A patient diagnosed with schizophrenia believes a local minister stirred evil spirits The patient threatens to bomb a local church The psychiatrist notifies the minister Select the answer with the correct rationale The psychiatrist:

Correct Answer: B

Rationale: In this scenario, the correct answer is B) demonstrated the duty to warn and protect. The psychiatrist has a legal and ethical responsibility to protect potential victims when a patient poses a serious threat. By notifying the minister of the patient's threat to bomb the church, the psychiatrist is fulfilling the duty to warn and protect, which takes precedence over patient confidentiality in situations where harm to others is imminent. Option A) released information without proper authorization is incorrect because in cases of serious threat, healthcare providers have a duty to breach confidentiality to protect potential victims. Option C) violated the patient’s confidentiality is also incorrect because in this situation, the duty to warn and protect overrides patient confidentiality. Option D) avoided charges of malpractice is incorrect as the primary concern here is the safety of potential victims, not potential legal repercussions for the psychiatrist. From an educational standpoint, it is crucial for healthcare providers, especially those in behavioral health, to understand their duty to warn and protect in cases where a patient poses a serious threat to others. This case highlights the complex balance between patient confidentiality and the responsibility to prevent harm, emphasizing the importance of ethical decision-making in healthcare practice.

Correct Answer: D

Rationale: When the patient (primary source) is unable to provide information due to confusion, secondary sources such as family members should be utilized. Option D is the best action as it ensures the nurse gathers critical data efficiently from the family member, who likely knows the patient’s history. Option A is impractical since the patient cannot answer, Option B unnecessarily escalates the task beyond the staff nurse’s scope, and Option C is irrelevant as a mental health advocate isn’t needed for this assessment.

Correct Answer: D

Rationale: The correct answer is D: "Are you comfortable conversing in English, or would you prefer to have a translator present?" This response demonstrates cultural sensitivity and respect for the patient's language preferences. It acknowledges the possibility that the patient may not be fluent in English and offers the option of a translator, ensuring effective communication and understanding during the assessment. Option A, "How did you get to the United States?" is intrusive and not relevant to the patient's current healthcare needs. Option B, "Would you like for a family member to help you talk with me?" assumes the patient has a family member present and may not address the language barrier. Option C, "An interpreter is available. Would you like for me to make a request for these services?" is more directive and less patient-centered compared to option D. In an educational context, this question highlights the importance of effective communication in healthcare settings, especially when interacting with patients from diverse cultural backgrounds. Nurses need to be aware of and respect patients' language preferences to provide quality care and build trust with patients. Understanding how to navigate language barriers is essential in delivering patient-centered care and promoting positive health outcomes.

Correct Answer: D

Rationale: Common terms used in assessing affect include blunted affect: showing little or a slow-to-respond facial expression; broad affect: displaying a full range of emotional expressions; flat affect: showing no facial expression; inappropriate affect: displaying a facial expression that is incongruent with mood or situation, often silly or giddy regardless of circumstances; restricted affect: displaying one type of expression, usually serious or somber.

Correct Answer: D

Rationale: The correct answer is D) Describe your relationships with your family. This option allows the nurse to gain a comprehensive understanding of the patient's family dynamics, communication patterns, support systems, and potential sources of stress or conflict. By encouraging the patient to describe their relationships, the nurse can uncover valuable information that may impact the patient's mental health. Option A) "Do you feel your family helps you?" is too direct and may not provide a nuanced understanding of the patient's family relationships. It also assumes that family support is always positive, which may not be the case for all patients. Option B) "How many people are in your family?" is a closed-ended question that focuses solely on the quantity of family members rather than the quality of relationships, missing important details that could impact the patient's mental health. Option C) "Whom are you closest to in your family?" is limited in scope and may not capture the complexity of the patient's relationships with different family members. It also assumes that closeness to a specific family member is the most significant factor in assessing family dynamics, which may not always be true. In an educational context, it is crucial for nurses to understand the importance of assessing a patient's family relationships in the context of mental health. Family dynamics play a significant role in an individual's well-being, and nurses need to be skilled in conducting thorough assessments to provide holistic care to patients. By choosing option D, nurses can gather detailed information to inform their care plans and interventions, ultimately promoting positive mental health outcomes for their patients.