NR 326 Exam 1 Active Learning Template

Grace J.
August 15, 2025August 15, 2025
CU BSN, NR-326

Student Name

Chamberlain University

NR-304: Health Assessment II

Prof. Name

Date

Actions the Nurse Should Take to Prevent Lawsuits

Nurses can prevent lawsuits by adhering to ethical principles and following legal standards of practice. Ethical principles in nursing include autonomy, beneficence, justice, and nonmaleficence. Autonomy means that each patient has the right to make their own healthcare decisions based on their values and beliefs. Assault is an act that causes genuine fear of being touched without consent, while battery refers to non-consensual touching. Beneficence involves actions guided by compassion, and justice implies that all patients have the right to fair and impartial treatment regardless of insurance status, age, gender, religion, or sexual preference. Nonmaleficence requires selecting interventions that are beneficial and do not cause harm. False imprisonment is the unauthorized confinement of a person using verbal or physical means, such as restraining a voluntary patient against their wishes.

Legal Issues in Psychiatric Nursing

Confidentiality requires written consent before sharing health information outside the treatment team. In emergencies, if information is released, the following must be documented: date of disclosure, recipient, reason for disclosure, reason written consent could not be obtained, and the specific information disclosed. Medical records play a critical role in malpractice cases. Documentation must be objective, nonjudgmental, and specific, including care plans and descriptions of interventions with evaluations. Duty to warn obligates healthcare workers to report threats of harm to the psychiatrist and team members; failure to do so may be considered negligence or a criminal act. Informed consent preserves patient autonomy. Before procedures, patients must receive written information, have adequate time to weigh risks and benefits, and be informed of alternatives. Consent is not required if the patient is mentally incompetent and treatment is necessary to preserve life, if refusal endangers another person, or if consent is obtained from a legal guardian. Consent may be withdrawn at any time.

Restraints and Seclusion

Restraints should never be used as punishment or staff convenience. Less restrictive measures, such as verbal de-escalation or chemical restraints, must be tried first. Staff must be trained in their safe use, and restraints or seclusion should be discontinued as soon as possible. Renewal intervals for restraint and seclusion orders are every four hours for adults (18 years and older), every two hours for children aged 9 to 17, and every hour for children under 9.

Voluntary and Involuntary Hospitalization

Voluntary admission occurs when a patient requests services and remains as long as treatment is necessary. They may leave at will unless deemed a danger to themselves or others, in which case their status may be changed to involuntary. Involuntary commitment must follow state and federal law and is justified if the person is imminently dangerous to themselves (suicidal), to others (violent or homicidal), or unable to care for basic needs (gravely disabled). Emergency commitments are initiated when a person’s behavior is clearly dangerous. These are time-limited, with a court hearing usually scheduled within 72 hours to determine discharge, voluntary admission, or extended involuntary hospitalization.

Types of Lawsuits in Psychiatric Nursing

Nurses may face lawsuits for breaches of confidentiality, such as revealing case details without consent. If this disclosure causes harm, the nurse may be liable for defamation of character, with libel referring to written statements and slander to spoken statements. Invasion of privacy occurs when a patient is searched without probable cause.

Identify and Provide Examples of the Phases of the Nurse-Client Relationship

The preinteraction phase involves preparing for the first meeting by obtaining information from medical records or others and reflecting on personal feelings. The orientation phase is when trust and rapport are established, and a contract is formed outlining expectations and responsibilities. The working phase is when therapeutic goals are addressed, patient insight is promoted, and resistance behaviors are managed. The termination phase occurs when goals are achieved or the patient is discharged, and progress is reviewed.

Identify the Various Types of Therapeutic Communication and Provide an Example

A therapeutic relationship requires rapport, trust, and empathy. Rapport is mutual acceptance and trust; trust is confidence in the nurse’s integrity and reliability; empathy is understanding the patient’s perspective. Sympathy, unlike empathy, involves sharing the patient’s emotions and losing objectivity. Veracity requires honesty in interactions. Manipulation refers to patient efforts to avoid separation or maintain control.

Phenothiazines – First Generation Antipsychotics

Phenothiazines and haloperidol are used to treat schizophrenia and other psychotic disorders. They relieve psychosis, improve positive symptoms, and may worsen negative symptoms. These medications historically enabled many patients to function more effectively and allowed research into mental illness origins.

