DR ERIC DR ERIC DR ERIC
MOD 4B: THOUGHT DISORDERS .................................................................................................................... 1
VARC CH06 – ETHICS .................................................................................................................................. 1
STUART CH08: LEGAL AND ETHICAL CONTEXT OF PSYCHIATRIC NURSING CARE ............................... 11
VARC CH12 – SCHIZOPHRENIA................................................................................................................. 17
STUART CH20: NEUROBIOLOGICAL RESPONSES AND SCHIZOPHRENIA AND PSYCHOTIC DISORDERS30
MOD 5A: VIOLENCE & ABUSE ...................................................................................................................... 37
VARC CH27 – ANGER, AGGRESSION & VIOLENCE.................................................................................... 37
STUART CH28: PREVENTING AND MANAGING AGGRESSIVE BEHAVIOR ............................................ 46
VARC CH28 – CHILD, OLDER ADULT, & INTIMATE PARTNER VIOLENCE .................................................. 57
VARC CH29 – SEXUAL ASSAULT ............................................................................................................... 64
STUART CH38: CARE OF SURVIVORS OF ABUSE AND VIOLENCE ......................................................... 72
MOD 5B: CHILDHOOD DISORDERS .............................................................................................................. 78
VARC CH11—CHILDHOOD AND NEURODEVELOPMENTAL DISORDERS .................................................. 78
STUART CH35: CHILD PSYCHIATRIC NURSING ..................................................................................... 87
STUART CH36: ADOLESCENT PSYCHIATRIC NURSING ......................................................................... 96
VARC CH21 – IMPULSE CONTROL DISORDERS ...................................................................................... 104
STUART CH21: SOCIAL RESPONSES AND PERSONALITY DISORDERS ................................................. 112
MOD 6A: MOOD DISORDERS ..................................................................................................................... 121
VARC CH13 – BIPOLAR DISORDERS........................................................................................................ 121
VARC CH14 – DEPRESSIVE DISORDERS .................................................................................................. 132
STUART CH18: EMOTIONAL RESPONSES & MOOD DISORDERS ........................................................ 143
VARC CH18 – EATING AND FEEDING DISORDERS .................................................................................. 151
STUART CH24: EATING REGULATION RESPONSES AND EATING DISORDERS .................................... 161
VARC CH25 – SUICIDE AND SELF-INJURY ............................................................................................... 168
STUART CH19: SELF-PROTECTIVE RESPONSES AND SUICIDAL BEHAVIOR......................................... 177
MOD 6B: NEURO DISORDERS .................................................................................................................... 184
VARC CH23 – NEUROCOGNITIVE DISORDERS ........................................................................................ 184
STUART CH22: COGNITIVE RESPONSES AND ORGANIC MENTAL DISORDERS .................................. 194
MOD 7: SUBSTANCE USE/ABUSE ............................................................................................................... 202
VARC CH22 SUBSTANCE/ADDICTIVE DISORDERS .................................................................................. 202
STUART CH23: CHEMICALLY MEDIATED RESPONSES & SUBSTANCE DISORDERS ............................. 213
MOD 4B: THOUGHT DISORDERS
VARC CH06 – ETHICS
1. Which action by a psychiatric nurse best applies the ethical principle of autonomy?
a. Exploring alternative solutions with the client, who then makes a choice.
b. Suggesting that two clients who were fighting be restricted to the unit.
c. Intervening when a self-mutilating client attempts to harm self.
d. Staying with a client demonstrating a high level of anxiety.
ANS: A
Autonomy is the right to self-determination, that is, to make one’s own decisions. By
exploring alternatives with the client, the client is better equipped to make an informed,
autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.
DR ERIC DR ERIC DR ERIC
,DR ERIC DR ERIC DR ERIC
2. A nurse finds a psychiatric advance directive in the medical record of a client currently
experiencing psychosis. The directive was executed during a period when the client was stable
and competent. What is the appropriate nursing action?
a. review the directive with the client to ensure it is current.
b. ensure that the directive is respected in treatment planning.
c. consider the directive only if there is a cardiac or respiratory arrest.
d. encourage the client to revise the directive in light of the current health problem.
