Psychiatric/Mental Health (Exam Two) Flashcards
A nurses primary responsibility is to the _________.
Patient
What does legislation determine?
What is right or good within a society
What concept systemically distinguishes the rightness and wrongness of certain behaviors?
Ethics
What term is used to describe ethical principals within the scope of medicine, nursing, and allied health?
Bioethics
Conduct that results from serious critical thinking about how individuals ought to treat others is referred to as what?
Moral behavior
Describe values.
Personal beliefs about what is important and desirable to self
Expectations to which an individual is entitled either by established laws, policies, or ethical principals are known as what?
Rights
Which ethical theory is based on the ‘greatest happiness’ principal?
Utilitarianism
What two underlying principals is utilitarianism associated with?
- Greatest good for the greatest number
- End justifies the means
Which ethical theory is directly opposed to utilitarianism?
Kantianism
Kantianism is also known as what?
Deontology
Describe the basic underlying principal of christian ethics?
Do unto others as you would have them do unto you
Which ethical theory emphasizes the rational that as human beings, we inherently know the difference between good and evil?
Natural law theory
The ethical egoism theory bases decisions on what?
Based on what is best for the individual making the decision
An operating room nurse asks a psychiatric nurse, "How can you work with the mentally ill day in and day out?" The psychiatric nurse replies, "Its just the right thing to do." The psychiatric nurse is operating from which ethical framework? A. Kantianism B. Christian ethics C. Ethical egoism D. Utilitarianism
A. Kantianism
An ethical dilemma in nursing is a situation that requires the nurse to make a choice between _____ ________ _________ ___________.
Two equally unfavorable alternatives
Provide an example of the ethical concept of ‘taking no action is considered an action taken’.
A nurse witnesses a fellow RN perform an action that could have brought harm to a patient, but the nurse chooses to not report it
What term describes the idea that individuals are capable of making independent decisions and health-care workers must respect these decisions?
Autonomy
Nurses who perform actions that serve in the clients best interest are adhering to which ethical principal?
Beneficence
Describe nonmaleficence.
Act of do no harm, either intentionally or unintentionally
Describe the ethical principal of justice.
All individuals should be treated equally and fairly
Provide and example in which the ethical principal of justice is violated.
A patient diagnosed with bipolar is denied treatment due to their inability to pay
Which ethical principals refers to one’s duty to always be truthful and not intentionally deceive or mislead clients?
Veracity
When might limitations be placed on the ethical principal of veracity?
- When the truth would knowingly produce harm
- When the truth would interfere with the recovery process
Patients have a right to know about their ________, _________, and _________.
- Diagnosis
- Treatment
- Prognosis
List the steps for making an ethical decision in chronological order.
- Assessment
- Problem identification
- Planning
- Implementation
- Evaluation
T/F: It is ethically and legally appropriate for psychiatric or mental health clients to refuse treatment, including medications.
True
When should the patient’s right to refuse treatment and/or medication be denied or overruled?
Patient exhibits behavior that is dangerous to self or others
List the three criteria that must be met to force medication without patient consent.
- Patient exhibits behavior that is dangerous to self or others
- Medication must have a reasonable chance of providing help to the patient
- Judged incompetent to evaluate the benefits of the treatment
T/F: The patient has a right to whatever level of treatment is effective and least restricts his or her freedom.
True
T/F: Harmless mentally ill individuals can be confined against their will even if they are able to remain safe outside of a hospital setting.
- False.
- Harmless mentally ill individuals cannot be confined against their will if they are able to remain safe outside of a hospital setting
What is the purpose of the Nurse Practice Act (NPA)?
Defines the legal parameters of professional and practical nursing
Nurse practice acts are examples of what type of law?
Statutory law
Describe common law.
Laws derived from decisions made in previous cases
Provide an example of common law.
How different states deal with a nurse’s refusal to provide care for a specific client
What is a tort? What are the different types of torts?
- Violation of civil law in which an individual has been wronged
- Intentional tort
- Unintentional tort
List examples of an unintentional tort.
