Question 1

When applying the biopsychosocial model to client care, the nurse integrates which psychological domain?

Accepted Answer

Cognitive approaches, behavior therapy, and client education are all based on the use of theories from the psychological domain. Family support involves the social domain. Nutritional therapy and sleep hygiene measures address the biologic domain.

Question 2

A nursing instructor is describing the impact of technology and electronic health records on psychiatric-mental health care. What would the instructor identify as a major challenge associated with technology?

Accepted Answer

One major challenge of new technology and electronic health records is maintaining confidentiality and privacy. Records are now readily available and easily accessed. Fragmented care is associated with changes in the health care delivery system. The growing knowledge base in conjunction with disseminating and applying this knowledge poses challenges related to education and professional standards.

Question 3

A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

Accepted Answer

Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue when some portion of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth.

Question 4

A nursing student is initiating a relationship with an assigned client. After meeting and spending approximately 20 minutes talking with the client, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of clients to play volleyball. The student starts to go with them but then remembers the promise to meet with the client. The student decides to forgo volleyball and talk with the client. The student's decision reflects which ethical principle?

Accepted Answer

Fidelity is faithfulness to obligations and duties. It is keeping promises. Fidelity is important in establishing trusting relationships. With autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, a health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Veracity is the duty to tell the truth.

Question 5

In a post-clinical conference, a group of students is engaged in a discussion with their instructor. The instructor repeatedly has the students analyze and evaluate the nursing interventions implemented throughout the clinical experience. What are the students engaged in?

Accepted Answer

Sound clinical reasoning depends on critical thinking skills and reflection. Reflection involves continual self-evaluation through observing, monitoring, and judging nursing behaviors with the goal of providing ideal interventions. In therapeutic use of self, the nurse guides, teaches, and advocates for clients through the therapeutic relationship. Interdisciplinary care involves collaboration with other professionals. Planning care involves participation of the client for the provision of services to the client.

Question 6

A group of students is reviewing the functions of psychiatric nurses. The students demonstrate understanding of the information when they identify which function as an advanced practice-level?

Accepted Answer

Psychopharmacology interventions are advanced practice level-functions. Milieu therapy, self-care promotion, and health promotion are basic-level functions.

Question 7

A nursing instructor has prepared a lecture about the scope and standards of practice of psychiatric nurses. The instructor determines that the education was effective when the students identify what commonality of basic- and advanced-level practice of psychiatric nurses?

Accepted Answer

Both basic- and advanced-level psychiatric nurses engage in case management. Only advanced practice-level psychiatric nurses engage in program development, clinical supervision, and community interventions.

Question 8

A nurse is working on developing ways to meet the challenge of knowledge development. Which action would be most appropriate?

Accepted Answer

Accessing new information through journals, electronic databases, and continuing education programs takes time and vigilance, but provides a sound basis for application of new knowledge. Improving access to community psychiatric care and reducing the burden of mental illness are ways to overcome stigma. Providing culturally competent, high-quality care is a means to address the challenges of the health care delivery system.

Question 9

A 22-year-old client diagnosed with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it." The nurse explains to the client, "Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better." This conversation reflects a conflict between which two types of ethical principles?

Accepted Answer

Ethical conflicts can occur when the client is being guided by the principle of autonomy and the nurse by the principle of beneficence. According to the principle of autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, the health care provider uses knowledge of science, and incorporates the art of caring, to develop an environment in which individuals achieve their maximal health care potential. Justice involves a duty to treat all fairly. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client. Veracity is the duty to tell the truth. Nonmaleficence is the duty to cause no harm.

Question 10

A nurse is faced with an ethical dilemma involving a client. Which question would be most important for the nurse to ask first when engaging in the process of ethical decision-making?

Accepted Answer

The first question that needs to be asked is, "What do I know about the situation?" This information is critical before being able to proceed. Next the nurse would reflect on the client's values, then about any assumptions, and then about personal feelings.

Question 11

A psychiatric-mental health nurse is adhering to the standards of practice. When engaging in clinical decision-making, the nurse is integrating what as the foundation?

