A nurse observes another nurse acting flirtatiously and bringing small gifts, such as candy, to a client in the behavioral health unit. Which action is a priority by the observing nurse?

In order to protect the rights of the client, the nurse should report the behavior to the supervisor.

The client is entitled to have a relationship with anyone and the nurse should ignore the behavior.

The nurse should confront the nurse and tell them the behavior must immediately stop.

Discuss this with the client and tell them they are being emotionally manipulated.

Answer and Explanation

The Correct Answer is A

When a nurse observes another nurse acting flirtatiously and bringing small gifts to a client in the behavioral health unit, it raises concerns about professional boundaries and the potential for unethical behavior. The priority action for the observing nurse is to protect the rights and well-being of the client.

Option A, reporting the behavior to the supervisor, is the appropriate course of action. Reporting the observed behavior to the supervisor ensures that the situation is investigated and addressed by the appropriate authorities within the healthcare facility. This action helps maintain the integrity of the therapeutic relationship between the client and healthcare team and protects the client from any potential exploitation or manipulation.

Options B, C and D are not appropriate actions:

B. Ignoring the behavior is not appropriate as it does not address the concerns about professional boundaries and the potential for unethical behavior. Ignoring such behavior may allow it to continue, potentially putting the client at risk.

C. Confronting the nurse directly without first reporting the behavior to the supervisor may not be the most appropriate course of action. It is essential to involve the appropriate authorities within the healthcare facility to conduct a proper investigation and address the situation professionally.

D. Discussing the situation with the client and making assumptions about emotional manipulation may not be appropriate or accurate. It is not the observing nurse's role to discuss such matters with the client. Instead, the appropriate course of action is to report the observed behavior to the supervisor or appropriate authority within the healthcare facility.

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Correct Answer is B

Explanation

Explanation: When completing a family assessment for a victim of intimate partner violence, the nurse may identify characteristics of the abuser that contribute to the abusive behavior. Among the options provided, "Needy and possessive of the partner" is the characteristic of the abuser. Abusers often display controlling behavior, which includes possessiveness and excessive need for control over their partners. This possessiveness may manifest as jealousy, isolation, and an attempt to limit the victim's freedom and independence.

A. An ability to feel remorse for the abuse - This characteristic is less likely to be present in an abuser. Abusers often exhibit a lack of remorse for their abusive behavior and may blame the victim or external factors for their actions.

C. An inflated sense of self-esteem - While some abusers may exhibit arrogance and an inflated sense of self-importance, it is not a defining characteristic of all abusers.

D. Encourages the partner to have a life outside the intimate relationship - Abusers typically do the opposite; they often seek to isolate their victims from their support systems and limit their social interactions outside the abusive relationship.

A. The nurse informs the client that the behavior will not be tolerated and will be addressed by the psychiatrist. B. The nurse throws the medication in the trash and documents the client refuses the medication. C. The nurse pushes the client, and the client falls to the floor and sustains a nosebleed. D. The nurse goes to the client's room and applies restraints, then forces the medication in the client's mouth.

Correct Answer is D

Explanation

Falsely imprisoning a client involves restricting their freedom and movement against their will without proper legal authority or justification. Option D demonstrates false imprisonment because the nurse applies restraints to restrict the client's movement and then forces the medication into the client's mouth, essentially depriving the client of their right to refuse treatment.

Options A, B, and C are not examples of false imprisonment:

A. The nurse informing the client that the behavior will not be tolerated and will be addressed by the psychiatrist is a response to the client's inappropriate behavior. It does not involve restricting the client's freedom or movement.

B. The nurse throwing the medication in the trash and documenting the client's refusal is an appropriate response to the client's refusal of medication. It respects the client's right to refuse treatment.

C. The nurse pushing the client and causing them to fall to the floor, resulting in a nosebleed, is an example of physical assault and battery, not false imprisonment. It is an inappropriate and harmful action by the nurse.

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A nurse observes another nurse acting flirtatiously and bringing small gifts, such as candy, to a client in the behavioral health unit. Which action is a priority by the observing nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is completing a family assessment for a victim of intimate partner violence. Which characteristic of the abuser will the nurse identify when completing the assessment?

Correct Answer is B

Explanation

A client is informed by the nurse that they must take their medication, and the client kicks the nurse and runs to their room. Which action by the nurse demonstrates that the nurse falsely imprisons the client?

Correct Answer is D

Explanation

A nurse auscultates a client's lung sounds and identifies crackles in the left lower lobe. Which of the following interventions should the nurse take

A client with depression is found to have attempted suicide in the bathroom and sustained injury. There is no documentation that the client was assessed every hour as prescribed. Which issue will the nursing staff and hospital potentially have to defend against?

A nurse is questioning another nurse about whether it is ethical to seclude a client because of loud and intrusive behavior on the unit. Which is the ethical principle that will best guide the nurse's decision on the appropriate use of seclusion?

The nurse is working with an adolescent client that is argumentative with staff and peers on the behavioral health unit. Which therapeutic response will be most beneficial for the client to decrease acting out behavior?

The nurse working in an outpatient clinic is performing an intake assessment for a female client. Which priority question will the nurse ask the client as part of the initial assessment?

The nurse is caring for a client who has been a victim of abuse since childhood. Which action(s) by the nurse is important so that the client feels safe, secure, and in control of their own body? Select all that apply. (Select All that Apply.)

A nurse observes another nurse acting flirtatiously and bringing small gifts, such as candy, to a client in the behavioral health unit. Which action is a priority by the observing nurse?

The nurse approaches a client who looks very sad and is sitting alone crying. Which is the best response by the nurse in this situation?