CH 6 PrepU

After teaching a group of nursing students about the least restrictive environment, the instructor determines that the education was successful when the group identifies which as the most restrictive setting?

Acute inpatient care

The nurse is providing care for a client with a diagnosis of depression. How can the nurse best address the client's needs in the biologic domain?

Administering the client's scheduled dose of citalopram

The depressed client is deciding which type of treatment would be beneficial. The nurse would document that the client is utilizing which ethical principle in this situation?

Autonomy

A nurse recruiter is interveiwing a nurse for a psychiatric-mental health nursing position at the community clinic. When reviewing the applicant's educational background, the recruiter would identify which as the preferred level of preparation?

Bachelor's degree

A client is being seen in the mental health clinic because of relapse. The client has been nonadherent with the medication regimen. The nurse reinforces the advantages of taking medications. The nurse is using which ethical principle?

Beneficence

A new nursing student is studying ethics in nursing and informs a client who wants to stop medication about its benefits and how the client will continue to feel better only if use of the drug continues. Which concept is the nursing student using?

Beneficence

Outpatient treatment can include which of the following services? Select all that apply.

Skills training Supportive group therapy Substance abuse counseling

A nursing student identifies which as the most important tool of psychiatric nursing?

Self

A nurse working in psychiatric-mental health who is a licensed registered nurse but also educationally prepared at the master's level and certified as a specialist is also known as which of the following?

APN

A client with depression who is undergoing a colonoscopy tomorrow is receiving preoperative education regarding the procedure. Which nursing task best describes the explanation of the procedure and the associated risks and benefits?

Acquiring informed consent

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports him or her in whatever decision he or she makes?

Advocate

What action by a nurse best promotes the ethical principle of justice?

Advocating for enhanced mental health services in an underserved neighborhood

A psychiatric-mental health nurse interested in joining a professional organization asks the psychiatric-mental health clinical nurse specialist about these organizations. Which organization would the clinical nurse specialist describe as the largest professional nursing organization focusing on mental health care?

American Psychiatric Nurses Association

A nurse is implementing interventions that address a client's psychological domain. Which intervention would be most appropriate?

Assisting with behavior therapy

A psychiatric mental health nurse is providing care for several clients and is aware of the need to adhere to the Standards of Practice. How can the nurse best demonstrate the standard of evaluation?

Determining whether a client's status has improved during milieu therapy

Researchers are educationally prepared at which level?

Doctorate

Which ethical principle is in jeopardy when segments of the mentally ill population do not have access to care?

Justice

A psychiatric-mental health nurse practitioner is one of several nurses representing their employment facility at a local job fair in the community. One of the attendees approaches the nurse practitioner and asks about the nurse practitioner role. When describing this role, which educational level would the nurse practitioner cite as being the minimum requirement?

Master's degree in Nursing

When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what?

Nonmaleficence

Which of the following provides a foundation for clinical decision-making?

Nursing process

A nurse is assessing a psychiatric client using the biopsychosocial model. Which area would the nurse address with the biologic domain?

Nutritional patterns

A nurse working in a remote area needs a psychiatrist to assist in diagnosing a client. The nurse schedules an interview between a psychiatrist and the client. The psychiatrist will observe and interview the client using videoconferencing software. This is a specific example of which of the following?

Telemedicine

The interdisciplinary team is discussing the best approach to planning the care for a client with complex psychiatric-mental health needs. When determining which tasks can be performed by the psychiatric-mental health registered nurse (PMH-RN) and which must be performed by the psychiatric-mental health advanced practice registered nurse (PMH-APRN), the team should prioritize guidelines from what source?

The American Nurses Association Standards of Practice

The psychological domain contains which theoretical bases? Select all that apply.

Thoughts Feelings Behavior

A client with bipolar disorder has been following the prescribed medication regimen. The client indicates to the nurse a desire to stop the medication now that the client is feeling better. The nurse tells the client that most likely the client will have to remain on the medication for life to keep the condition under control. The nurse is practicing which principle?

Veracity

The nurse must be truthful and honest when caring for mental health clients. In this instance, the nurse is utilizing which ethical principle?

Veracity

Which is an activity of an advanced practice registered nurse and beyond the scope of practice of a registered nurse?

Which is an activity of an advanced practice registered nurse and beyond the scope of practice of a registered nurse?

The concept of "least-restrictive environment" indicates that clients with mental health disorders have a right to be treated with programs or services that ...

achieve the highest level of functioning

The nurse is working with a client who has expressed a desire to discontinue treatment. The care team knows that this decision would have negative consequences for the client and is discussing the ethics of the situation. In order to best address the situation, the nurse should first:

ask reflective questions in order to fully understand the situation.

