A client with paranoid schizophrenia believes evil spirits are being summoned by a local minister and verbally threatens to bomb a local church.
The psychiatric nurse notifies the local minister.
The psychiatric nurse has:
Released the client's information without proper authorization.
Avoided charges of malpractice.
Demonstrated the duty to warn and protect.
Violated the patient's privacy and confidentiality.
The Correct Answer is C
Choice A rationale:
While it's true that the nurse has released the client's information without their explicit consent, this action is justified under the duty to warn and protect.
This duty supersedes the general obligation to maintain confidentiality when there's a serious and imminent threat to identifiable individuals or the public.
In this case, the client's verbal threat to bomb a local church constitutes a credible and foreseeable risk of harm, necessitating the breach of confidentiality to protect potential victims.
Choice B rationale:
Although the nurse's actions may help to avoid malpractice charges by demonstrating responsible care and adherence to ethical obligations, this is not the primary reason for notifying the minister.
The primary goal is to avert harm and fulfill the duty to warn, not to shield oneself from legal liability.
Choice C rationale:
This is the correct answer. The nurse has acted in accordance with the duty to warn and protect, which is a legal and ethical obligation in healthcare.
This duty mandates that healthcare professionals take reasonable steps to warn potential victims and protect the public when a patient communicates a serious threat of harm.
Choice D rationale:
While confidentiality is a cornerstone of healthcare ethics, it's not absolute.
The duty to warn and protect allows for limited breaches of confidentiality when necessary to prevent serious harm, as in this case.
The nurse's actions align with ethical principles and legal requirements, even though they involve disclosing confidential information.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","E"]
Explanation
The correct answer is choiceAandE.
Choice A rationale:
Monitoring the client’s weight daily is crucial in managing anorexia nervosa.It helps track the client’s progress and ensures that any significant weight changes are promptly addressed.
Choice B rationale:
Allowing the client to choose their meals can be counterproductive.Clients with anorexia nervosa may make choices that do not support their nutritional needs, potentially exacerbating their condition.
Choice C rationale:
Allowing the client to practice strenuous exercises is not advisable.Strenuous exercise can further deplete the client’s already low energy reserves and exacerbate malnutrition.
Choice D rationale:
Staying with the client during meals and for 2 hours after meals is incorrect.The recommended practice is to stay with the client for 30 minutes after meals to monitor for any purging behaviors.
Choice E rationale:
Providing the client with small meals frequently is beneficial. It helps in managing their nutritional intake without overwhelming them, which can be more acceptable and manageable for clients with anorexia nervosa.
Correct Answer is C
Explanation
Choice A: Lock the doors to the unit and secure windows so they cannot be opened: While removing potential means of self-harm from the environment is a safety precaution, it is not the most immediate or effective intervention for a client actively experiencing suicidal ideation who has refused a safety contract. Locking doors and windows may increase anxiety and feelings of entrapment, potentially exacerbating the client's distress and hindering open communication. Additionally, it may not address underlying emotional and psychological factors contributing to the suicidal thoughts.
Choice B: Remove any objects from the client's environment that could be used for self-harm: Similar to Choice A, removing potential means can be a helpful safety measure but should not be the primary intervention in this situation. It is important to recognize that clients can find alternative means if they are determined to self-harm, and focusing solely on environmental control can detract from addressing the root of the suicidal crisis.
Choice C: Assign a staff member to stay with the client at times: This option prioritizes the client's safety and emotional well-being by providing constant support and supervision. A dedicated staff member can:
Monitor the client's behavior and emotional state closely, potentially identifying early warning signs of impending self-harm.
Provide open and non-judgmental support, allowing the client to express their thoughts and feelings freely without fear of being alone with their distress.
Engage in therapeutic communication, helping the client explore alternative coping mechanisms and develop safety plans for managing suicidal urges.
Alert other healthcare professionals if the client's condition deteriorates or if there is any immediate risk of self- harm.
Offer a sense of security and reassurance, knowing someone is constantly available to listen and intervene if needed.
Choice D: Provide the client with plastic eating utensils for meals: While this precaution may reduce the risk of self- harm at mealtimes, it addresses a very specific concern and does not address the broader issue of the client's suicidal ideation. It is also important to consider that plastic utensils may not be effective in preventing self-harm if the client is determined and resourceful.
Therefore, assigning a staff member to stay with the client at all times is the most appropriate and immediate action to prioritize the client's safety and emotional well-being in this situation. This approach fosters open communication, provides continuous support, and allows for early intervention if necessary. While environmental controls and risk assessments can be valuable complementary strategies, they should not overshadow the importance of close human connection and emotional support in crisis situations.
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