room, and sets a laptop on the desk.
“Thanks so much, Melanie, I was just going to call you.”
Melanie quickly slips out of the room and lets the glass door close behind her with a muffled bang.
“Mrs. Waters,” Geoff says, “I’m very sorry for all of that. I had no idea this computer wasn’t working.”
“I get it,” Sylvie says. She shuffles her feet and adjusts her sleeve.
“Please go ahead. I don’t want to rush you, but I just want to make sure you get to say everything you want to say before our time is up. We shouldn’t have any more interruptions.”
“I just need to think,” says Sylvie.
1. How might Geoff’s behavior be making Sylvie uncomfortable? (10 points)
2. Other than Geoff’s behavior, what else could have been done beforehand to make Sylvie feel comfortable during this interview? (10 points)
Scenario 4: This scenario and related questions (2) are worth 20 points.
On your first clinical day, you are assigned to work with an older adult, Ms. Schneider, who is depressed. Your first impression is, “Oh, she looks like my rude Aunt Elaine. She even dresses like her.” You approach her with a vague feeling of uneasiness and say, “Hello, Ms. Schneider. I am a nursing student, and I will be working with you today.” She tells you that “a student” could never understand what she is going through.
Identify transference and countertransference issues in this situation. What is your most important course of action? (10 points)
What are some useful responses you could give Ms. Schneider regarding her concern about whether you could understand what she is going through? (10 points)
Scenario 5: This scenario and related questions (3) are worth 30 points.
The nurse is admitting a patient, Mike, to the psychiatric unit involuntarily. Mike has a history of Schizophrenia with paranoid delusions. Mike came into the emergency room 6 hours prior with a police officer who picked him up after receiving a petition for treatment. The petition was completed by the patient’s girlfriend, Carrie. The petition cites that the patient is a danger to himself. Carrie last saw the patient running down the street shouting obscenities. The patient was seen running in front of cars and yelling that someone was after him. Carrie has also noted signs of increased paranoia in the petition, stating that “Mike sits in the living room all day with sheets over the windows so nobody can see in. He says it is to keep the bad people out. He has been like this for at least 10 days.”
The patient was seen in the ER by the ER psychiatrist who agrees that Mike is a danger to himself and files an initial certification. Now that Mike is being admitted to the unit, the involuntary admission process can continue.
What additional documentation needs to be completed by the inpatient psychiatrist to support the involuntary admission of this patient? (10 points)
What assessment findings are present in this case to support involuntary commitment? (10 points)
During Mike’s initial assessment, he tells the nurse he is not happy about being admitted involuntarily. Mike says, I hate Carrie. This is all her fault. I’ll kill her.”
Discuss the nurse’s duty to warn. Does this instance require a duty to warn? Provide a rationale. (10 points)
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