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A 22-year-old patient with schizophrenia is refusing his antipsychotic medication. He states, 'I don?t like the dopey way it makes me feel. I feel like I?m walking under water when I take it.' The nurse explains to him, 'Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better.' This conversation reflects a conflict between which two types of ethical principles?
- A. Autonomy and justice
- B. Paternalism and veracity
- C. Justice and nonmaleficence
- D. Autonomy and beneficence
Correct Answer: D
Rationale: The patient?s refusal of medication reflects autonomy (self-determination), while the nurse?s insistence on medication to improve symptoms reflects beneficence (acting for the patient?s benefit). This creates an ethical conflict, as the nurse?s approach prioritizes the patient?s well-being over their right to choose. The other options do not accurately capture this dynamic: justice involves fairness, paternalism involves overriding autonomy, veracity involves truthfulness, and nonmaleficence involves avoiding harm.
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A nursing instructor has prepared a lecture about the scope and standards of practice of psychiatric nurses. The instructor determines that the teaching was effective when the students identify which of the following as common to both basic and advanced level practice?
- A. Case management
- B. Program development
- C. Clinical supervision
- D. Community interventions
Correct Answer: A
Rationale: Case management is a core function in psychiatric nursing, common to both basic and advanced practice levels, as it involves coordinating care to meet patient needs. Program development, clinical supervision, and community interventions are typically advanced practice functions, requiring specialized skills or leadership roles.
A nurse is faced with an ethical dilemma involving a patient. Which question would be most important for the nurse to ask first when engaging in the process of ethical decision making?
- A. What are my own feelings about the situation?
- B. What assumptions am I making that need more data?
- C. What do I know about the situation?
- D. What do I know about the patient?s values?
Correct Answer: C
Rationale: Ethical decision-making begins with gathering facts to understand the situation fully, making 'What do I know about the situation?' the most important first question. This ensures decisions are based on accurate information. While feelings, assumptions, and patient values are important, they are secondary to establishing the factual context.
A nursing student is initiating a relationship with an assigned patient. After meeting and spending approximately 20 minutes talking with the patient, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of patients to play volleyball. The student starts to go with them but then remembers the promise to meet with the patient. The student decides to stay behind and talk to with her patient. The student?s decision reflects which ethical principle?
- A. Autonomy
- B. Beneficence
- C. Fidelity
- D. Veracity
Correct Answer: C
Rationale: Fidelity refers to keeping promises and maintaining loyalty to commitments. By choosing to honor the promise to meet with the patient instead of joining the volleyball game, the student demonstrates fidelity. Autonomy relates to respecting the patient?s decision-making, beneficence involves promoting well-being, and veracity pertains to truthfulness, none of which are as directly relevant.
A group of students is reviewing the functions of psychiatric nurses. The students demonstrate understanding of the information when they identify which of the following as an advanced practice level function?
- A. Milieu therapy
- B. Promotion of self-care
- C. Psychopharmacology interventions
- D. Health promotion activities
Correct Answer: C
Rationale: Advanced practice psychiatric nurses have specialized training, often including prescriptive authority and expertise in managing medications. Psychopharmacology interventions, which involve prescribing and managing psychotropic medications, are specific to advanced practice roles. Milieu therapy, self-care promotion, and health promotion activities are typically within the scope of basic-level psychiatric nursing.
A nurse had developed a plan of care for a patient with depression. Which nursing diagnosis would reflect the social domain?
- A. Imbalanced Nutrition, Less Than Body Requirements related to lack of appetite.
- B. Powerlessness related to feelings of lack of control over the situation.
- C. Ineffective Role Performance related to inability to participate as family provider
- D. Risk for Suicide related to depressed mood and feelings of oneself as a failure
Correct Answer: C
Rationale: The social domain of the biopsychosocial model addresses interpersonal relationships and social roles. Ineffective Role Performance related to inability to participate as a family provider directly reflects the social domain, as it involves the patient?s role within the family. Imbalanced Nutrition is biological, while Powerlessness and Risk for Suicide are primarily psychological.