NR 326 – FINAL EXAM
Mental Health Nursing Questions and Answers| Updated|
Pass Guaranteed
1. A voluntarily admitted client refuses a scheduled antipsychotic dose. What
should the nurse do?
Answer: Respect the refusal, explore the reasons (side effects, fear, beliefs),
provide information, document the refusal and notify the provider.
Rationale: Clients have the right to refuse medication. The nurse does not force,
coerce or hide medication in food, but works to understand and address
concerns.
2. May a client who is involuntarily hospitalized refuse medication?
Answer: Yes, in non-emergency situations, unless a court has found the client
incompetent and ordered treatment. Medication can be given over objection
only in an emergency involving imminent danger.
Rationale: Involuntary admission restricts liberty, but does not remove the
right to refuse treatment. Emergency exceptions are narrow and documented.
NR 326 Final Exam– Page 1
,3. Differentiate beneficence from nonmaleficence, using a medication example.
Answer: Beneficence means acting for the client's good (giving an
antipsychotic to relieve psychosis). Nonmaleficence means avoiding harm
(monitoring for and minimizing side effects such as tardive dyskinesia).
Rationale: Nursing decisions weigh benefits against harms. Both principles
apply to nearly every treatment.
4. A client with capacity refuses ECT that the team believes would help. Which
ethical principles conflict, and which prevails?
Answer: Autonomy conflicts with beneficence, and the client's autonomous
decision prevails if the client has capacity.
Rationale: Respecting self-determination is fundamental. The nurse ensures
the client has adequate information and does not pressure the client.
5. How does the principle of justice apply to staffing assignments?
Answer: Care and resources are distributed fairly according to need, without
discrimination or favoritism.
Rationale: Justice requires fair, equitable treatment of all clients.
6. A voluntarily admitted client demands to leave. What is the nurse's first
action?
Answer: Explain the process, notify the provider, and ask the client to put the
request in writing as policy requires, while continuing to monitor.
Rationale: A voluntary client may request discharge, and the provider
evaluates whether the client meets involuntary criteria within the time allowed
by state law.
7. What are the typical criteria for involuntary commitment?
Answer: A mental illness that causes danger to self, danger to others, or grave
disability (inability to meet basic needs).
Rationale: Specific criteria and holding periods vary by state and must include
due process, with a right to a hearing.
8. When may a facility restrict a client's mail or telephone use?
Answer: Only for a documented, individual therapeutic reason ordered by the
provider, and never as punishment.
NR 326 Final Exam– Page 2
, Rationale: Communication with the outside world is a protected right, and
restrictions must be justified, limited and reviewed.
9. Who obtains informed consent, and what happens if the client lacks capacity?
Answer: The provider performing the treatment obtains consent. The nurse
may witness. If the client lacks capacity, a legally authorized surrogate or
guardian consents.
Rationale: Capacity is decision-specific and can change. Consent requires
understanding of risks, benefits and alternatives.
10. Summarize the requirements for restraint or seclusion.
Answer: Used only for imminent danger when less restrictive measures fail,
with a provider order, a face-to-face evaluation within one hour, time-limited
orders (4 hours for adults, 2 hours for ages 9–17, 1 hour for under 9),
continuous monitoring and release as soon as safe.
Rationale: These follow regulatory standards. Documentation of behaviors,
alternatives and monitoring is required.
11. What does the least restrictive environment principle require?
Answer: Using the least restrictive intervention that keeps the client and
others safe, such as de-escalation or voluntary medication before restraint.
Rationale: It protects liberty and dignity.
12. What is the duty to warn or protect?
Answer: When a client makes a serious threat against an identifiable person,
the clinician must take steps to protect the intended victim, which may include
breaking confidentiality.
Rationale: Established by Tarasoff, with details varying by state. Share only
what is necessary.
13. What are the elements of negligence in nursing?
Answer: Duty, breach of duty, causation and harm.
Rationale: An example would be failing to assess suicide risk or to follow
observation orders, which results in client harm.
