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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.
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Which situations qualify as abandonment on the part of a nurse?
- A. The nurse allows a patient with acute mania to refuse hospitalization without taking further action.
- B. The nurse terminates employment without referring a seriously mentally ill patient for aftercare.
- C. The nurse calls police to bring a suicidal patient to the hospital after a suicide attempt.
- D. The nurse refers a patient with persistent paranoid schizophrenia to community treatment.
- E. The nurse asks another nurse to provide a patient's care because of concerns about countertransference.
Correct Answer: A,B
Rationale: Failing to ensure continued care for acutely ill patients constitutes abandonment. Other actions provide for patient safety or self-awareness.
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.
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.
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.
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.