A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent for most of the session. Another patient comes to the door of the room, interrupts, and says, “I really need to talk to you right now.” The nurse should:
Say to the interrupting patient, “I am not available to talk with you at the present time”
End the unproductive session with the current patient and spend time with the patient who has just interrupted
Invite the interrupting patient to join in the session with the current patient
Tell the patient who interrupted, “This session will be 5 more minutes; then, I will talk with you”
The Correct Answer is D
Choice A reason: Bluntly stating unavailability dismisses the interrupting patient’s needs without offering a solution, potentially escalating distress. This approach lacks therapeutic communication, as it fails to acknowledge the patient’s urgency or provide a clear plan, which is critical in maintaining trust in a mental health setting.
Choice B reason: Ending the current session prematurely disrespects the silent patient’s therapeutic process. Silence may reflect processing or discomfort, requiring time to build trust. Abruptly shifting focus undermines the current patient’s care, potentially worsening their mental health and disrupting the therapeutic relationship.
Choice C reason: Inviting the interrupting patient to join violates confidentiality and disrupts the current patient’s safe space. Combining sessions without consent breaches ethical principles, potentially causing discomfort or mistrust, which hinders therapeutic progress for both patients in a mental health context.
Choice D reason: Acknowledging the interruption and scheduling a follow-up in 5 minutes respects both patients’ needs. It maintains the current patient’s therapeutic time while addressing the interrupting patient’s urgency, ensuring fairness and trust. This approach upholds ethical care and supports a therapeutic environment for mental health treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Coercing treatment violates the voluntary client’s autonomy. Legally, voluntary patients can refuse medication unless they pose imminent danger, requiring involuntary commitment. Manipulation or disruption does not meet legal criteria for forced treatment, as mental health laws prioritize patient rights absent clear harm risks.
Choice B reason: A 302 (involuntary commitment) requires evidence of imminent danger to self or others, not just disruptive behavior. Family petitions cannot override this legal threshold without clinical justification, and manipulation alone does not qualify, making this option incorrect for enforcing treatment in a voluntary client.
Choice C reason: As a voluntary client, the individual retains the right to refuse treatment unless deemed a danger to self or others. Mental health laws protect autonomy, and manipulation or lack of progress does not justify forced medication, making refusal a legal right in this scenario.
Choice D reason: Involuntary commitment by a doctor requires evidence of imminent danger or inability to care for oneself, not just disruptive behavior or nonadherence. Without such criteria, the client’s voluntary status protects their right to refuse, making involuntary commitment legally inappropriate in this situation.
Correct Answer is D
Explanation
Choice A reason: Assault involves threatening harm, not applicable here, as the issue is failure to document assessments, not intentional threats by staff. The client’s self-harm resulted from inadequate monitoring, not a staff-initiated threat, making assault an incorrect legal issue in this scenario.
Choice B reason: Battery involves unauthorized physical contact, not relevant to failure to document assessments. The client’s self-harm stemmed from inadequate observation, not staff-inflicted harm, making battery an inappropriate legal claim compared to negligence in monitoring and documentation.
Choice C reason: Suicide risk is a clinical concern, not a legal issue to defend against. While the client’s self-harm indicates risk, the hospital’s liability arises from failure to follow monitoring protocols, not the risk itself, making this option incorrect for the legal defense context.
Choice D reason: Malpractice involves negligence, such as failing to document hourly assessments for a high-risk client, leading to harm. This breach of standard care (1:1 observation) allowed self-harm, making the hospital liable for not adhering to protocols, requiring defense against malpractice for inadequate monitoring and documentation.
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