- Malpractice
- Negligence actions
List examples of an intentional tort.
-Touching of another person without consent
A patient on the psychiatric unit is threatening to sue the facility. List appropriate responses by the nurse.
- Work with patient in a professional manner
- Maintain professional demeanor
- Remain calm
Which constitutional amendments protect an individuals right to privacy?
- Fourth amendment
- Fifth amendment
- Fourteenth amendment
What is the federal statue that protects private patient information from being disclosed?
Health Insurance Portability and Accountability Act (HIPAA)
What must be provided for patient health-care information to be shared with anyone outside the current treatment team?
Written consent
List exceptions to the laws of privacy and confidentiality.
- A duty to warn
- Suspected child or elder abuse
The nurse should ensure what three major elements of informed consent have been addressed with the patient?
- Knowledge
- Competency
- Free will
In what situation can seclusion or restrains be administered or utilized?
The patient is a danger to themself or a danger to others
In what instance can restraints or seclusion be utilized by health-care professionals?
Patient exhibits behavior that is dangerous to self or others
A schizophrenic patient was ordered to be placed in restraints by the HCP for three hours after threatening to commit suicide. After one hour, the patient has reverted to normal self and is no longer suicidal. What is the most appropriate intervention to be performed by the nurse?
Remove the restraints
How often must a patient be monitored if they are placed in restraints or in seclusion?
Every 15 minutes
How often should restraints be removed if the patient is 18 years of age or older?
Every 4 hours
How often should restraints be removed if the patient is between the ages of 9 and 17 years of age?
Every 2 hours
How often should restraints be removed if the patient is under 9 years of age?
Every 1 hour
A patient placed in restraints must be examined face-to-face by a HCP within _____ _______ of restraints being applied.
One hour
The deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means is referred to as what?
False imprisonment
From a legal standpoint, who is allowed to have a person involuntarily hospitalized?
- Law enforcement officer
- Judge
- State
List the criteria necessary for a patient to be involuntarily hospitalized by the state?
- The person is imminently dangerous to himself or herself
- The person is a danger to others
- The person is unable to take care of basic personal needs
Describe negligence.
Failure to follow a standard of care
Describe malpractice.
Breach of duty of care by a medical professional
List the four elements that must be proven for a patient to prevail in a malpractice claim.
- A duty to the patient existed based
- A breach of duty occurred
- The client was injured
- The injury was a direct cause of the breach of standard of care
Describe assault.
Acts that result in a person’s fear that he or she will be touched
Describe battery.
Nonconsensual touching of another person
A nurse may be charged with what type of lawsuit for confining a client against his or her wishes outside of an emergency situation?
False imprisonment
As a last resort, an agitated, physically aggressive patient is placed in four-point restraints. The patient yells, “I’ll sue you for assault and battery.” The unit manager determines that the nurses are protected under which condition?
A. The client is voluntarily committed and poses a danger to others on the unit
B. The client is voluntarily committed and has a history of being a danger to others
C. The client is voluntarily committed because of violent behavior
D. The Client is involuntarily committed and is refusing treatment
A. The client is voluntarily committed and poses a danger to others on the unit
A nurse gave a patient 5mg of haloperidol for agitation. The patient's chart was clearly stamped "allergic haldol." The client suffered anaphylactic shock and died. How would the nurse's actions be labeled? A. Intentional tort B. Negligence C. Battery D. Assault
B. Negligence
An interaction between two people in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention is known as what?
Therapeutic relationship
What must the nurse determine before a therapeutic relationship can be established?
Personal attitudes, values, and beliefs
When are therapeutic nurse-patient relationships most likely to occur?
When each views the other as a unique human being
Which is the primary nursing goal when establishing a therapeutic relationship with a client?
A. To promote client growth
B. To develop the nurse’s personal identity
C. To establish a purposeful social interaction
D. To develop communication skills
A. To promote client growth
Therapeutic relationships are ______ oriented.
Goal
List the characteristics that aid in achieving a therapeutic relationship.
