In which situation would the ethical principle of fidelity be most relevant for a mental health nurse?
Ensuring medication administration accuracy.
When documenting patient care.
Ensuring all patient information is kept confidential.
Maintaining consistent involvement in patient therapy sessions.
The Correct Answer is D
Choice A reason: Ensuring medication accuracy is primarily related to the principle of nonmaleficence (doing no harm) and the professional standard of care. While it involves a commitment to safety, it is a technical competency rather than a direct application of the interpersonal loyalty and promise-keeping defined by fidelity.
Choice B reason: Documenting care is a legal and professional duty tied to accountability and veracity (truth-telling). While it is essential for the continuity of care, it does not capture the essence of fidelity, which is centered on the faithfulness and commitment inherent in the specialized nurse-patient relationship.
Choice C reason: Confidentiality is an independent ethical and legal obligation. While keeping secrets is a form of faithfulness, in nursing ethics, confidentiality is usually categorized under its own specific mandates and privacy laws rather than being the primary example of the principle of fidelity in clinical practice.
Choice D reason: Fidelity refers to the nurse's obligation to be faithful to their commitments and to maintain the trust established in the therapeutic relationship. By consistently attending therapy sessions and following through on promises made to the client, the nurse demonstrates loyalty and reliability, which are crucial for the progress of psychiatric treatment.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: This description refers to humanistic or psychodynamic therapy, which focuses on self-actualization and insight into past behaviors to drive change. While developing self-awareness is a component of overall mental health, it does not describe the specific behavioral desensitization mechanics that define prolonged exposure therapy for PTSD.
Choice B reason: This accurately describes Eye Movement Desensitization and Reprocessing (EMDR) therapy, not prolonged exposure therapy. EMDR uses bilateral stimulation, such as guided eye movements or tapping, to help the brain reprocess traumatic memories. While both are used for PTSD, they are distinct therapeutic modalities with different procedural protocols.
Choice C reason: Prolonged exposure therapy is a form of cognitive-behavioral therapy that utilizes "in vivo" and "imaginal" exposure. By repeatedly and safely facing the trauma-related stimuli that the client has been avoiding, the process of emotional processing occurs, leading to a reduction in the conditioned fear response and associated symptoms.
Choice D reason: This describes the fundamental premise of standard Cognitive Behavioral Therapy (CBT). While prolonged exposure is a subset of CBT, this broad definition focuses on cognitive restructuring. Prolonged exposure is more specific, focusing on the behavioral extinction of fear through direct confrontation with the trauma memory and related triggers.
Correct Answer is ["B","C","D"]
Explanation
Choice A reason: The client's blood pressure is not identified as a concerning finding in the provided nursing notes. While monitoring vitals is standard practice, there is no evidence of autonomic instability or hypertensive crisis that would take priority over the acute psychiatric symptoms the client is currently exhibiting.
Choice B reason: Hallucinations, specifically the command hallucinations mentioned where voices are "telling me I need to save the world," require immediate follow-up. Command hallucinations significantly increase the risk of unpredictable or dangerous behavior, as the client may feel compelled to act on these internal stimuli to fulfill a perceived mission.
Choice C reason: The client's report of insomnia ("I can't sleep") is a critical finding because sleep deprivation is a powerful trigger for the exacerbation of psychotic symptoms. In schizophrenia, a lack of restorative sleep can lead to a rapid decline in reality testing and an increase in the intensity of both hallucinations and delusions.
Choice D reason: The client is exhibiting clear delusions, such as believing they "need to save the world" and perceiving a man in the corner who is going to hurt them. These fixed false beliefs indicate an acute relapse of psychosis due to medication non-adherence and require immediate intervention to ensure the safety of the client.
Choice E reason: While the client only consumed 50% of their meal, appetite changes are less critical than the active positive symptoms of psychosis. Nutritional intake should be monitored over time, but in the context of an acute behavioral crisis with hallucinations, it is not one of the top three priorities for immediate follow-up.
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