ANS: B
The nurse has an obligation to honor the right to self-determination. An advanced psychiatric
directive supports that goal. Since the client is currently psychotic, the terms of the directive
now apply.
3. Two hospitalized clients fight whenever they are together. During a team meeting, a nurse
asserts that safety is of paramount importance, so treatment plans should call for both clients
to be secluded to keep them from injuring each other. What would be the outcome of this
assertion?
a. reinforcement of the autonomy of the two clients.
b. violation of the civil rights of both clients.
c. commission of an intentional tort of battery.
d. Correct placement on emphasis on safety.
ANS: B
Clients have a right to treatment in the least restrictive setting. Safety is important, but less
restrictive measures should be tried first. Unnecessary seclusion may result in a charge of
false imprisonment. Seclusion violates the client’s autonomy. The principle by which the
nurse is motivated is beneficence, not justice. The tort represented is false imprisonment.
4. In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by
using restraint to prevent one client from self-mutilation, while the care plan for another self-
mutilating client requires one-on-one supervision.” Which ethical principle most clearly applies to this situation?
a. Beneficence
b. Autonomy
c. Fidelity
d. Justice
ANS: D
The nurse is concerned about justice, that is, fair distribution of care, which includes treatment
with the least restrictive methods for both clients. Beneficence means promoting the good of
others. Autonomy is the right to make one’s own decisions. Fidelity is the observance of
loyalty and commitment to the client.
DR ERIC DR ERIC DR ERIC
,DR ERIC DR ERIC DR ERIC
5. Which scenario best demonstrates an example of a tort.
a. The plan of care for a client is not completed within 24 hours of the client’s
admission.
b. A nurse gives a prn dose of an antipsychotic drug to an agitated client because the
unit is short-staffed.
c. An advanced practice nurse recommends hospitalization for a client who is
dangerous to self and others.
d. A client’s admission status changed from involuntary to voluntary after the client’s
hallucinations subside.
ANS: B
A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary
medication for the convenience of staff controls behavior in a manner similar to secluding a
client; thus, false imprisonment is a possible charge. The other options do not exemplify torts.
6. What is the legal significance of a nurse’s action when a client verbally refuses medication
and the nurse gives the medication over the client’s objection?
a. Negligence
b. Malpractice
c. Standard of care.
d. Battery.
ANS: D
Battery is an intentional tort in which one individual violates the rights of another through
touching without consent. Forcing a client to take medication after the medication was refused
constitutes battery. The charge of battery can be brought against the nurse. The medication
may not necessarily harm the client; harm is a component of malpractice. Such an action is
not considered appropriate standard of care.
7. Which nursing intervention demonstrates false imprisonment?
a. A confused and combative client says, “I’m getting out of here, and no one can
stop me.” The nurse restrains this client without a health care provider’s order and
then promptly obtains an order.
b. A client has been irritating and attention seeking much of the day. A nurse escorts
the client down the hall saying, “Stay in your room, or you’ll be put in seclusion.”
c. An involuntarily hospitalized client with suicidal ideation runs out of the
psychiatric unit. The nurse rushes after the client and convinces the client to return
to the unit.
d. An involuntarily hospitalized client with homicidal ideation attempts to leave the
facility. A nurse calls the security team and uses established protocols to prevent
the client from leaving.
ANS: B
False imprisonment involves holding a competent person against his or her will. Actual force
is not a requirement of false imprisonment. The individual needs only to be placed in fear of
imprisonment by someone who has the ability to carry out the threat. If a client is not
DR ERIC DR ERIC DR ERIC
, DR ERIC DR ERIC DR ERIC
competent (confused), then the nurse should act with beneficence. Clients admitted
involuntarily should not be allowed to leave without permission of the treatment team.