NR 326 Final Exam– Page 3
Mental Health Nursing Questions and Answers| Updated|
Pass Guaranteed
1. A voluntarily admitted client refuses a scheduled antipsychotic dose. What
should the nurse do?
Answer: Respect the refusal, explore the reasons (side effects, fear, beliefs),
provide information, document the refusal and notify the provider.
Rationale: Clients have the right to refuse medication. The nurse does not force,
coerce or hide medication in food, but works to understand and address
concerns.
2. May a client who is involuntarily hospitalized refuse medication?
Answer: Yes, in non-emergency situations, unless a court has found the client
incompetent and ordered treatment. Medication can be given over objection
only in an emergency involving imminent danger.
Rationale: Involuntary admission restricts liberty, but does not remove the
right to refuse treatment. Emergency exceptions are narrow and documented.
NR 326 Final Exam– Page 1
,3. Differentiate beneficence from nonmaleficence, using a medication example.
Answer: Beneficence means acting for the client's good (giving an
antipsychotic to relieve psychosis). Nonmaleficence means avoiding harm
(monitoring for and minimizing side effects such as tardive dyskinesia).
Rationale: Nursing decisions weigh benefits against harms. Both principles
apply to nearly every treatment.
4. A client with capacity refuses ECT that the team believes would help. Which
ethical principles conflict, and which prevails?
Answer: Autonomy conflicts with beneficence, and the client's autonomous
decision prevails if the client has capacity.
Rationale: Respecting self-determination is fundamental. The nurse ensures
the client has adequate information and does not pressure the client.
5. How does the principle of justice apply to staffing assignments?
Answer: Care and resources are distributed fairly according to need, without
discrimination or favoritism.
Rationale: Justice requires fair, equitable treatment of all clients.
6. A voluntarily admitted client demands to leave. What is the nurse's first
action?
Answer: Explain the process, notify the provider, and ask the client to put the
request in writing as policy requires, while continuing to monitor.
Rationale: A voluntary client may request discharge, and the provider
evaluates whether the client meets involuntary criteria within the time allowed
by state law.
7. What are the typical criteria for involuntary commitment?
Answer: A mental illness that causes danger to self, danger to others, or grave
disability (inability to meet basic needs).
Rationale: Specific criteria and holding periods vary by state and must include
due process, with a right to a hearing.
8. When may a facility restrict a client's mail or telephone use?
Answer: Only for a documented, individual therapeutic reason ordered by the
provider, and never as punishment.
NR 326 Final Exam– Page 2
, Rationale: Communication with the outside world is a protected right, and
restrictions must be justified, limited and reviewed.
9. Who obtains informed consent, and what happens if the client lacks capacity?
Answer: The provider performing the treatment obtains consent. The nurse
may witness. If the client lacks capacity, a legally authorized surrogate or
guardian consents.
Rationale: Capacity is decision-specific and can change. Consent requires
understanding of risks, benefits and alternatives.
10. Summarize the requirements for restraint or seclusion.
Answer: Used only for imminent danger when less restrictive measures fail,
with a provider order, a face-to-face evaluation within one hour, time-limited
orders (4 hours for adults, 2 hours for ages 9–17, 1 hour for under 9),
continuous monitoring and release as soon as safe.
Rationale: These follow regulatory standards. Documentation of behaviors,
alternatives and monitoring is required.
11. What does the least restrictive environment principle require?
Answer: Using the least restrictive intervention that keeps the client and
others safe, such as de-escalation or voluntary medication before restraint.
Rationale: It protects liberty and dignity.
12. What is the duty to warn or protect?
Answer: When a client makes a serious threat against an identifiable person,
the clinician must take steps to protect the intended victim, which may include
breaking confidentiality.
Rationale: Established by Tarasoff, with details varying by state. Share only
what is necessary.
13. What are the elements of negligence in nursing?
Answer: Duty, breach of duty, causation and harm.
Rationale: An example would be failing to assess suicide risk or to follow
observation orders, which results in client harm.
NR 326 Final Exam– Page 3
