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How does a psychiatric nurse best implement the ethical principle of autonomy?
- A. By intervening when a self-mutilating patient attempts to harm self.
- B. Staying with a patient who is demonstrating a high level of anxiety
- C. Suggesting that two patients who are fighting be restricted to the unit.
- D. Exploring alternative options with a patient, regarding medications.
Correct Answer: D
Rationale: Exploring options with the patient supports autonomy by enabling informed, self-determined decisions. Intervening with self-mutilation or staying with an anxious patient reflects beneficence and fidelity, while restricting fighting patients aligns with fidelity and justice.
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Which documentation of a patient's behavior best demonstrates a nurse's observations?
- A. Isolates self from others. Frequently fell asleep during group. Vital signs stable.
- B. Calmer and more cooperative. Participated actively in group. No evidence of psychotic thinking.
- C. Appeared to hallucinate. Patient frequently increased volume on television, causing conflict with others
- D. Wears four layers of clothing. States, 'I need protection from dangerous bacteria trying to penetrate my skin.'
Correct Answer: D
Rationale: Specific observations and direct quotes provide clear, objective documentation, unlike vague or subjective options.
After leaving work, a staff nurse realizes that documentation of the administration of a medication to a patient was omitted. This off-duty nurse telephones the unit and tells the nurse, 'Please document the administration of the medication I forgot to do. My password is alphal.' What action should the on-duty nurse take?
- A. Suggest the nurse return and document.
- B. Refer the matter to the charge nurse to resolve.
- C. Access the record and document the information.
- D. Report the request to the patient's health care provider.
Correct Answer: B
Rationale: Referring to the charge nurse ensures policy compliance and proper documentation without risking unauthorized access.
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.
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.
Which scenario is an example of a tort?
- A. The primary nurse completes the plan of care for a patient but takes a full 24 hours after the admission to do so.
- B. An advanced practice nurse recommends that a patient who has a history of danger to self and others be voluntarily hospitalized when reporting audio hallucinations.
- C. A patient's admission status is changed from involuntary to voluntary after the patient's hallucinations subside after medication is started.
- D. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent any possible violence because the unit is short staffed.
Correct Answer: D
Rationale: Giving unnecessary medication for staff convenience is a tort, akin to false imprisonment, violating patient rights. The other scenarios do not involve rights violations.