A client with depression tells the nurse, "I want to stop taking my antidepressant medication because I don't like taking medications." The nurse discusses the benefits of adhering to the medication plan and strongly urges the client to use the medication. The nurse interprets the client's statement as reflecting which ethical principle?

autonomy

A psychiatric-mental health nurse is conducting an in-service education program for a group of staff nurses at a community mental health center. The nurse is discussing the challenges in today's health care climate for psychiatric nursing. The nurse determines that additional discussion is needed based on which statement by the group?

"Although knowledge is rapidly growing, little of this knowledge applies to psychiatric care and mental disorders."

A psychiatric-mental health clinical nurse specialist has been asked to be a guest speaker at a seminar for psychiatric nurses on the topic of the changing face of psychiatric nursing. After the seminar, one of the attendees comes up to the clinical nurse specialist and asks how the speaker became a clinical nurse specialist. Which response would be most appropriate?

"I obtained my master's degree and then got certified by an accrediting agency."

A psychiatric-mental health nurse is reviewing the medical record of a client with depression admitted to the acute inpatient facility because of a suicide attempt. Which statement by the client would the nurse correlate with the psychological domain of the biopsychosocial framework?

"I've lost any feelings of pleasure that I had with life."

The nurse is complaining about a client that has dementia. The client is mobile and slaps the nurse on the gluteus maximus each time he passes by. The nurse tells the client, "If you don't behave yourself, I am going to throw you out and you won't have anywhere to go." The charge nurse overhears the nurse, and states "Do you realize what your statement could be construed as?" What is the best statement for the nurse to respond?

"It could be construed as assault"

The nursing ethics committee is reviewing the ethical principle of justice. One committee member states, "What are some examples of justice?" Which statement(s) by the nurse exemplifies justice? Select all that apply.

"Nurses should be fair when they distribute care among the clients that they are assigned." "Nurses should make sure that all clients have a meal if they are permitted to eat."

The nurse educator is teaching the nursing class about autonomy and asks the student nurse "What are the basic elements of autonomy?" Which statement(s) by the student nurse would require more teaching? Select all that apply.

"Removing from harm" "Remaining faithful to ethical principles" "Removing evil"

A nursing instructor is teaching about the three domains of the biopsychosocial model. When discussing the social domain, the instructor recognizes a need for further education when a student states which of the following?

"Social factors usually cause psychiatric disorders."

A client with schizophrenia will not take medication because the client is gaining weight. This client is exercising which ethical principle?

Autonomy

The client is to undergo a computed tomography (CT) scan of the head with contrast. Ensuring that the client has provided informed consent for a treatment regimen displays which ethical principle?

Autonomy

The client's right to self-determination and independence is guided by which ethical principle?

Autonomy

A client with persistent depression is considering electroconvulsive therapy (ECT). The nurse has seen ECT be effective in other cases. When the client expresses fear and doubt about undergoing ECT, the nurse tries to talk the client into it, because the nurse truly believes it will help the client. Which two ethical concepts are in conflict?

Beneficence and autonomy

A client with insomnia has been prescribed a sleep medication that does not contain REM sleep suppressors. This is an example of an intervention related to which domain in the biopsychological model?

Biologic

An experienced nurse working in mental health uses the holisitc and well-supported biopsychosocial model. The nurse correctly identifies which of the following as domains of this model? Select all that apply.

Biologic Psychological Social

A psychiatric-mental health nurse is developing a plan of care for a client with panic disorder. The nurse uses assessment data and cues from the client to identify immediate and long-term problems. The nurse actively works with the client to problem solve. The nurse is using which tool?

Clinical reasoning

A psychiatric-mental health nurse is thinking about becoming an advanced practice psychiatric-mental health nurse. Which activity would the nurse be able to complete with this new role that the nurse would not be able to do now?

Clinical supervision

A psychiatric-mental health nurse is conducting a review course for a group of psychiatric-mental health nurses. The topic of the course is ethics in psychiatric nursing. The nurse determines that additional review is needed when the group identifies which concept as an ethical principle?

Competency

A nurse working in a psychiatric facility needs to be competent to practice safe care. The nurse obtains this competency through which of the following avenues? Select all that apply.

Education Experience

A new graduate practicing in a psychiatric center has learned that there are two levels of practice: basic and advanced. The graduate correctly identifies which of the following as used to help differentiate these levels? Select all that apply.

Educational preparation Complexity of practice Performance of nursing function

A group of psychiatric-mental health nurses are working to reduce the effect of stigma for patients with mental health problems in the community. Which role would the nurses most likely assume to achieve their outcome?

Educator

A nurse is reviewing information about standards of professional performance for psychiatric-mental nurses. The nurse demonstrates understanding of this concept, identifying which area as being addressed? Select all that apply.

