1) A woman has just presented at the emergency department after being raped. The initial nursing action would be which of the following?

1) Perform a nursing history and physical as quickly as possible

2) Refer her to a rape crisis hotline

3) Provide emotional support and reassure safety

4) Encourage her to file changes immediately

2) A client was brought to the emergency department by police after neighbors complained that the client was loud and disruptive. The client is paranoid and quit and states, No one can be trusted. Which of the criteria for involuntary admission does this client meet?

1) Gravely disabled

2) Dangerous to self

3) He does not meet any of the necessary criteria

4) Dangerous to others

3) A teaching about the differences of conversational and atypical antipsychotics was effective when the client says which of the following?

1) Side effects are more likely with conventional antipsychotics than atypical antipsychotics

2) Conventional antipsychotics block serotonin only

3) Conventional antipsychotics treat both positive and negative symptoms of schizophrenia

4) Conventional antipsychotics block both dopamine and serotonin

4) All are included in the plan of care for a client with schizophrenia. Which nursing intervention should the nurse perform first when caring for this client?

1) Maintain reality through frequent contact

2) Observe for signs of fear and agitation

3) Encourage the client to participate in the treatment milieu

4) Assess community support systems

5) A new nurse witnesses the charge nurse on the psychiatric unit carrying an empty syringe and using it to threaten the children with shots if they do not behave. The new nurse recognizes this behavior as an example of..

1) Malpractice

2) Assault

3) False imprisonment

4) Battery

Answers:

1.

Answer: 1) Perform a nursing history and physical as quickly as possible

When victims of sexual assault arrive at an emergency room, one of the first people they meet is a forensic nurse, who is trained to collect evidence from the incident. To collect evidence and ensure the quality of care for victims, forensic nurses who are qualified as sexual assault nurse examiners  follow scientific and legal protocols.

Assessing and treating injuries, preventing sexually transmitted illnesses and pregnancy, and providing psychological support are all purposes of sexual assault and rape testing for SANEs. The International Association of Forensic Nurses ) certifies these particularly trained nurses, who endeavor to address and validate patient concerns, minimize trauma, and encourage healing. They collect information for use in judicial actions by following processes established by local jurisdictions. To ensure that victims receive justice, an uniform procedure is required.

"A prompt, high-quality medical forensic investigation might possibly verify and treat sexual assault patients' concerns, reduce trauma, and facilitate recovery. Simultaneously, it increases the possibility that evidence gathered will aid in criminal case investigation, resulting in abusers being held accountable and further sexual violence being avoided.

2.

Answer: 3) He does not meet any of the necessary criteria

Involuntary admittance to a closed inpatient psychiatric unit (also known as a "302") happens when a mental health professional analyzes the patient and determines that, because to mental illness, the patient is at risk of harming self or others, or is unable to care for self. Based on comments and actions in the previous 30 days, the offender must constitute a "clear and present threat" to self or others.

The following are the requirements for involuntary hospitalization:

• Patients must engage in potentially harmful conduct toward themselves or others,
•  be helpless and unable to meet their basic daily needs, 
•  be at risk of "vital damage" to their mental health if they do not receive treatment.

Involuntary commitment cannot be justified only on the basis of mental disease. The client is not a risk to himself or others in this situation, and he is not severely incapacitated.

3.

Answer: 1) Side effects are more likely with conventional antipsychotics than atypical antipsychotics

Antipsychotic medications are used to treat psychosis, a severe psychiatric disorder. Hallucinations, delusions, and disordered thinking are common symptoms of psychosis, which is defined by the deformation of thoughts in which a person loses contact with reality.

Extrapyramidal side effects are significantly less common with atypical antipsychotics. As a result, they've been linked to weight gain, metabolic issues, and sexual adverse effects, among other things.

Typical antipsychotics are more prone to elicit extrapyramidal adverse effects, such as tremors, spasms, muscle rigidity, and a loss of muscle control and coordination. Even if the medication is stopped, the effects may become permanent in some circumstances.

