A nurse is caring for a client who is involuntarily admitted for major depressive disorder and refuses to take a prescribed oral antianxiety medication. Which of the following actions should the nurse take?

Implement consequences until the client takes the medication.

Inform the client that he does not have the right to refuse the medication.

Offer the client the medication at the next scheduled dose time.

Administer the medication to the client via IM injection.

Answer and Explanation

The Correct Answer is C

A. Implement consequences until the client takes the medication:
Punitive measures should never be used in healthcare, especially in the context of mental health treatment. Coercion and punitive consequences can lead to mistrust and hinder the therapeutic relationship, which is crucial in mental health care.

B. Inform the client that he does not have the right to refuse the medication:
While it's important for the client to understand the potential consequences of refusing medication, it's also crucial to respect the client's autonomy and right to make decisions about their own treatment. Involuntary admission doesn't negate the individual's right to be informed and involved in their care decisions to the extent they are able.

C. Offer the client the medication at the next scheduled dose time:
Respecting the client's autonomy is a fundamental ethical principle in nursing care. The nurse should continue to offer the medication to the client at the scheduled times. It's essential to maintain open communication with the client, addressing concerns and attempting to build trust, which can sometimes lead to the client accepting the medication voluntarily.

D. Administer the medication to the client via IM injection:
Administering medication against a patient's will is ethically and legally questionable without proper authorization, especially if the patient is not an immediate danger to themselves or others. This approach should be avoided whenever possible.

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Correct Answer is A

Explanation

A. Reassure staff members that the debriefing is confidential:
Explanation: Ensuring confidentiality is crucial in creating a safe space for individuals to express their emotions and thoughts freely. It builds trust among the participants, making them more likely to open up about their experiences during the debriefing session. Confidentiality encourages honest communication and helps individuals feel secure in sharing their feelings without fear of repercussions.

B. Have staff members discuss their involvement in the event:
Explanation: After establishing confidentiality, the next step is to encourage participants to discuss their involvement in the traumatic event. This can help individuals process their experiences, share their perspectives, and express their emotions related to the incident. Sharing their involvement can provide context to their reactions and emotions, facilitating a more comprehensive understanding of their experiences.

C. Ask staff members to describe their most traumatic memories of the event:
Explanation: Encouraging individuals to describe their most traumatic memories of the event is a way to help them confront and process specific experiences that might be causing distress. This step allows participants to verbalize and share their emotions and memories related to the incident. Talking about these specific memories can be therapeutic and can contribute to the overall healing process.

D. Provide stress-management exercises to the staff members:
Explanation: Providing stress-management exercises, such as relaxation techniques or breathing exercises, comes after individuals have had the opportunity to share their experiences. These exercises can help participants manage immediate stress and anxiety during the debriefing session. They provide practical tools for coping with overwhelming emotions and can be beneficial for individuals who are feeling distressed or overwhelmed during the process.

A. Long-term isolation B. Dysthymic disorder C. Alcohol intoxication D. Schizoid personality disorder

Correct Answer is C

Explanation

A. Long-term isolation: Long-term isolation, or social isolation, can lead to feelings of loneliness and depression. While prolonged isolation can contribute to mental health issues, it is not a direct risk factor for violent behavior. People who are socially isolated might suffer from emotional distress, but it doesn't necessarily make them violent.

B. Dysthymic disorder: Dysthymic disorder, also known as persistent depressive disorder, is a type of chronic depression. While individuals with dysthymic disorder may experience low moods and a lack of interest in activities, it doesn't inherently make them prone to violence. Depression is more likely to cause self-directed harm (such as self-harm or suicide) rather than violent behavior towards others.

C. Alcohol intoxication: Alcohol is a substance that impairs judgment and reduces inhibitions. When a person is intoxicated, they may act aggressively or violently, even in situations where they wouldn't normally do so. Alcohol intoxication can lead to a loss of control, impaired decision-making, and aggressive behavior, making it a significant risk factor for violent actions.

D. Schizoid personality disorder: Schizoid personality disorder is characterized by a lack of interest in social relationships, emotional coldness, and detachment. While individuals with this disorder may prefer to be alone and avoid social interactions, they are not necessarily prone to violent behavior. Schizoid personality disorder primarily affects social functioning rather than predisposing someone to violence.

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A nurse is caring for a client who is involuntarily admitted for major depressive disorder and refuses to take a prescribed oral antianxiety medication. Which of the following actions should the nurse take?

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