A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful?

Correct Answer: B

Rationale: For a malpractice suit to be successful, the client or family needs to prove the following four elements: (1) Duty: a legally recognized relationship (i.e., physician to client, nurse to client) existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. (2) Breach of duty: the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. (3) Injury or damage: the client suffered some type of loss, damage, or injury. (4) Causation: the breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner. The nurse did have a duty to the client. The nurse did not breach this duty by the nursing actions. The client did experience loss of autonomy from being restrained. Since there was no breach of duty, there was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.

Correct Answer: B

Rationale: In the context of behavioral health nursing, demonstrating genuineness with a patient diagnosed with schizophrenia is crucial for building trust and therapeutic rapport. The correct answer, B) use congruent communication strategies, is the most appropriate choice. Congruent communication involves aligning verbal and nonverbal cues to convey sincerity and authenticity. This approach is essential when interacting with individuals with schizophrenia as they may already struggle with interpreting social cues. Option A) restating what the patient says, although a valuable active listening technique, may not necessarily demonstrate genuineness on its own. It is important to go beyond just repeating words to truly connect with the patient. Option C) using self-revelation in patient interactions can blur professional boundaries and shift the focus away from the patient's needs, potentially hindering the therapeutic relationship. Option D) consistently interpreting the patient's behaviors can come off as judgmental and may lead to misunderstandings or misinterpretations of the patient's experiences, undermining the nurse-patient relationship. Educationally, understanding and applying congruent communication strategies in interactions with patients, especially those with schizophrenia, not only fosters trust and rapport but also enhances the overall quality of care provided. It is crucial for nurses to develop effective communication skills to promote positive outcomes in behavioral health settings.

Correct Answer: B

Rationale: The correct answer is B) The nurse’s action blurs the boundaries of the therapeutic relationship. In the context of mental health nursing, it is essential to maintain clear boundaries in the therapeutic relationship between the nurse and the patient. By inviting the patient to a staff picnic, the nurse is crossing a professional boundary and potentially blurring the lines between a therapeutic relationship and a social one. This can create confusion for the patient and may hinder the therapeutic progress that has been made during the patient's stay at the facility. Option A is incorrect because the invitation does not necessarily facilitate dependency on the nurse but rather blurs professional boundaries. Option C is incorrect as the invitation is not directly related to addressing a diversional activity deficit. Option D is incorrect because while community integration is important, it should be done in a structured and appropriate manner, not through a casual invitation to a social event. In an educational context, it is crucial for nurses working in behavioral health to understand the importance of maintaining professional boundaries in therapeutic relationships to ensure the best outcomes for their patients. By adhering to these boundaries, nurses can provide effective and ethical care that supports the recovery and well-being of individuals with mental illness.

Correct Answer: B

Rationale: In this scenario, option B is the correct analysis of the nurse's behavior. The nurse's gesture of reaching out to take the patient's hand is premature because the patient's cultural and individual interpretation of touch is unknown. In the field of behavioral health, it is crucial to be mindful of cultural differences and individual preferences when it comes to physical touch, especially in sensitive situations like the loss of a child. Option A is incorrect because while the gesture may stem from empathy and compassion, it is essential to prioritize the patient's comfort and boundaries above all else. Option C is incorrect as it assumes the patient will perceive the gesture as intrusive without considering individual differences. Option D is also incorrect as it makes a blanket statement that psychiatric patients should not be touched, which is not always the case and depends on the situation and individual preferences. In an educational context, this question highlights the importance of cultural competence, communication skills, and respecting boundaries in nursing practice, especially in behavioral health settings. Nurses need to be aware of non-verbal communication cues and be sensitive to the needs and preferences of their patients to provide effective and patient-centered care.

Correct Answer: B

Rationale: Denial is the most common defense mechanism in alcoholism, where individuals refuse to acknowledge the reality of their addiction (e.g., 'I don’t have a problem'). Displacement (A) involves redirecting emotions to another target, Projection (C) attributes one’s own feelings to others, and Compensation (D) offsets weaknesses with strengths—none align as closely with alcoholism as Denial.