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Introduction To Mental Health Nursing > Mental Health

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Total Questions : 15

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Question 1:

A client who is involuntarily committed to an inpatient psychiatric unit loses which of the following rights?

A. Right to freedom B. Right to refuse treatment C. Right to sign legal documents D. The client loses no rights

Answer and Explanation

Choice A:

Involuntary commitment legally restricts a person's ability to leave the facility, as their freedom is curtailed for safety reasons. This is the primary right affected by the commitment process.

Choice B:

Clients generally retain the right to refuse treatment, including medications, unless they are deemed unable to make informed decisions due to their mental state or a court order mandates treatment.

Choice C:

The ability to sign legal documents is not automatically revoked. Clients may still engage in legal matters unless a separate legal determination, such as guardianship, restricts this right.

Choice D:

While involuntarily committed, clients do not lose all rights. They retain rights such as humane treatment, access to legal counsel, and the ability to refuse certain interventions unless legally overridden.

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Question 2:

A nurse notices a physician beginning a physical examination of a disoriented client without closing the curtain or obtaining consent. What is the nurse's best response?

A. Notify the charge nurse of the physician’s oversight B. Close the curtain and ensure the client is properly draped C. Ask the client if they are comfortable being examined in public D. Say nothing to avoid conflict with the physician

Answer and Explanation

Choice A:

Notifying the charge nurse does not provide immediate protection for the client. While reporting concerns is important, the priority is ensuring privacy at the moment.

Choice B:

Closing the curtain and draping the client maintains privacy and dignity, preventing unnecessary exposure. This action is immediate and directly addresses the physician’s oversight without escalating the situation.

Choice C:

A disoriented client may not be able to make an informed decision about their comfort level. The nurse must proactively safeguard their dignity rather than relying on their response.

Choice D:

Saying nothing allows the breach of privacy to continue, failing to uphold ethical nursing responsibilities.

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Question 3:

A client is scheduled for electroconvulsive therapy (ECT). Which action by the nurse ensures the client’s right to informed consent?

A. Explaining the procedure in detail B. Asking the client to sign the consent form as quickly as possible C. Witnessing the client’s signature and ensuring they understand the procedure D. Telling the client the doctor will explain everything

Answer and Explanation

Choice A:

While explaining the procedure is important, it does not guarantee full understanding or voluntary consent. The nurse must verify comprehension, as simply providing information does not ensure the client grasps the risks, benefits, and alternatives. Misconceptions or unanswered questions can lead to uninformed decisions.

Choice B:

Pressuring the client to sign quickly undermines informed consent, which requires adequate time for discussion and decision-making. Rushing the process increases the risk of ethical and legal violations. Clients must be given the opportunity to ask questions, consider their options, and make an informed choice without coercion.

Choice C:

Witnessing the client’s signature and confirming their understanding ensures that consent is truly informed. The nurse must assess comprehension and clarify any concerns before the client signs. This includes ensuring the client is aware of potential side effects, expected outcomes, and alternative treatments. If confusion arises, further discussion is necessary before proceeding.

Choice D:

Delegating the responsibility entirely to the physician does not fulfill the nurse’s duty to advocate for the client’s understanding and autonomy. While physicians provide detailed explanations, nurses ensure comprehension and voluntary decision-making. Ignoring this responsibility can result in uninformed consent, which is legally and ethically unacceptable.

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Question 4:

A nurse sees a former psychiatric inpatient client at a grocery store. Which of the following actions maintain client confidentiality? Select all that apply

A. Avoiding eye contact and walking away. B. Responding only if the client initiates interaction. C. Approaching and greeting the client by name. D. Informing the cashier that the client was recently hospitalized. E. Asking the client if they need any assistance.

Answer and Explanation

Choice A:

Avoiding eye contact and walking away prevents unintentional acknowledgment of the client’s health history, protecting confidentiality in a public setting.

Choice B:

Making eye contact and responding only if the client initiates interaction respects privacy while allowing natural social engagement without disclosing sensitive information.

Choice C:

Approaching and greeting the client by name risks implying familiarity from a healthcare context, potentially breaching confidentiality by signaling prior hospitalization to others nearby.

Choice D:

Informing the cashier about the client’s recent hospitalization directly violates confidentiality by disclosing protected health information without consent, contravening legal and ethical standards.