8. Which client meets criteria for involuntary hospitalization for psychiatric treatment?
a. The client who is noncompliant with the treatment regimen.
b. The client who fraudulently files for bankruptcy.
c. The client who sold and distributed illegal drugs.
d. The client who threatens to harm self and others.
ANS: D
Involuntary hospitalization protects clients who are dangerous to themselves or others and
cannot care for their own basic needs. Involuntary commitment also protects other individuals
in society. The behaviors described in the other options are not sufficient to require
involuntary hospitalization.
9. A nurse prepares to administer a scheduled intramuscular (IM) injection of an antipsychotic
medication to an out-patient diagnosed with schizophrenia. As the nurse swabs the site, the
client shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.” What
is the nurse’s best action?
a. Assemble other staff for a show of force and proceed with the injection, using
restraint if necessary.
b. Stop the medication administration procedure and say to the client, “Tell me more
about the side effects you’ve been having.”
c. Proceed with the injection but explain to the client that there are medications that
will help reduce the unpleasant side effects.
d. Say to the client, “Since I’ve already drawn the medication in the syringe, I’m
required to give it, but let’s talk to the doctor about delaying next month’s dose.”
ANS: B
Clients diagnosed with mental illness retain their civil rights unless there is clear, cogent, and
convincing evidence of dangerousness. The client in this situation presents no evidence of
dangerousness. The nurse, as an advocate and educator, should seek more information about
the client’s decision and not force the medication.
10. Which understanding about the relationship between substandard institutional policies and
individual nursing practice should guide nursing practice?
a. Agency policies do not exempt an individual nurse of responsibility to practice
according to professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and
therefore override other standards of care.
c. Faced with substandard policies, a nurse has a responsibility to inform the
supervisor and discontinue client care immediately.
d. Interpretation of policies by the judicial system is rendered on an individual basis
and therefore cannot be predicted.
DR ERIC DR ERIC DR ERIC
MOD 4B: THOUGHT DISORDERS .................................................................................................................... 1
VARC CH06 – ETHICS .................................................................................................................................. 1
STUART CH08: LEGAL AND ETHICAL CONTEXT OF PSYCHIATRIC NURSING CARE ............................... 11
VARC CH12 – SCHIZOPHRENIA................................................................................................................. 17
STUART CH20: NEUROBIOLOGICAL RESPONSES AND SCHIZOPHRENIA AND PSYCHOTIC DISORDERS30
MOD 5A: VIOLENCE & ABUSE ...................................................................................................................... 37
VARC CH27 – ANGER, AGGRESSION & VIOLENCE.................................................................................... 37
STUART CH28: PREVENTING AND MANAGING AGGRESSIVE BEHAVIOR ............................................ 46
VARC CH28 – CHILD, OLDER ADULT, & INTIMATE PARTNER VIOLENCE .................................................. 57
VARC CH29 – SEXUAL ASSAULT ............................................................................................................... 64
STUART CH38: CARE OF SURVIVORS OF ABUSE AND VIOLENCE ......................................................... 72
MOD 5B: CHILDHOOD DISORDERS .............................................................................................................. 78
VARC CH11—CHILDHOOD AND NEURODEVELOPMENTAL DISORDERS .................................................. 78
STUART CH35: CHILD PSYCHIATRIC NURSING ..................................................................................... 87
STUART CH36: ADOLESCENT PSYCHIATRIC NURSING ......................................................................... 96
VARC CH21 – IMPULSE CONTROL DISORDERS ...................................................................................... 104
STUART CH21: SOCIAL RESPONSES AND PERSONALITY DISORDERS ................................................. 112
MOD 6A: MOOD DISORDERS ..................................................................................................................... 121
VARC CH13 – BIPOLAR DISORDERS........................................................................................................ 121
VARC CH14 – DEPRESSIVE DISORDERS .................................................................................................. 132
