A nurse is caring for a 25-year-old client admitted to the mental healthcare unit with a severe mental disorder. Which of the following measures should the nurse consider first whenever a client is admitted to the mental healthcare unit?
A) Consider the possibility of withdrawal from alcohol or drugs.
B) Document any unusual occurrences, such as injuries or altercations.
C) Check for overuse of defense mechanisms in the client.
D) Observe if the person has unprovoked bursts of temper.
A
Feedback:
Whenever a client is admitted to a mental healthcare unit, the nurse should consider the possibility of withdrawal from alcohol or drugs. The use of these substances is very common in this population, and withdrawal can be life threatening. People with no previous psychosis may experience psychiatric symptoms during withdrawal from alcohol or drugs. Documenting any unusual occurrences, such as injuries or altercations, checking for overuse of defense mechanisms in the client, and observing if the person has unprovoked bursts of temper are not the first thing to consider when the client is admitted to a mental healthcare unit.
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