Ethics Leadership Communication Collaboration

A client's plan of care includes revoking privileges for inappropriate behavior, based on a contract between the client and the nurse who wrote the plan. Another nurse decides to ignore this because the client promises that the client will adhere to the contract in the future. The second nurse's behavior may have violated which ethical principle?

Fidelity

Earlier in the shift, the nurse promised to help a client acquire some paper and a pen and draft a letter to a family member later in the day. The nurse became increasingly busy during the shift but has now taken some time to assist the client in this way. What ethical principle has the nurse best exemplified?

Fidelity

When faced with what appears to be a client-focused ethical dilemma, the nurse should initially ...

Implement the steps of an ethical decision-making model

A psychiatric-mental health nurse is reading a journal article about different professional organizations and their missions. When reading a synopsis about the American Psychiatric Nurses Association, which information would the nurse expect to find? Select all that apply.

Improves mental health care for culturally diverse persons Helps shape health policy involving mental health services Advance psychiatric-mental health nursing practice.

A client comes to the emergency department with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which principle is being ignored by discharging this client?

Justice

A psychiatric-mental health nurse is conducting a program for a community group on safety measures and the mandatory use of protective helmets for children when riding bicycles, skateboards and roller skating. The nurse is applying which ethical principle as the foundation for this program?

Paternalism

Mandatory use of seat belts is an example of which ethical principle?

Paternalism

Which statement is inconsistent with the social domain of the biopsychosocial model?

Psychiatric disorders are caused by societal factors.

A psychiatric-mental health nurse is conducting an in-service program for a group of nurses which includes a review about the American Nurses Association standards of practice for psychiatric-mental health nursing. After describing these standards, the nurse determines that the teaching was successful when the group identifies which information?

Psychiatric-mental health advanced practice nurses are the only ones who may provide psychotherapy.

A client with complex psychosocial and mental health needs requires case management. What members of the health care team may perform case management for this client? Select all that apply.

Psychiatric-mental health registered nurse Psychiatric-mental health advanced practice nurse

The advanced practice psychiatric nurse is working with a client who has generalized anxiety disorder. The nurse is teaching the client skills at identifying and managing the thoughts that exacerbate his anxiety. What domain is this nurse primarily addressing?

Psychological

While caring for a client with insomnia, the nurse teaches the client to use guided imagery. This intervention is an example of which domain?

Psychological

A psychiatric-mental health nurse is practicing at the advanced level. Which function would this nurse be able to perform based on the nurse's advanced level of preparation?

Psychotherapy

Which are functions of assertive community treatment? Select all that apply.

Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses

A psychiatric-mental health nurse is reading a journal article about clinical reasoning. The nurse demonstrates understanding of the article by identifying clinical reasoning as dependent on critical thinking and:

Reflection

When working with clients with mental illness, a psychiatric-mental health nurse examines the nurse's own interactions with clients to improve communication skills. The nurse is using which tool?

Reflection

Which situations depict a nurse employing the principles of fidelity while providing care? Select all that apply.

The nurse tells the client, "I will return to give you pain medication in 1 hour." The nurse returns in 1 hour.

A client with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the way it makes me feel, I feel like I'm under water when I take it." The nurse explains, "schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. Your symptoms will get better if you take the medication." This conversation reflects conflict between which ethical principles?

autonomy and beneficence

The client has not been on speaking terms with the client's parents for several years. The parents have expressed a desire to reunite with the client. At first, the client agreed to a family meeting, and then decided not to meet with the parents. The nurse has encouraged the client to attend the family meeting knowing that the family's support would be valuable. What ethical principles are in conflict in this situation?

autonomy and beneficence

Providing milieu therapy is an example of the use of which ethical principle?

beneficence

The nurse is teaching a client about the importance of adhering to a medication regimen. The client does not believe that it is important. The nurse is communicating which ethical principle

beneficence

Which domain of the biopsychosocial model encompasses functional health patterns such as exercise and sleep?

biologic

The nurse is planning the care of a newly-admitted client and is ensuring that the client received holistic care. In order to achieve this goal, the nurse should:

collaborate closely with other care providers to ensure the client's medical needs are met.

A nurse is reviewing the Standards of Professional Performance. Which area would the nurse most likely find being addressed?

communication

After spending 45 minutes talking with an assigned patient, the student nurse promises to visit again after lunch. After lunch, the nursing student returns and talks with her client. The student's action reflects which ethical principle?

fidelity

Which ethical principles become an issue in mental health when a segment of a population does not have access to health care?

justice

Which of the following medication classifications are used to assist clients to calm down? Select all that apply.

medications Antipsychotics Mood stabilizers

Which member of an interdisciplinary team assists the client with transition into the workplace?

occupational therapist

Mandatory use of helmets when driving a motorcycle is an example of which ethical principle?

paternalism

When providing care to a patient with major depression, what is the most important tool the nurse would use?

self