STUART CH18: EMOTIONAL RESPONSES & MOOD DISORDERS ........................................................ 143
VARC CH18 – EATING AND FEEDING DISORDERS .................................................................................. 151
STUART CH24: EATING REGULATION RESPONSES AND EATING DISORDERS .................................... 161
VARC CH25 – SUICIDE AND SELF-INJURY ............................................................................................... 168
STUART CH19: SELF-PROTECTIVE RESPONSES AND SUICIDAL BEHAVIOR......................................... 177
MOD 6B: NEURO DISORDERS .................................................................................................................... 184
VARC CH23 – NEUROCOGNITIVE DISORDERS ........................................................................................ 184
STUART CH22: COGNITIVE RESPONSES AND ORGANIC MENTAL DISORDERS .................................. 194
MOD 7: SUBSTANCE USE/ABUSE ............................................................................................................... 202
VARC CH22 SUBSTANCE/ADDICTIVE DISORDERS .................................................................................. 202
STUART CH23: CHEMICALLY MEDIATED RESPONSES & SUBSTANCE DISORDERS ............................. 213
MOD 4B: THOUGHT DISORDERS
VARC CH06 – ETHICS
1. Which action by a psychiatric nurse best applies the ethical principle of autonomy?
a. Exploring alternative solutions with the client, who then makes a choice.
b. Suggesting that two clients who were fighting be restricted to the unit.
c. Intervening when a self-mutilating client attempts to harm self.
d. Staying with a client demonstrating a high level of anxiety.
ANS: A
Autonomy is the right to self-determination, that is, to make one’s own decisions. By
exploring alternatives with the client, the client is better equipped to make an informed,
autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.
DR ERIC DR ERIC DR ERIC
,DR ERIC DR ERIC DR ERIC
2. A nurse finds a psychiatric advance directive in the medical record of a client currently
experiencing psychosis. The directive was executed during a period when the client was stable
and competent. What is the appropriate nursing action?
a. review the directive with the client to ensure it is current.
b. ensure that the directive is respected in treatment planning.
c. consider the directive only if there is a cardiac or respiratory arrest.
d. encourage the client to revise the directive in light of the current health problem.
ANS: B
The nurse has an obligation to honor the right to self-determination. An advanced psychiatric
directive supports that goal. Since the client is currently psychotic, the terms of the directive
now apply.
3. Two hospitalized clients fight whenever they are together. During a team meeting, a nurse
asserts that safety is of paramount importance, so treatment plans should call for both clients
to be secluded to keep them from injuring each other. What would be the outcome of this
assertion?
a. reinforcement of the autonomy of the two clients.
b. violation of the civil rights of both clients.
c. commission of an intentional tort of battery.
d. Correct placement on emphasis on safety.
ANS: B
Clients have a right to treatment in the least restrictive setting. Safety is important, but less
restrictive measures should be tried first. Unnecessary seclusion may result in a charge of
false imprisonment. Seclusion violates the client’s autonomy. The principle by which the
nurse is motivated is beneficence, not justice. The tort represented is false imprisonment.
4. In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by
using restraint to prevent one client from self-mutilation, while the care plan for another self-
mutilating client requires one-on-one supervision.” Which ethical principle most clearly applies to this situation?
a. Beneficence
b. Autonomy
c. Fidelity
d. Justice
ANS: D
The nurse is concerned about justice, that is, fair distribution of care, which includes treatment
with the least restrictive methods for both clients. Beneficence means promoting the good of
others. Autonomy is the right to make one’s own decisions. Fidelity is the observance of
loyalty and commitment to the client.
DR ERIC DR ERIC DR ERIC
,DR ERIC DR ERIC DR ERIC
5. Which scenario best demonstrates an example of a tort.
a. The plan of care for a client is not completed within 24 hours of the client’s
admission.
b. A nurse gives a prn dose of an antipsychotic drug to an agitated client because the
unit is short-staffed.
c. An advanced practice nurse recommends hospitalization for a client who is
dangerous to self and others.
d. A client’s admission status changed from involuntary to voluntary after the client’s
hallucinations subside.
