Psychiatric Assessment and Fundamentals of Mental Health and Psychiatric Nursing NCLEX Quiz:T/B

Psychiatric Assessment and Fundamentals of Mental Health and Psychiatric Nursing NCLEX Quiz /Final Exam Psych; Test Bank: 463 Questions with Explanation

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2022/2023

1. A psychiatric nurse best implements the ethical principle of autonomy when he or she:

a. intervenes when a self-mutilating patient attempts to harm self.

b. stays with a patient who is demonstrating a high level of anxiety.

c. suggests that two patients who are fighting be restricted to the unit.

d. explores alternative solutions with a patient, who then makes a choice.

{{Correct Ans- ANS: D

Autonomy is the right to self-determination, that is, to make one's own decisions. When the nurse explores alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. Staying with a highly anxious patient or intervening with a self-mutilating patient demonstrates beneficence and fidelity. Suggesting that two fighting patients be restricted to the unit demonstrates the principles of fidelity and justice.

2. Which action by a psychiatric nurse best supports patients' rights to be treated with dignity and respect?

a. Consistently addressing each 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 Ans- ANS: A

A simple way of showing respect is to address the patient by title and surname rather than assuming that the patient would wish to be called by his or her first name. Discussing a patient's condition with a health care provider in the elevator violates confidentiality. Informing a treatment team that the patient is too drowsy to participate in care planning violates patient autonomy. Encouraging a patient to participate in the unit milieu exemplifies beneficence and fidelity.

3. Two hospitalized patients fight 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. This assertion:

a. reveals that the nurse values the principle of justice.

b. reinforces the autonomy of the two patients.

c. violates the civil rights of the two patients.

d. represents the intentional tort of battery.

{{Correct Ans- ANS: C

Patients have a right to treatment in the least restrictive setting. Less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion removes the patient's autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment, not battery.

4. 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 Ans- ANS: D

The nurse is concerned about justice, that is, the fair treatment with the least restrictive methods for both patients. Beneficence means promoting the good of others. Autonomy is the right to make one's own decisions. Fidelity is the observance of loyalty and commitment to the patient.

5. Which scenario is an example of a tort?

a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patient's admission.

b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized.

c. A patient's admission status is changed from involuntary to voluntary after the patient's hallucinations subside.

d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violent acting-out because a unit is short staffed.

{{Correct Ans- ANS: D

A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff members controls behavior in a manner similar to secluding a patient; thus false imprisonment is a possible charge. The other options do not exemplify torts.

6. A nurse's neighbor asks, "Why aren't people with mental illness kept in state institutions anymore?" What is the nurse's best response?

a. "Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent."

b. "Less restrictive settings are now available to care for individuals with mental illness."

c. "Our nation has fewer persons with mental illness; therefore fewer hospital beds are needed."

d. "Psychiatric institutions are no longer popular as a consequence of negative stories in the press."

{{Correct Ans- ANS: B

The community is a less restrictive alternative than hospitals for the treatment of people with mental illness. The remaining options are incorrect and part of the stigma of mental illness.

7. 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 patient has been irritating, seeking the attention of nurses most of the day. Now 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 and uses established protocols to prevent the patient from leaving.

{{Correct Ans- ANS: B

False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. The patient in one distracter is not competent, and the nurse is acting beneficently. The patients in the other distracters have been admitted as involuntary patients and should not be allowed to leave without permission of the treatment team.

8. A patient should be considered for involuntary commitment for psychiatric care when he or she:

a. is noncompliant with the treatment regimen.

b. sold sells and distributes illegal drugs.

c. threatens to harm self and others.

d. fraudulently files for bankruptcy.

{{Correct Ans- ANS: C

Involuntary commitment protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization.

9. A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot injection) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, "Stop, 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 Ans- ANS: A

Patients with mental illness retain their civil rights unless clear, cogent, and convincing evidence of dangerousness exists. The patient in this situation presents no evidence of being dangerous. The nurse, an as advocate and educator, should seek more information about the patient's decision and should not force the medication.

10. Several nurses are concerned that agency policies related to restraint and seclusion practices 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 Ans- ANS: A

Nurses are professionally bound to uphold the American Nurses Association (ANA) standards of practice, regardless of lesser standards established by a health care agency or state. Conversely, if the agency standards are higher than the ANA standards of practice, the agency standards must be upheld. The courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.