In a team meeting, a nurse says, 'I'm concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision.' Which ethical principle most clearly applies to this situation?

Correct Answer: D

Rationale: The correct answer is D) Justice. In this scenario, justice is the ethical principle that most clearly applies. Justice in healthcare ethics refers to the fair distribution of resources and the equitable treatment of all individuals. The nurse's concern about using restraint for one patient while providing one-on-one supervision for another patient highlights the issue of fairness and equity in care delivery. Option A) Beneficence, focuses on doing good and promoting the well-being of patients. While using restraint may be viewed as a way to prevent harm, the issue at hand is more about fairness and justice in resource allocation. Option B) Autonomy, pertains to respecting patients' rights to make their own decisions about their care. Although autonomy is an important ethical principle, it is not the primary concern in this situation. Option C) Fidelity, relates to being faithful to commitments and agreements made with patients. While fidelity is crucial in building trust with patients, it is not the central ethical principle at play in the nurse's dilemma. Educationally, understanding the ethical principles in nursing is vital for making sound clinical decisions and providing ethical care. Nurses must navigate complex ethical dilemmas like the one presented in this question to ensure that their practice upholds the principles of justice, beneficence, autonomy, and fidelity. This scenario underscores the importance of considering fairness and equity in healthcare decision-making processes.

Correct Answer: D

Rationale: In this scenario, option D is an example of 'attending' because it demonstrates active listening and a willingness to provide emotional support. By expressing a desire to sit with the patient, the nurse is showing empathy and creating a therapeutic environment for the patient to feel comfortable opening up. Option A is incorrect because it minimizes the patient's feelings by comparing them to others' stress levels and dismissing the patient's current situation. This response lacks empathy and fails to acknowledge the patient's emotional state. Option B is incorrect as it comes across as confrontational and may make the patient feel defensive. The question seems judgmental and does not convey a sense of understanding or support for the patient's feelings. Option C is incorrect because it focuses solely on the medical aspect of treatment and does not address the patient's emotional needs or provide reassurance. It lacks the human connection necessary for effective therapeutic communication. In the context of nursing care, 'attending' is a crucial component of building a therapeutic nurse-patient relationship. By actively listening, showing empathy, and providing emotional support, nurses can create a safe space for patients to express their thoughts and feelings, ultimately enhancing the quality of care and promoting positive outcomes in mental health treatment.

Correct Answer: C

Rationale: In the context of managing aggressive behavior in a patient with schizophrenia displaying agitation, disorganized speech, and paranoia, the most appropriate medication choice from the options provided is Haloperidol (Option C). Haloperidol is a first-generation antipsychotic medication that is commonly used to address symptoms of psychosis, including agitation and paranoia. It exerts its therapeutic effects by blocking dopamine receptors in the brain, thereby helping to reduce hallucinations, delusions, and other psychotic symptoms associated with schizophrenia. Clozapine (Option A) is a second-generation antipsychotic that is often reserved for cases of treatment-resistant schizophrenia due to its potential for serious side effects such as agranulocytosis. While effective, it is not typically the first choice for managing acute aggression in schizophrenia. Lithium (Option B) is a mood stabilizer commonly used in the treatment of bipolar disorder, not for managing acute psychotic symptoms like agitation and paranoia in schizophrenia. Fluoxetine (Option D) is a selective serotonin reuptake inhibitor (SSRI) used primarily in the treatment of depression and some anxiety disorders. It is not indicated for managing the symptoms of schizophrenia, particularly aggressive behaviors. Educationally, understanding the rationale behind selecting the appropriate medication for specific symptoms in schizophrenia is crucial for nursing practice. It is essential for nurses to be able to differentiate between various medications used in psychiatric care to provide safe and effective patient care. By grasping the pharmacological principles and therapeutic uses of different medications, nurses can contribute significantly to the holistic management of patients with mental health disorders.

Correct Answer: C

Rationale: In teaching a patient with major depressive disorder about a selective serotonin reuptake inhibitor (SSRI), it is crucial to include information on the delayed onset of action. Option C, stating that it may take several weeks before feeling the full effects of the medication, is correct. This is important because patients often expect immediate results and may discontinue the medication prematurely if not informed otherwise. Educating patients about the delayed therapeutic effect prepares them for realistic expectations and promotes medication adherence. Option A is incorrect as SSRI medications typically cause initial activation rather than sedation. Option B is irrelevant as the concern with tyramine-containing foods is more associated with MAOIs rather than SSRIs. Option D is incorrect and potentially harmful to suggest stopping the medication once the patient starts feeling better, as abruptly discontinuing an SSRI can lead to withdrawal symptoms or a relapse of depression. Educationally, understanding the pharmacokinetics and therapeutic timeline of SSRI medications is essential for patients to make informed decisions about their treatment and to manage their expectations effectively. By providing accurate information, nurses empower patients to actively participate in their care and enhance treatment outcomes.

Correct Answer: B

Rationale: In the context of suicide prevention, it is crucial for public health nurses to understand the social groups at highest risk to effectively target interventions. The correct answer is B) Native American. Native American populations in the United States face unique social, historical, and systemic challenges that contribute to higher rates of suicide compared to other social groups. Factors such as historical trauma, loss of cultural identity, poverty, and limited access to mental health services contribute to their increased risk. Option A) South American, Option C) African American, and Option D) Japanese American are not the groups at highest risk for suicide as indicated in research and epidemiological data. While these groups may also experience disparities in mental health and well-being, the prevalence of suicide is notably higher among Native American populations. For educational context, it is essential for nurses to have a culturally sensitive approach when working with diverse populations to address mental health issues such as suicide. By understanding the specific risk factors and challenges faced by different social groups, nurses can tailor their interventions to be more effective and culturally appropriate, ultimately leading to better outcomes in suicide prevention efforts.