A newly licensed nurse is assisting with the involuntary admission of a client who has depression to an acute care mental health facility. Which of the following guidelines should the nurse follow when caring for the client?

The client can undergo electroconvulsive therapy without giving informed consent.

The nurse can share information with the client's family without his permission.

The client has the right to refuse medication.

The nurse may use restraints as needed (PRN).

Answer and Explanation

The Correct Answer is C

Choice A reason: Electroconvulsive therapy (ECT) requires informed consent, as it is a significant medical procedure involving anesthesia and induced seizures. Informed consent is a process where a patient is fully informed about the procedures and risks involved in a treatment and voluntarily agrees to it.

Choice B reason: Nurses cannot share information with a client's family without the client's permission due to confidentiality laws, except in specific circumstances defined by law. Patient information is protected under the Health Insurance Portability and Accountability Act (HIPAA), which requires patient consent for disclosure.

Choice C reason: Patients have the right to refuse medication. This right is part of the patient's autonomy and informed consent process. A mentally competent adult can refuse treatment, even if it may result in serious illness or death.

Choice D reason: The use of restraints in mental health facilities is highly regulated. Restraints may only be used when necessary to prevent immediate harm to the patient or others and must be discontinued as soon as the risk of harm has subsided.

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Correct Answer is B

Explanation

Choice A reason: Discouraging the client from expressing anger is not therapeutic and can inhibit emotional expression, which is important in managing depression.

Choice B reason: Reinforcing assertive communication techniques is beneficial as it helps clients express themselves in a healthy way, which is a key aspect of depression management.

Choice C reason: Setting goals is important, but it should be done collaboratively with the client to empower them and ensure the goals are realistic and achievable.

Choice D reason: Scheduling daily self-care activities is helpful, but teaching the client how to manage their own schedule can promote independence and self-efficacy.

A. An Asian male B. A Black female C. A Hispanic female D. A White male

Correct Answer is B

Explanation

Choice A reason: While all individuals can develop heart failure, an Asian male is not considered the highest risk group based on the available data.

Choice B reason: A Black female is at a higher risk for developing heart failure, especially due to factors like hypertension, diabetes, and certain socioeconomic factors³.

Choice C reason: A Hispanic female may have multiple risk factors for heart failure, but the prevalence and risk are not as high as in the Black female population³.

Choice D reason: A White male, while at risk for heart failure, does not have the highest risk when compared to a Black female with the same age and health conditions³.

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A newly licensed nurse is assisting with the involuntary admission of a client who has depression to an acute care mental health facility. Which of the following guidelines should the nurse follow when caring for the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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