Nokea
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.
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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.
Which action by a psychiatric nurse best supports a patient's right to be treated with dignity and respect?
- A. Consistently addressing a patient by title and surname
- B. Strongly encouraging a patient to participate in the unit milieu
- C. Discussing a patient's condition with another health care provider in the elevator
- D. Informing a treatment team that a patient is too drowsy to participate in care planning
Correct Answer: A
Rationale: Addressing a patient by title and surname shows respect. Discussing a patient's condition in an elevator breaches confidentiality, informing the team about drowsiness violates autonomy, and encouraging participation reflects beneficence and fidelity.
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.
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.
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.