During an appointment with his psychiatric-mental health nurse practitioner (PMHNP), a 35-year-old man makes a credible threat to murder the ex-husband of his girlfriend. Of the following, what should the PMHNP do?
Call the police to inform them of the threat.
Call the potential victim to warn him of the threat.
Call the girlfriend to warn her of the threat, so she can let her ex-husband know.
Do nothing; this would violate confidentiality.
The Correct Answer is A
Choice A reason: When a patient makes a credible threat of serious harm to an identifiable individual, the PMHNP has a duty to warn and protect. This includes notifying law enforcement to prevent potential violence. This action is supported by legal precedents such as the Tarasoff ruling and aligns with ethical obligations to protect third parties.
Choice B reason: While warning the potential victim may seem appropriate, it is not the most secure or legally sound method. Law enforcement is better equipped to assess and manage threats, and direct contact with the victim may pose risks or violate procedural safeguards.
Choice C reason: Indirectly warning the victim through a third party is unreliable and may delay intervention. It also risks breaching confidentiality without ensuring the threat is properly addressed.
Choice D reason: Doing nothing in the face of a credible threat violates both ethical and legal responsibilities. Confidentiality has limits, especially when public safety is at risk.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: While the PMHNP may not have a formal relationship with the company, her close friendship with a representative creates a potential for bias. Personal relationships can influence prescribing behavior, even unconsciously.
Choice B reason: Disclosure to patients is not typically required unless there is a direct financial relationship or incentive. However, the ethical concern lies in the potential for bias, not necessarily the need for patient disclosure in this context.
Choice C reason: This is the most accurate answer. A close friendship with a pharmaceutical representative can create a conflict of interest, even if no incentives are offered. The emotional connection may unconsciously influence prescribing decisions, which raises ethical concerns about impartiality.
Choice D reason: While indirect financial gain is possible, the core issue is the influence of personal relationships on professional decisions. Gifts may contribute to bias, but the friendship itself is the primary concern.
Correct Answer is B
Explanation
Choice A reason: While PMP data may reveal patterns suggestive of inappropriate prescribing, its primary function is not to police prescribers but to support safe prescribing practices.
Choice B reason: The PMP allows prescribers to review controlled substance prescriptions linked to their patients and DEA numbers. It helps identify potential misuse, diversion, and overlapping prescriptions, supporting clinical decision-making and regulatory compliance.
Choice C reason: The PMP monitors prescribing across all licensed providers, not just nurse practitioners and physician assistants. This choice inaccurately limits its scope.
Choice D reason: The PMP tracks all controlled substance prescriptions, not just those for patients with substance use disorders. It is a broad surveillance and safety tool.
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