The emergency department
1. The following clients are seen in the emergency department. The psychiatric unit has one bed. The advanced practice nurse acting as admitting officer should recommend for admission the client who
A. The client is experiencing tremors and has a need for medication adjustment.
B. The client is experiencing anxiety and a sad mood after separation from her spouse.
C. The client is a single parent and hears voices stating, “Kill your infant son.
D. The client argued with her boyfriend and inflicted a superficial cut on her arm.
2. A Vietnamese immigrant is a student at the local community college nursing program. The nursing instructor is concerned because the student has poor eye contact and has difficulty asking the direct questions necessary for client assessment. The nursing instructor arranges for the student to be assessed by the nurse practitioner in the college health service. This action reflects:
A. Appropriate secondary prevention by the instructor.
B. Insufficient understanding of the student’s culture.
C. A violation of the student’s civil rights.
D. Prejudice and discrimination.
3. Outcomes established with the mentally ill client in the community compared with those planned for a hospitalized client will:
A. Involve a longer time frame
B. Involve a short time frame
C. Involve the same time frame
4. The nurse receives three telephone calls regarding a newly admitted client. The psychiatrist wishes to see the client for an assessment interview, the medical doctor wants to perform a physical examination, and the client’s lawyer wishes to set up an appointment to see the client. The nurse schedules the three activities for the client. This exemplifies the role of the nurse know as:
A. Advocate.
B. Milieu manager.
C. Care manager.
D. Provider of care.
5. Two psychotic clients in the inpatient unit get into fights when they are in the same room. During a team meeting, one nurse suggests the safety of the two clients is of paramount importance and that their treatment plans should call for both to place in seclusion to keep them from injuring each other. The suggestion is significant because it:
A. Reinforces the autonomy of the two patients.
B. Violates the civil rights of both patients.
C. Represents the intentional tort of battery.
D. Correctly places emphasis on safety.
6. A voluntary client on a psychiatric inpatient unit asks the nurse to get her the forms for discharge against medical advice so she can leave immediately. The best response for the nurse to make would be:
A. “I can’t give you those forms without your health care provider’s knowledge.”
B. “I will get them for you, but let’s talk about your decision to leave treatment.”
C. “Since you signed your consent for treatment, you may leave if you desire.”
D. “I’ll get the forms for you right now and bring them to your room.”
7. The nurse caring for a 72-year-old client admitted for treatment of depression notes that the physician’s order to begin therapy with an antidepressant calls for a dose greater than the usual adult dose. The nurse should:
A. Hold the medication and consult the health care provider.
B. Check the electronic formulary on the unit’s computer.
C. Give the usual adult dose.
D. Implement the order as prescribed.
8. The psychiatric home care nurse makes visits to a Hispanic client being treated for depression. The client greets the nurse with a smile and eagerly offers to make coffee. The nurse initiates a handshake, politely refuses the coffee so as not to make work for the client, and suggests they talk about how the client is doing. During the session the nurse notes the client seems less spontaneous in affect and becomes more withdrawn. In analyzing the situation, the nurse should correctly conclude that:
A. The client may feel rejected by the nurse.
B. The client is experiencing rapid cycling.
C. The client feels the nurse has broached a taboo subject.
D. The client feels the nurse’s social touch is inappropriate.
9. A student nurse tells the instructor “I don’t feel as though I’m helping my assigned client. I don’t have the opportunity to engage him in formal counseling sessions. I only spend time with him as he has time between appointments.” The best reply for the instructor would be:
A. “It is appropriate for beginners to progress slowly and develop skills.” B. “It’s all new to you. By the end of your second week on the unit, you will find you feel more helpful.”
C. “I’m sorry you’re feeling disappointed. Have you considered whether your goals for the experience were realistic?”
D. “In informal contacts your psychosocial communication skills help him feel listened to and supported. You provide feedback and encourage the use of adaptive coping skills.”
10. The treatment team discusses plans regarding two clients who both exhibit self-mutilating behavior. The nurse expresses concern about the decision to use restraints on one client while assigning one-to-one supervision for the other. Which ethical principle is the nurse concerned about violating?
A. Justice.
B. Autonomy.
C. Beneficence.
D. Fidelity
