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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.
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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.
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.
In which situations does a nurse have a duty to intervene and report?
- A. A peer is unable to write behavioral outcomes.
- B. A health care provider consults the Physicians' Desk Reference.
- C. A peer tries to provide patient care in an alcohol-impaired state.
- D. A team member has violated the boundaries of a vulnerable patient.
- E. A patient refuses a medication prescribed by a licensed health care provider.
Correct Answer: C,D
Rationale: Impaired care and boundary violations jeopardize safety, requiring intervention. Other situations are less critical or acceptable.
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.
A patient diagnosed with mental illness asks a psychiatric technician, 'What's the matter with me?' The technician replies, 'Your wing nuts need tightening.' The nurse who overheard the exchange should take action based on what principle?
- A. Violation of the patient's right to be treated with dignity and respect
- B. The nurse's obligation to report caregiver negligence
- C. Preventing defamation of the patient's character
- D. Supervisory liability
Correct Answer: A
Rationale: The technician's response violates the patient's right to respectful treatment, constituting emotional abuse.