Choice E:

Asking the client if they need assistance may suggest a professional relationship, potentially compromising confidentiality by implying prior healthcare interactions in a public setting.

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Question 5:

A client's home was destroyed by a tornado. She has minor injuries but is experiencing disabling anxiety. What is the best nursing intervention?

A. Encourage her to focus on how lucky she is to be alive B. Discuss stages of grief C. Identify community resources to support D. Suggest she find a new home with storm shelter

Answer and Explanation

Choice A:

Encouraging the client to focus on being lucky minimizes her current distress and invalidates her feelings of loss and anxiety, which is not therapeutic and can hinder emotional processing.

Choice B:

Discussing the stages of grief, while relevant to loss, is not the most immediate or direct intervention for disabling anxiety caused by an acute traumatic event and the loss of her home; immediate practical support is prioritized.

Choice C:

Identifying community resources directly addresses the client's immediate and long-term needs stemming from the tornado's destruction and disabling anxiety, aligning with Maslow's hierarchy by assisting with safety and security needs.

Choice D:

Suggesting she find a new home with a storm shelter, while a practical consideration for the future, is premature and dismissive of her current acute anxiety and the immediate need for support in the aftermath of trauma.

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Question 6:

A psychiatric client tells the nurse, “Please don’t tell anyone about my sexual abuse.” What is the best nursing response?

A. “Yes, I will keep this information confidential.” B. “I will share this only with team members involved in your care.” C. “Why don’t you want the team to know?” D. “Let’s talk about your feelings about this.”

Answer and Explanation

Choice A:

Absolute confidentiality is not appropriate in cases of abuse disclosure, as healthcare providers have a duty to report and address safety concerns.

Choice B:

Sharing information with the treatment team ensures coordinated care while maintaining professional confidentiality. Nurses are obligated to disclose abuse-related information to appropriate healthcare professionals to facilitate intervention and support.

Choice C:

Asking why the patient does not want the team to know may feel intrusive and could discourage further disclosure. A supportive approach is preferred.

Choice D:

While discussing feelings is important, it does not address the ethical obligation to ensure proper intervention and support.

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Question 7:

A nurse is assessing a client in the psychiatric unit. Which of the following are tasks of the orientation phase of the nurse-client relationship? Select all that apply

A. Establish a contract for intervention. B. Identify client’s strengths and limitations. C. Problem solve situational crises. D. Promote client’s insight and perception of reality. E. The formulation of nursing diagnostic statements.

Answer and Explanation

Choice A:

Establishing a contract for intervention is a primary task of the orientation phase. This involves setting mutual goals, discussing roles, responsibilities, and the parameters of the therapeutic relationship, including confidentiality and time frames.

Choice B:

Identifying the client’s strengths and limitations is integral to the initial assessment during the orientation phase. This helps the nurse understand the client's current state, resources, and areas needing support, informing the development of a tailored plan of care.

Choice C:

Problem-solving situational crises is typically a task performed during the working phase of the nurse-client relationship. In this phase, the client and nurse actively collaborate to address the client's identified problems and develop coping strategies.

Choice D:

Promoting client’s insight and perception of reality is a core activity that takes place during the working phase. This involves exploring the client's thoughts, feelings, and behaviors, and helping them to understand their patterns and develop healthier responses. The orientation phase focuses on establishing the foundation for such work.

Choice E:

The formulation of nursing diagnostic statements occurs in the orientation phase. This is a crucial step that involves analyzing assessment data collected from the client to identify actual or potential health problems, forming the basis for subsequent planning and intervention.

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Question 8:

A nurse observes bruises on a child visiting a client on the psychiatric unit. What is the nurse’s legal responsibility?

A. Ask the child how the bruises occurred B. Notify the physician and document it in the chart C. Report the suspicion to child protective services D. Wait to see if it happens again

Answer and Explanation

Choice A:

Directly asking the child may not yield accurate information due to fear or coercion, limiting the effectiveness of disclosure. Nurses must rely on professional observation and mandated reporting rather than attempting personal interrogation, which may further distress the child.

Choice B:

Informing the physician and documenting findings support care coordination but do not fulfill the mandated reporting obligation. Without direct notification to child protective services, intervention may be delayed, increasing risk to the child and failing legal responsibilities.

