Psychiatric Nursing Review Part I

1. The charge nurse in an acute care setting assigns to a male client, who’s on one-to-one suicide precautions, to a psychiatric aide. This assignment is considered:

a. Poor nursing practice because a registered nurse should work with this client

b. Reasonable nursing practice because one-to-one supervision requires the total attention of a staff member

c. Outside the responsibility of an aide

d. Illegal to delegate to an aide

2. What’s a nurse most important role in caring for an adult client with a mental disorder?

a. To offer advice

b. To know how to solve the client’s problem

c. To establish trust and rapport

d. To set limits with the client

3. Unhealthy personal boundaries are a product of dysfunctional families and a lack of positive role models. Unhealthy boundaries may also be a result of:

a. Structured limit setting

b. A supportive environment

c. Abuse and neglect

d. Direction and attention

4. The nurse in-charge is displaying assertive behavior when she:

a. Says what’s on her mind at the expense of others

b. Expresses an air of superiority

c. Avoids unpleasant situations and circumstances

d. Stands up for her rights while respecting the rights of others.

5. In a group therapy setting, one male member is very demanding, repeatedly interrupting others and taking most of the group time. The nurse’s best response would be:

a. “Will you briefly summarize your point because others need time also?”

b. “Your behavior is obnoxious and drains the group.”

c. To ignore the behavior and allow him vent

d. “I’m so frustrated with your behavior”

6. The nurse is aware that the primary indication for the use of electroconvulsive therapy (ECT) is:

a. Severe agitation

b. Antisocial behavior

c. Noncompliance with treatment

d. Major depression with psychotic features

7. Two nurses are discussing a female client’s condition in the elevator. The employer of the mentioned client overhears the conversation and fires the client. The nurses may be liable for which act?

a. Assault

b. Battery

c. Neglect

d. Breach of confidentiality

8. A nurse at a substance abuse center answers the phone. A probation officer asks if the male client is in treatment. The nurse responds, “No, the client you’re looking for isn’t here.” Which statement best describes the nurse’s response?

a. Correct because she didn’t give out information about the client

b. A violation of confidentiality because she informed the officer that the client wasn’t there

c. A breach of the principle of veracity because the nurse is misleading the officer

d. Illegal because she’s withholding information from law enforcement agents.

9. The employer of a female client on the psychiatric unit calls the nursing station inquiring about the client’s progress. The nurse doesn’t know if consent has been given by the client to allow the staff to give information out to caller on the phone. Which response by the nurse would be best?

a. “I’m not permitted to discuss her progress.”

b. “I’ll give you the name and telephone number of her physician.”

c. “I’ll have her call you.”

d. “I can’t confirm whether your employee is a client here.”

10. A voluntary male client in a health care facility decided to leave the unit before treatment is complete. To detain the client, the nurse refuses to return his personal effects. This is an example of:

a. False imprisonment

b. Limit setting

c. Slander

d. Violation of confidentiality

ANSWERS AND RATIONALE

# 1. Answer B. A psychiatric aide can sit with the client and provide safety. The nurse is still responsible for assessing the client and ensuring that one-to-one supervision occurs. Aides are capable of providing one-to-one observation. It isn’t illegal to delegate observation to an aide.

# 2. Answer C. It’s extremely important that the nurse establish trust and rapport. The nurse shouldn’t offer advice. Instead, she should help the client develop the coping mechanisms necessary to solve his own problems. Setting limits is also important as developing trust and rapport.

# 3. Answer C. Abuse and neglect lead to poor self-concept and role confusion, which are the basis for unhealthy personal boundaries. Healthy boundaries are established in childhood when parents provide consistent, supportive environment, and direction and attention.

# 4. Answer C. The basic element of assertive behavior includes the ability to express feelings and thoughts while respecting the rights of others. Doing so at the expense of others and expressing superiority are aggressive behaviors, and avoiding unpleasant situation is a form of passive behavior.

# 5. Answer A. Asking the client to summarize his point redirects the clients to focus his comments and allows him to make his point. Telling the client that his behavior is obnoxious is judgmental, and ignoring the behavior doesn’t help facilitate communication. Expressing frustration focuses more on the nurse than on the client’s need.

# 6. Answer D. ECT is indicated for major depression. ECT isn’t indicated severe agitation, antisocial behavior, or treatment noncompliance.

# 7. Answer D. Breach of confidentiality occurs when a nurse shares information that can cause harm to an individual. Assault is an act that results in fear that one will be touched without consent.
Battery involves unconsented touching of another person. Neglect is the failure to do what’s deemed reasonable in a situation.

# 8. Answer B. The nurse violated confidentiality by informing the officer that the client wasn’t in treatment. Even with law enforcement agents, the nurse must be a client advocate and protect the client’s confidentiality. Because it’s unknown in this question whether the client is actually in treatment, it can’t be concluded that the nurse is misleading the officer because her statement may be truthful. Information can be legally withheld when a court order isn’t in place.

# 9. Answer D. The nurse’s release of information to the client’s employer without the client’s consent is a breach of confidentiality. The stigma associated with psychiatric illness may affect the client’s employment; therefore, it’s better to maintain confidentiality and refrain from disclosing any information about the client, including whether she’s a client in the hospital.

# 10. Answer A. Confining a voluntary client against his will be considered false imprisonment. Limit setting is a therapeutic technique used to achieve a desired behavior, and wouldn’t involve confining a voluntary client. Slander is oral defamation of character. The nurse hasn’t given out any information about the client, so confidentiality hasn’t been violated.