- Rapport
- Trust
- Respect
- Genuineness
- Empathy
A psychiatric patient asks if they can tell the nurse a secret and makes the nurse promise to not share the information with anyone. When ensuring confidentiality with the client, what is an appropriate statement to make to the client?
I will not repeat what we discuss unless it affects your care, then I will share the information with the health-care team
The nurses ability to be open, honest, and “real” in interactions with the patient describes what concept?
Genuineness
A nurse who accurately perceives or understands what the patient is feeling and encourages the patient to explore those feelings is described as being _________.
Empathetic
A nurse who actually shares what the patient is feeling and experiences a need to alleviate distress is described as being ___________.
Sympathetic
What concept contributes to the process of personal identification and the promotion of positive self-concept?
Empathy
List the phases of a therapeutic nurse-client relationship.
- Preinteraction phase
- Orientation phase
- Working phase
- Termination phase
The orientation phase of the therapeutic nurse-client relationship is also known as what?
Introductory phase
When referring to the phases of a therapeutic nurse-patient relationship, in which phase does the nurse become self-aware and evaluate any feelings that may affect their ability to care for the patient?
Preinteraction phase
What is the primary goal of the orientation phase of the therapeutic nurse-client relationship?
- Establish rapport and trust
- Develop treatment goals
What is the primary goal of the working phase of the therapeutic nurse-client relationship?
- Gain insight to patient behaviors
- Promote patient change
- Incorporate alternative behaviors
In which phase of the therapeutic nurse-client relationship is conflict and resistance to change in behavior most likely to occur?
Working phase
Which phase of the therapeutic nurse-client relationship prioritizes promoting the patient’s insight and perception of reality?
Working phase
Describe transference.
Patient unconsciously transfers feelings formed toward a person from their past onto the nurse
If transference is displayed by a patient, what is the primary goal of the nurse?
- Teach patient to assume responsibility
- Help patient assign the correct meaning to the relationship based on current circumstances
What phenomena refers to the nurses behavioral and emotional responses to the patient in which the nurse transfers feelings about past experiences or people onto the patient?
Countertransference
What statements made by the patient may indicate they are having difficulty during the termination phase of the therapeutic nurse-client relationship?
- “I can’t discharge”
- “I don’t switch nurses well”
When does the termination phase of the therapeutic nurse-client relationship usually occur?
- Patient reached goals
- Patient is discharged
- Clinical rotation has ended
A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the preinteraction phase of the nurse-patient relationship, which interaction should the nurse employ?
A. Acknowledging the patient’s actions and encouraging alternative behaviors
B. Establishing rapport and developing treatment goals
C. Providing community resources on aggression management
D. Exploring personal thoughts and feelings that may adversely impact the provision of care
D. Exploring personal thoughts and feelings that may adversely impact the provision of care
Emotional boundaries and physical distance boundaries are encompassed under which boundary of the nurse-client relationship?
Personal boundaries
Hays and Larson describe the role of the nurse as providing the patient with the opportunity to accomplish what in regard to therapeutic communication?
- Identify and explore problems relating to others
- Discover healthy ways of meeting emotional needs
- Experience a satisfying interpersonal relationship
Describe communicaiton.
An interactive process of transmitting information between two or more entities
List preexisting conditions that influence the ways in which messages are received.
- Values
- Attitudes
- Cultures
- Religion
- Knowledge
- Gender
- Age
- Social status
The distance maintained when conversing with strangers or acquaintances is known as what?
Social distance
The closest distance individuals allow between themselves and others is known as what?
Intimate distance
The distance maintained when conversing or interacting with close friends or during personal conversation is known as what?
Personal distance
The unit manager needs to meet with a client who is exhibiting escalating hostility. Which would be the most appropriate location for the nurse to meet with this client? A. The clients room with the door shut B. A quiet corner of the day room C. The nurses station D. The unit's treatment room
B. A quite corner of the day room
What type of communication, used by caregivers, is nonjudgmental, discourages defensiveness, and promotes trust?
