Nokea
A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate to a patient diagnosed with schizophrenia. As the nurse swabs the site, the patient shouts, 'Stop! I don't want to take that medicine anymore. I hate the side effects.' Select the nurse's best initial action.
- A. Stop the medication administration procedure and say to the patient, 'Tell me more about the side effects you've been having.'
- B. Say to the patient, 'Since I've already drawn the medication in the syringe, I'm required to give it, but let's talk to the doctor about skipping next month's dose.'
- C. Proceed with the injection but explain to the patient that other medications are available that may help reduce the unpleasant side effects.
- D. Notify other staff members to report to the room for a show of force and proceed with the injection, using restraint if necessary.
Correct Answer: A
Rationale: Stopping to discuss side effects respects the patient's rights and autonomy, absent evidence of dangerousness. Forcing medication violates civil rights.
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A newly admitted patient who is acutely psychotic is a private patient of the senior psychiatrist. To whom does the psychiatric nurse who is assigned to this patient owe the duty of care?
- A. Health care provider
- B. Profession
- C. Hospital
- D. Patient
Correct Answer: D
Rationale: The primary duty of care is owed to the patient, despite accountability to others.
A nurse volunteers for a committee that must revise the hospital policies and procedures for suicide precautions. Which resources would provide the best guidance?
- A. Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5)
- B. State's nurse practice act
- C. State and federal regulations that govern hospitals
- D. Summary of common practices of several local hospitals
- E. American Nurses Association Scope and Standards of Practice
Correct Answer: C,E
Rationale: Hospital regulations set minimum standards, and ANA standards elevate practice. DSM-5 and nurse practice acts are irrelevant, and local practices may not comply with best standards.
Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
- A. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
- B. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
- C. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
- D. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
Correct Answer: A
Rationale: Nurses must uphold ANA standards, even if agency policies are substandard. Agency policies do not override professional standards, and leaving or judicial interpretation are not primary guides.
A nurse cares for an older adult patient admitted for treatment of depression. The health care provider prescribes an antidepressant medication, but the dose is more than the usual adult dose. The nurse is obligated to take what action?
- A. Implement the order as written but document the concern.
- B. Hold the medication and then notify the health care provider.
- C. Consult a drug reference if a pharmacist is not available.
- D. Give the usual geriatric dosage at the scheduled times.
Correct Answer: B
Rationale: Holding the medication and consulting the provider protects the patient, as geriatric doses are typically lower.
In a team meeting, a nurse says, 'I'm concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision.' Which ethical principle most clearly applies to this situation?
- A. Beneficence
- B. Autonomy
- C. Fidelity
- D. Justice
Correct Answer: D
Rationale: The nurse's concern about differing treatments for similar behaviors reflects justice, ensuring fair and equitable care. Beneficence promotes good, autonomy supports self-determination, and fidelity upholds loyalty.