Stress

The autonomic nervous system mediates the stress response, with sympathetic and parasympathetic divisions. The hypothalamic-pituitary axis and sympathetic adrenomedullary systems are key components. Physical stimuli such as temperature extremes, electric shock, or injury trigger the fight-or-flight response, which may include pupil dilation, bladder contraction, and increased cardiac output, blood pressure, and heart rate.

Zoloft (Sertraline)

Zoloft is an SSRI antidepressant approved for treating OCD. The daily dosage is 50–100 mg, with higher doses sometimes needed for OCD than for depression. Side effects include sleep disturbances, headache, and restlessness.

Conversion Disorder (Somatic Symptom Disorder)

Conversion disorder involves physical symptoms without organic cause, often resulting from emotional conflict. Symptoms may include aphonia, anosmia, or pseudocyesis and are more common in women and young adults. Many cases resolve when the diagnosis is accepted. Nursing interventions include health teaching, encouraging emotional expression, and teaching coping strategies.

Differentiate Anger and Aggression

Anger is an automatic response to hurt, frustration, or fear, which can lead to physical health problems or depression if suppressed. Aggression is behavior intended to threaten or injure another’s self-esteem or safety, ranging from self-protective responses to violent acts.

Cognitive Therapy

Cognitive therapy helps patients change thinking and behavior to improve mood, functioning, and well-being. It is used for depression, anxiety disorders, OCD, PTSD, eating disorders, substance abuse, personality disorders, schizophrenia, bipolar disorder, and somatic symptom disorders. Effectiveness is shown when patients monitor thoughts, recognize connections between thoughts and behaviors, and notice symptom reduction.

Lithium

Lithium is a mood stabilizer used for bipolar disorder. Sodium depletion increases lithium toxicity risk, while excess sodium reduces its effectiveness. Early signs of toxicity include vomiting and diarrhea. Serum lithium levels should be maintained between 0.6 and 1.2 mEq/L and measured 12 hours after the last dose.

Differentiate Involuntary and Voluntary Commitment

Involuntary commitment follows legal protocols when a patient is dangerous to self or others, mentally ill and in need of treatment, or gravely disabled. Voluntary commitment occurs when the patient agrees to treatment and can request discharge at any time, retaining the right to revoke consent.

Differentiate Types of Amnesia

Localized amnesia is the inability to recall incidents during a specific period. Selective amnesia is recalling only certain events from that period. Generalized amnesia is total loss of personal identity and life history. Retrograde amnesia is the inability to recall memories formed before the causative event.

Describe Guided Imagery

Guided imagery techniques include deep breathing, mindfulness meditation, and visualization to increase awareness and control over anxiety symptoms. Socratic dialogue involves the therapist questioning the patient to explore their situation, potentially uncovering dysfunctional thinking.

Describe OCD

Obsessive-compulsive disorder involves distressing obsessions, compulsions, or both, causing significant impairment. Obsessions are recurrent intrusive thoughts recognized as irrational, while compulsions are ritualistic behaviors performed to reduce anxiety. Patients are taught to recognize anxiety triggers and use relaxation or exercise to interrupt compulsive cycles.

Describe the Various Defense Mechanisms

Compensation involves developing strengths to counter perceived weaknesses. Rationalization uses excuses to justify actions. Denial rejects reality. Reaction formation adopts behaviors opposite to true feelings. Displacement redirects anger to a less threatening target. Regression reverts to earlier developmental stages. Identification adopts admired traits. Intellectualization uses reasoning to avoid emotion. Sublimation channels unacceptable impulses into acceptable activities. Introjection internalizes others’ values. Suppression consciously dismisses thoughts. Isolation separates emotion from events. Undoing attempts to reduce guilt through reparative actions. Projection blames others for one’s own faults.

Electroconvulsive Therapy (ECT)

ECT is used for severe depression, mania in bipolar disorder, or schizophrenia when other treatments fail. Patient and family teaching includes maintaining nutrition and following provider instructions. Medications given include anticholinergics to reduce secretions, anesthetics, and muscle relaxants such as methohexital or propofol. The goal is symptom relief. Side effects may include nausea, headache, fatigue, confusion, and memory loss.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.