Therapeutic communication
___________ __________ is acknowledging and indicating awareness, which is considered better than complementing, which often reflects judgement.
Giving recognition
Provide an example of the giving recognition therapeutic communication technique.
- “I see you made your bed”
- “I noticed you ate all of your meal today”
___________ ___________ allow the patient to direct the focus of the interaction and emphasized the importance of the patient’s role in the communication process.
Broad openings
Provide an example of the broad openings therapeutic communication technique.
- “What would you like to talk about today?”
- “Is there anything you want to discuss?”
_________ _______ offer the patient encouragement to continue with minimal input from the nurse.
General leads
Provide an example of the general leads therapeutic communication technique.
- “Yes, I see”
- “Go on”
- “And after that?”
___________ the main idea of what the patient has said lets the patient know whether an expressed statement has been understood and gives him or her the chance to continue or to clarify if necessary.
Restating
Provide an example of the restating therapeutic communication technique.
Patient: “I can’t study. My mind keeps wandering”
Nurse: “You have trouble concentrating”
_________ occurs whenever questions and feelings are referred back to the patient so that the patient is empowered to actively engaged in problem-solving rather than simply asking the nurse for advice.
Reflecting
Provide an example of the reflecting therapeutic communication technique.
Patient: “Don’t you think I should tell my boss I’m not putting up with that?”
Nurse: “What do you think you should do?”
Encouraging the patient to identify a plan for behavior change promotes developing better coping skills describes which therapeutic communication technique?
Formulating a plan of action
Provide an example of the formulating a plan of action therapeutic communication technique.
“What could you do differently if you are faced with this situation in the future?”
As the move-out date to leave the shelter gets closer, a battered wife states, “I’m afraid to leave here. I’m afraid for my safety and the safety of my children.” Which nursing statement is most supportive?
A. This is a difficult transition. Let’s formulate a plan to keep you all safe in the community
B. It’s the policy that patients can only live here for 30 days. Maybe we can ask for more time.
C. You’ve had a month to come up with a plan for keeping you and your family safe
D. Hopefully your husband has been in counseling I’m sure this will work out fine
A. This is a difficult transition. Let’s formulate a plan to keep you all safe in the community
Giving ________ __________ may discourage the patient from further expressing their feelings if the patient believes their feelings will only be downplayed or ridiculed.
False reassurance
Provide an example of the giving false reassurance nontherapeutic communication technique.
Patient: “My husband doesn’t love me anymore. I think he wants a divorce”
Nurse: “I’m sure he must still love you. Everything will be fine”
_________ _________ implies that the nurse knows what is best and nurtures the patient in the dependent role by discouraging independent thinking.
Giving advice
Provide an example of the giving advice nontherapeutic communication technique.
“You need to do deep breathing exercises when you become anxious”
The nurse is performing an initial assessment on a newly admitted patient who is oriented times four. Which of the following communication techniques would best facilitate obtaining accurate and complete patient data? A. Closed-ended questions B. Requesting an explanation C. Open-ended questions D. Interpreting
C. Open-ended questions
The S in the acronym SOLER indicates what nonverbal behavior?
Sit squarely facing the patient
The O in the acronym SOLER indicates what nonverbal behavior?
Observe an open posture
The L in the acronym SOLER indicates what nonverbal behavior?
Lean forward toward the patient
The E in the acronym SOLER indicates what nonverbal behavior?
Establish eye contact
The R in the acronym SOLER indicates what nonverbal behavior?
Relax
Which communication style may decrease defensive patient responses?
Motivational interviewing
Feedback should contain what type of information to be considered useful to the patient?
- Concrete information
- Specific information
- Critical information
What is the primary focus of the assessment portion of the nursing process?
- Evaluate patient mental status
- Identify patient safety
- Identify patient ability to function
List tools available to assist in gathering information during the assessment portion of the nursing process?
Biopsychosocial assessment
Goals, or outcomes, must be __________, ______________, and __________.
- Measurable
- Time-bound
- Realistic