ANS: B
A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary
medication for the convenience of staff controls behavior in a manner similar to secluding a
client; thus, false imprisonment is a possible charge. The other options do not exemplify torts.
6. What is the legal significance of a nurse’s action when a client verbally refuses medication
and the nurse gives the medication over the client’s objection?
a. Negligence
b. Malpractice
c. Standard of care.
d. Battery.
ANS: D
Battery is an intentional tort in which one individual violates the rights of another through
touching without consent. Forcing a client to take medication after the medication was refused
constitutes battery. The charge of battery can be brought against the nurse. The medication
may not necessarily harm the client; harm is a component of malpractice. Such an action is
not considered appropriate standard of care.
7. Which nursing intervention demonstrates false imprisonment?
a. A confused and combative client says, “I’m getting out of here, and no one can
stop me.” The nurse restrains this client without a health care provider’s order and
then promptly obtains an order.
b. A client has been irritating and attention seeking much of the day. A nurse escorts
the client down the hall saying, “Stay in your room, or you’ll be put in seclusion.”
c. An involuntarily hospitalized client with suicidal ideation runs out of the
psychiatric unit. The nurse rushes after the client and convinces the client to return
to the unit.
d. An involuntarily hospitalized client with homicidal ideation attempts to leave the
facility. A nurse calls the security team and uses established protocols to prevent
the client from leaving.
ANS: B
False imprisonment involves holding a competent person against his or her will. Actual force
is not a requirement of false imprisonment. The individual needs only to be placed in fear of
imprisonment by someone who has the ability to carry out the threat. If a client is not
DR ERIC DR ERIC DR ERIC
, DR ERIC DR ERIC DR ERIC
competent (confused), then the nurse should act with beneficence. Clients admitted
involuntarily should not be allowed to leave without permission of the treatment team.
8. Which client meets criteria for involuntary hospitalization for psychiatric treatment?
a. The client who is noncompliant with the treatment regimen.
b. The client who fraudulently files for bankruptcy.
c. The client who sold and distributed illegal drugs.
d. The client who threatens to harm self and others.
ANS: D
Involuntary hospitalization protects clients who are dangerous to themselves or others and
cannot care for their own basic needs. Involuntary commitment also protects other individuals
in society. The behaviors described in the other options are not sufficient to require
involuntary hospitalization.
9. A nurse prepares to administer a scheduled intramuscular (IM) injection of an antipsychotic
medication to an out-patient diagnosed with schizophrenia. As the nurse swabs the site, the
client shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.” What
is the nurse’s best action?
a. Assemble other staff for a show of force and proceed with the injection, using
restraint if necessary.
b. Stop the medication administration procedure and say to the client, “Tell me more
about the side effects you’ve been having.”
c. Proceed with the injection but explain to the client that there are medications that
will help reduce the unpleasant side effects.
d. Say to the client, “Since I’ve already drawn the medication in the syringe, I’m
required to give it, but let’s talk to the doctor about delaying next month’s dose.”
ANS: B
Clients diagnosed with mental illness retain their civil rights unless there is clear, cogent, and
convincing evidence of dangerousness. The client in this situation presents no evidence of
dangerousness. The nurse, as an advocate and educator, should seek more information about
the client’s decision and not force the medication.
10. Which understanding about the relationship between substandard institutional policies and
individual nursing practice should guide nursing practice?
a. Agency policies do not exempt an individual nurse of responsibility to practice
according to professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and
therefore override other standards of care.
c. Faced with substandard policies, a nurse has a responsibility to inform the
supervisor and discontinue client care immediately.
d. Interpretation of policies by the judicial system is rendered on an individual basis
and therefore cannot be predicted.
DR ERIC DR ERIC DR ERIC
