Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
The policies do not absolve an individual nurse of the responsibility to practice according to professional standards of nursing care
In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises
Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care
Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted
The Correct Answer is A
Choice A reason: Nurses must adhere to professional standards, ensuring safe care despite substandard policies. Restraint use, for example, must minimize harm and respect patient dignity, regardless of policy. This aligns with ethical principles and evidence-based practices for managing agitation linked to neurotransmitter imbalances, upholding nurse accountability.
Choice B reason: Leaving the premises after informing a supervisor abandons patients, violating ethical duties. Professional standards require nurses to advocate for safe practices, like appropriate restraint use for dopamine-driven agitation, within the system. This option is impractical and neglects patient care responsibilities, making it incorrect.
Choice C reason: Agency policies do not override professional standards. Nurses are accountable to evidence-based practices, ensuring interventions like restraints for severe agitation are safe and ethical. Policies may guide but cannot excuse deviations from standards addressing neurobiological safety needs, making this option scientifically and ethically incorrect.
Choice D reason: Judicial interpretation varies, but nursing practice is guided by professional standards, not unpredictable legal outcomes. Standards ensure safe, ethical care, like minimizing restraint use for serotonin-related agitation, regardless of policy or judicial variability. This option is irrelevant to guiding daily nursing practice.
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Correct Answer is D
Explanation
Choice A reason: Linking mental illness to brain disorders, like dopamine imbalances in schizophrenia, is factual and reduces stigma by emphasizing neurobiological causes. This aligns with scientific understanding, not perpetuating blame or stereotypes, making it an incorrect choice for reflecting stigma.
Choice B reason: Genetic predisposition, such as serotonin transporter gene variations, is a scientific explanation for mental illness. This reduces stigma by highlighting biological causes, not personal failings, aligning with evidence-based understanding and making it an incorrect choice for stigmatizing mental illness.
Choice C reason: Recognizing mental illness in children, like ADHD with dopamine deficits, normalizes early diagnosis and treatment. This factual statement reduces stigma by acknowledging neurobiological conditions across ages, making it an incorrect choice for reflecting stigmatizing attitudes toward mental illness.
Choice D reason: Blaming mental illness on family breakdown ignores neurobiological causes, like serotonin or dopamine imbalances, and perpetuates stigma by implying personal or social failure. This judgmental view misrepresents scientific evidence, making it the correct choice for reflecting stigmatizing attitudes toward mental illness.
Correct Answer is A
Explanation
Choice A reason: Paroxetine, an SSRI, is first-line for GAD, enhancing serotonin in the amygdala and prefrontal cortex, reducing excessive worry. Its efficacy and tolerability, with minimal dependence risk, align with evidence-based guidelines for long-term anxiety management, making it the preferred choice.
Choice B reason: Imipramine, a tricyclic antidepressant, affects serotonin and norepinephrine but has significant anticholinergic side effects, reducing tolerability. It is not first-line for GAD due to slower onset and side effect profile compared to SSRIs, which better target anxiety’s neurobiological basis.
Choice C reason: Hydroxyzine, an antihistamine, reduces anxiety via histamine receptor blockade, causing sedation. It is used as needed, not for chronic GAD management. SSRIs, like paroxetine, offer sustained serotonin modulation, making hydroxyzine a less effective, non-first-line option for long-term treatment.
Choice D reason: Alprazolam, a benzodiazepine, enhances GABA activity, providing rapid anxiety relief but carries high dependence risk. It is not first-line for GAD, as SSRIs offer safer, long-term serotonin-based treatment, making alprazolam unsuitable for chronic management due to addiction potential.
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