Antipsychotic medicines work by inhibiting dopamine type 2 (D2) receptors in the dopaminergic system. Atypical antipsychotics have a low affinity and occupancy for dopaminergic receptors but a high affinity for serotoninergic receptors 5-HT2A.

4.

Answer: 2) Observe for signs of fear and agitation

Agitation, defined as excessive physical and verbal activity, is common in psychiatric patients and has a negative impact on schizophrenia and bipolar disorder treatment.  When substance misuse is present, the likelihood for agitation to lead to violent behavior is amplified. 

Treatment strategies for agitation, as well as disease symptoms, may assist to reduce the suffering — as well as the financial effect — of these disorders. A medicine that lowers agitation in individuals with schizophrenia or bipolar disorder must have a quick beginning of action in order to effectively manage these conditions.

Nursing Evaluation

Recognize the symptoms of schizophrenia. Take note of the typical signs and symptoms of schizophrenia (e.g., speech abnormalities, thought distortions, poor social interactions).

Create a sense of trust and rapport. Patients should not be teased or made fun of. Expect that the patient will put you through extensive tests. Introduce yourself and explain what you're looking for.

Increase your level of performance. Evaluate the patient's capacity to do daily activities (ADLs).

Examine good signs and symptoms. Examine for command hallucinations and investigate the responses. Examine whether the client's system of beliefs is fragmented, poorly ordered, well-organized, systematized, or extensive and is not supported by reality.

Examine unfavorable symptoms. Examine for schizophrenia's unfavorable symptoms (as mentioned above).
Examine medical history. Examine whether the client is taking any drugs, what they are, and how well they are adhering to their treatment plan.

Examine support system. Check to see if the family is well-informed on the illness. Is the family aware of the importance of drug adherence?

5.

Answer: 2) Assault

Although assault and battery is a common criminal charge, many people are unaware of the legal term. Assault is the deliberate act of instilling fear in another person that they will be harmed. To commit assault, you don't have to really hurt somebody. In a nursing home, violence might take the form of verbal threats or acting like you're going to hit them.

Battery is the intentional infliction of bodily injury on another person. In contrast to assault, battery does not need the victim to be warned or afraid before being hurt. Battery would be defined as a nursing home worker surprising the patient and pushing them from behind. When someone threatens to hurt someone and then physically harms that person, it is called assault and battery.

When a health care practitioner or provider fails to offer proper treatment, fails to take the appropriate action, or provides inferior treatment, the patient suffers suffering, injury, or death.

A medical error is usually the cause of malpractice or neglect. This could be in the areas of diagnosis, drug administration, health management, therapy, and follow-up.

The following are some examples of situations when an error or negligence could result in a lawsuit:

• Failure to diagnose or misdiagnosis
• surgery that is either unnecessary or improper
• discharged too soon
• failure to order necessary tests or act on the results
• failure to follow up
• giving the incorrect dosage or medication
• after surgery, leaving objects inside the patient's body
• Performing surgery on the incorrect region of the body
• After surgery, the patient is in excruciating pain.
• Infections acquired in the hospital that could be fatal

False incarceration happens when someone purposefully restricts another person's capacity to move freely without legal authorization or justification. This is also known as wrongful incarceration in the first degree, and it is defined in your state's penal code.

Reference

Procedures for sexual assault nurse examiners | Duquesne School of nursing. (2020, May 20). Duquesne University School of Nursing. https://onlinenursing.duq.edu/blog/emergency-department-procedures-sexual-assault-nurse-examiners/

Voluntary and involuntary commitment to inpatient hospitalization. (2020, August 27). NAMI MAIN LINE PA | National Alliance on Mental Illness. https://namimainlinepa.org/voluntary-and-involuntary-commitment-to-inpatient-hospitalization/

Typical and atypical antipsychotic drugs. (n.d.). GoodTherapy - Find the Right Therapist. https://www.goodtherapy.org/drugs/anti-psychotics.html

Assault and battery. (n.d.). Nursing Home Abuse - Elder Abuse, Neglect & More. https://www.nursinghomeabuseguide.org/elder-abuse/assault-and-battery/