Choice C:

Reporting suspected child abuse is a nurse's legal duty, ensuring swift protective action. Child protective services conduct investigations to assess safety, preventing ongoing harm. Failure to report could result in neglecting the child's welfare and potential legal repercussions for the healthcare provider.

Choice D:

Waiting for repeated incidents can lead to prolonged abuse and worsen harm. Nurses must act immediately upon suspicion, prioritizing the child's safety over observational delays. Hesitation to report violates ethical duties and legal requirements in child protection protocols.

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Question 9:

A nurse brings a client’s morning medications, and the client says, “Just tell my wife. She gives me all my pills.” Which of the following responses by the nurse appropriately address the client’s request? Select all that apply

A. “You also need to learn about your medications. What will you do if something happens to your wife?” B. “Because your wife manages your medications, I will write out a list for her with instructions.” C. “Let me know when your wife will be visiting next, and then I can go over the medications with both of you.” D. “This sounds like a good plan. You are fortunate to have a caring wife.” E. “It’s important for you to understand your medications, but I can also involve your wife in the teaching.”

Answer and Explanation

Choice A:

While emphasizing patient responsibility is important, this response may come across as confrontational rather than supportive, potentially discouraging engagement in medication education.

Choice B:

Providing a written list for the wife assumes she will always be available, neglecting the need for direct patient education. The patient must also understand their medications for independent management.

Choice C:

Including the wife in medication education fosters shared responsibility while ensuring the patient remains informed. This approach supports adherence and allows both individuals to ask questions, improving understanding and safety.

Choice D:

Simply affirming the patient's reliance on their wife does not address the importance of personal medication knowledge, missing an opportunity for education and empowerment.

Choice E:

Encouraging the patient to learn about their medications while involving their wife ensures comprehensive education. This strategy balances autonomy with caregiver support, reducing reliance on a single individual for medication management.

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Question 10:

A client reports continued but improving insomnia, anorexia, and crying spells following the death of the client’s spouse 1 month ago. Which is the most appropriate nursing diagnosis that a nurse should establish for the client?

A. Impaired adjustment B. Ineffective coping C. Dysfunctional grieving D. Family processes interrupted

Answer and Explanation

Choice A:

Emotional distress and functional ability are key here. The client exhibits emotional symptoms like insomnia, anorexia, and crying, but the improvement over time and presence of some coping indicate partial adaptation, consistent with impaired adjustment. The timeframe of one month fits diagnostic criteria, and the symptoms don’t yet qualify as major depressive disorder or pathological grief.

Choice B:

Ineffective coping is incorrect because the client is showing signs of improving symptoms, which implies some coping strategies are working. This diagnosis is more appropriate when no coping mechanisms are evident or distress is escalating.

Choice C:

Dysfunctional grieving is incorrect because the client’s response is within normal expectations for acute grief. There is no evidence of prolonged, delayed, or distorted grief processes which are necessary for this diagnosis.

Choice D:

Family processes interrupted is not appropriate as there is no information suggesting family role disruption, dysfunction, or strain in family dynamics. The issue is focused solely on the individual’s emotional response to personal loss.

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Question 11:

A nurse is caring for a client with dementia. Which intervention takes top priority?

A. Providing foods that are easy to eat B. Providing the opportunity for rest and sleep C. Keeping the incontinent client clean and dry D. Creating a safe environment

Answer and Explanation

Choice A:

While nutrition is important, it is not the most immediate concern. A client cannot safely eat or be fed unless the environment prevents choking, distraction, or injury first. Safety enables all other care aspects to be effective.

Choice B:

Rest and sleep are important but not urgent unless affected by agitation or behavioral issues. Lack of sleep does not immediately endanger the client like falls or elopement might. Rest becomes a priority after safety is established.

Choice C:

Hygiene and skin care are essential but do not surpass the need for a secure environment. Incontinence care reduces infection risk and discomfort but does not address immediate injury potential from environmental hazards.

Choice D:

Safety risks and impaired judgment are dominant in dementia care. The client’s decreased ability to assess risk makes them prone to falls, ingestion of harmful substances, and wandering. A secure environment prevents injury and supports autonomy within safe limits.

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Question 12:

A nurse is establishing a therapeutic relationship with a client. Which of the following best describes this type of relationship in mental health nursing?

