Nokea
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.
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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 patient being treated in an alcohol rehabilitation unit reveals to the nurse, 'I feel terrible guilt for sexually abusing my 6-year-old child before I was admitted.' Based on state and federal law, what action is the nurse expected to take?
- A. Anonymously report the abuse by telephone to the local child abuse hotline.
- B. Replying, 'I'm glad you feel comfortable talking to me about it.'
- C. Respecting the nurse-patient relationship of confidentiality.
- D. Filing a written report on the agency letterhead.
Correct Answer: A
Rationale: Federal law allows anonymous reporting of child abuse in treatment settings, balancing confidentiality and legal obligations.
Which individual diagnosed with a mental illness may need emergency or involuntary hospitalization for mental illness?
- A. The patient who resumes using heroin while still taking methadone.
- B. The patient who reports hearing angels playing harps during thunderstorms.
- C. The patient who throws a heavy plate at a waiter at the direction of command hallucinations.
- D. The patient who does not show up for an outpatient appointment with the mental health nurse.
Correct Answer: C
Rationale: Throwing a plate due to hallucinations indicates danger to others, justifying involuntary hospitalization.
An adolescent hospitalized after a violent physical outburst tells the nurse, 'I'm going to kill my father, but I know you can't tell anyone.' What is the nurse's best response?
- A. You're right. Federal law requires me to keep that information private.'
- B. Those kinds of thoughts will make your hospitalization even longer.'
- C. You really should share these kinds of thoughts with your psychiatrist.'
- D. I am required to share information like this with your treatment team.'
Correct Answer: D
Rationale: Threats of harm must be shared with the treatment team to ensure safety, overriding confidentiality.
A patient should be considered for involuntary commitment for psychiatric care when demonstrating what behavior?
- A. Nonadherent with the treatment regimen.
- B. Sells and distributes illegal drugs.
- C. Threatens to harm self and others.
- D. Fraudulently files for bankruptcy.
Correct Answer: C
Rationale: Involuntary commitment is warranted for danger to self or others, as in threats of harm. Other behaviors, while problematic, do not meet this criterion.