Nokea
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.
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Two hospitalized patients resort to physical fighting when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. Which does this assertion indicate about the nurse who presented it?
- A. Reveals that the nurse has a strong sense of justice.
- B. Values the reinforcement of the autonomy of the two patients.
- C. Has a poor understanding of the civil rights of the two patients.
- D. Doesn't understand the actions that constitute the intentional tort of battery.
Correct Answer: C
Rationale: The nurse's suggestion of seclusion ignores the right to the least restrictive treatment, indicating a poor understanding of civil rights. Seclusion removes autonomy, is motivated by beneficence, not justice, and risks false imprisonment, not battery.
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.
The spouse of a patient who experiences delusions asks the nurse, 'Are there any circumstances under which the treatment team is justified in violating the patient's right to confidentiality?' What is the nurse's best response?
- A. We can't violate that confidence under any circumstances.'
- B. We can do that only at the discretion of the psychiatrist.'
- C. We are obligated to answer questions asked by law enforcement.'
- D. We are not bound if the patient threatens the life of another person.'
Correct Answer: D
Rationale: The duty to warn overrides confidentiality when a patient threatens harm, as per legal standards.
A nurse's neighbor asks, 'Why aren't people with mental illness kept in state institutions anymore?' What is the nurse's best response?
- A. Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent.'
- B. Less restrictive settings are now available to care for individuals with mental illness.'
- C. Our nation has fewer persons with mental illness; therefore, fewer hospital beds are needed.'
- D. Psychiatric institutions are no longer popular as a consequence of negative stories in the press.'
Correct Answer: B
Rationale: Community-based, less restrictive settings are preferred for mental health care, reducing institutionalization. The other options perpetuate stigma or are factually incorrect.
Which nursing intervention demonstrates false imprisonment?
- A. A confused and combative patient says, 'I'm getting out of here and no one can stop me.' The nurse restrains this patient without a health care provider's order and then promptly obtains an order.
- B. A nurse escorts the patient down the hall, saying, 'Stay in your room or you'll be put in seclusion.'
- C. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit.
- D. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team uses established protocols to prevent the patient from leaving.
Correct Answer: B
Rationale: Threatening seclusion without justification creates fear of confinement, constituting false imprisonment. The other scenarios involve justified actions for patient safety or incompetence.