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The family of a patient whose insurance will not pay for continuing hospitalization considers transferring the patient to a public psychiatric hospital. The family expresses concern that the patient will 'never get any treatment.' Which reply by the nurse would be most helpful?
- A. Under the law, treatment must be provided. Hospitalization without treatment violates patients' rights.'
- B. That's a justifiable concern because the right to treatment extends only to the provision of food, shelter, and safety.'
- C. Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable.'
- D. All patients in public hospitals have the right to choose both a primary therapist and a primary nurse.'
Correct Answer: A
Rationale: The 1964 Hospitalization of Mentally Ill Act ensures treatment rights in public hospitals, reassuring the family.
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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.
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.
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 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.
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.