A. A relationship where the nurse and client become close friends. B. A collaborative relationship where mutual learning and growth occur. C. A social interaction where the nurse helps meet emotional needs. D. A relationship based on fulfilling nurse’s goals.

Answer and Explanation

Choice A:

Becoming close friends with a client crosses professional boundaries. It compromises objectivity and may hinder the ability to provide appropriate care due to emotional involvement.

Choice B:

Collaborative and growth-oriented, this type of relationship centers on the client’s well-being. It facilitates emotional healing, builds insight, and empowers the patient, all while maintaining clear boundaries and therapeutic intent.

Choice C:

While emotional needs are acknowledged in mental health care, social interaction is not the goal. A therapeutic relationship is structured and focused on clinical outcomes, not casual emotional support.

Choice D:

A relationship focused on the nurse’s goals is self-serving and violates the ethical principles of nursing care. The therapeutic relationship must prioritize the client's needs, not the providers.

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Question 13:

A nursing student submits clinical paperwork using a client’s full name. Which of the following is the instructor’s priority response?

A. Reinforce the importance of documentation. B. Remind the student to maintain confidentiality. C. No action is needed if the client is incompetent. D. Explain HIPAA laws after class.

Answer and Explanation

Choice A:

Reinforcing documentation is important, but it does not address the immediate breach of confidentiality, which takes precedence. Legal and ethical obligations must be corrected first.

Choice B:

Maintain confidentiality is a priority in any healthcare setting. Using a client's full name in student paperwork is a direct breach of protected health information. The instructor must immediately correct this to prevent recurrence and reinforce legal compliance.

Choice C:

Client competency does not negate the need for privacy. Even incompetent clients are fully protected under privacy laws and ethical practice standards.

Choice D:

Explaining HIPAA after class delays corrective action. The breach has already occurred and must be addressed immediately to prevent further risk and ensure learning is timely and effective.

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Question 14:

A nurse is using seclusion for a violent client. Which of the following practices are appropriate? Select all that apply

A. Documenting the client’s behavior every 15 minutes. B. Discontinuing seclusion as soon as the client is calm. C. Keeping the client in seclusion for the full order time regardless of behavior. D. Allowing visitors during seclusion if supervised. E. Restricting all food and water until seclusion ends.

Answer and Explanation

Choice A:

Documenting the client’s behavior every 15 minutes ensures continuous monitoring and legal compliance with regulatory standards requiring frequent observation. The frequency reflects best practice in high-risk situations.

Choice B:

Discontinuing seclusion as soon as the client is calm aligns with the principle of the least restrictive intervention and seclusion should end immediately once the risk no longer exists.

Choice C:

Keeping the client for the full order regardless of behavior overrides the requirement to terminate seclusion early when safe, and violates the least restrictive mandate.

Choice D:

Allowing visitors during seclusion increases risk and violates seclusion protocols which require patient isolation to maintain safety and control.

Choice E:

Restricting food and water constitutes deprivation and is unethical and illegal; patients must have access to basic physiological needs throughout seclusion per Maslow and legal standards.

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Question 15:

A nurse is assessing five clients in the psychiatric unit. Which clients are legally able to give informed consent for treatment? Select all that apply

A. A 17‑year‑old client with a supportive parent B. A client declared incompetent by court C. A client with psychosis who is oriented and cooperative D. An unconscious trauma client E. An adult client without cognitive impairments and understanding of treatment

Answer and Explanation

Choice A:

A 17-year-old minor generally cannot provide legal consent unless mature-minor or emancipation status applies, which isn’t indicated, so lacks legal authority independently.

Choice B:

A client declared incompetent by court lacks legal capacity explicitly and cannot provide informed consent for treatment under any circumstances until restored.

Choice C:

A client with psychosis who is oriented and cooperative demonstrates intact capacity domains—understanding, appreciation, reasoning, and expression—so can legally consent to treatment despite psychiatric symptoms.

Choice D:

An unconscious trauma patient cannot understand or communicate information, and implied consent applies only in emergencies—not for ongoing psychiatric or elective treatments.

Choice E:

An adult with no cognitive impairments who clearly understands treatment meets all legal criteria—including competence, disclosure, absence of coercion—thus is fully capable of informed consent.

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