Accepted Answer

Although developmental issues, commitment, and accountability are all concepts addressed in clinical decision-making, the foundation for all clinical decision-making is the nursing process.

Question 12

A group of nurses is reviewing the standards of professional performance. The nurses demonstrate understanding when they identify what as a standard of professional performance?

Accepted Answer

Collaboration is a standard of professional performance. Prescriptive authority and consultation are subcategories of implementation which is a standard of practice. Planning is a standard of practice.

Question 13

A psychiatric-mental health nurse is providing care to clients diagnosed with a mental illness and is investigating factors related to client safety, delivery of care services, and cost-effectiveness. The nurse is involved with which area of professional performance?

Accepted Answer

Resource utilization addresses factors related to safety, effectiveness, cost, and impact of practice in the planning and delivery of nursing care. Education involves attaining knowledge and competency in current nursing practice. Quality of practice addresses the systematic enhancement of the quality and effectiveness of nursing practice. Collaboration involves working together (collaborating) with clients, family, and others in the conduct of nursing practice.

Question 14

When applying the biopsychosocial model to a client with a mental health problem, the nurse addresses which psychological domain?

Accepted Answer

The psychological domain addresses thoughts, feelings, and behavior. Sleep patterns are addressed in the biologic domain. Family functioning and cultural groups are assessed in the social domain.

Question 15

A nurse has developed a plan of care for a client diagnosed with depression. For problems related to the social domain, which issue would the nurse most likely identify?

Accepted Answer

The issue related to the inability to participate as a family provide reflects the social domain because the client is not fulfilling the role in the family. Poor nutrition reflects the biologic domain. Powerlessness and risk for self-harm reflect the psychological domain.

Question 16

A nurse is engaged in exercises to develop self-awareness. The nurse is using which tool?

Accepted Answer

Reflection involves continual self-evaluation through observing, monitoring, and judging nursing behaviors. Reflection skills are used in all aspects of psychiatric nursing practice, from enhancing self-awareness and examining nurse-client interactions to evaluation of the system of care. Interdisciplinary care involves collaboration with other professionals and the client in all settings. Plan of care is the individualized plan used to direct client care. Clinical reasoning involves critical thinking skills and reflection.

Question 17

A nurse is looking for information about the parameters of professional psychiatric-mental health nursing practice that provide the framework for nursing practice. The nurse would most likely seek out which source?

Accepted Answer

The ANA and the psychiatric nursing organizations collaborate in defining the boundaries of psychiatric-mental health nursing and informing society about the parameters of practice. The standards are authoritative statements that describe the responsibilities for which the practitioners are accountable. The six standards of practice include competencies for which Psychiatric-Mental Health Registered Nurse (PMH-RN) and Advanced Practice Psychiatric-Mental Health Registered Nurses (PMH-APRN) are accountable and define the parameters of psychiatric-mental health nursing practice. Ten standards of professional performance for psychiatric-mental health nurses define and inform society about the professional role of psychiatric-mental health nurses. The Code of Ethics for Nurses presents ethical values, obligations, duties and professional ideals, establishes an ethical standard, and confirms nursing's commitment to society. The State Board of Nursing is considered the legal agency for the practice of nursing.

Question 18

A psychiatric-mental health nurse is working with local government officials in establishing programs that allow access to services for all individuals in the community. The nurse is integrating which ethical principle?

Accepted Answer

Justice is the duty to treat all fairly, thus distributing the risks and benefits equally. Justice becomes an issue in mental health when a segment of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties, that is, keeping promises.

Question 19

The plan of care for a client with schizophrenia identifies certain outcomes. Which outcomes would the nurse identify as addressing the biologic domain? Select all that apply.

Accepted Answer

Biologic domain outcomes include minimizing the adverse effects of drug therapy and improving nutritional status. Improving problem solving skills involves the psychological domain. Promoting economic stability and providing family education address the social domain.

Quiz 6: Ethics, Standards, and Nursing Frameworks