NURS 4010 LATEST 2026 EXAM TEST PAPER QUESTIONS
AND SOLUTIONS GUARANTEE A+
✔✔principles of communication: specific techniques - ✔✔-ask open ended questions
-ask close ended questions for specific information such as dates (don't want them to
feel interrogated)
-clarify
-paraphrase
-restate
-reflect
-explore
-use silence (if pt is emotional allowing time for them to regroup before asking
something else)
-active listening (don't let mind wander)
✔✔principles of communication: guidelines for initial interviews - ✔✔-speak briefly
-when you don't know what to say, say nothing at all
-avoid advice- do not suggest things, let them come to them on their own- their fault if it
doesn't work, not yours
-avoid relying on questions
-pay attention to nonverbal cues
-keep focus on the client
✔✔influences on communication - ✔✔-values, beliefs, attitudes
-culture & religion
-social status
-gender
-age or developmental level
-environment of transaction
-70-90% of effective communication is non-verbal
-physical appearance & dress (body adornments such as piercings, tattoos, jewelry)
-body movement & posture
-touch
✔✔transference - ✔✔occurs when client unconsciously attributes or transfers feelings
toward the nurse from previous relationships, not therapeutic and boundaries are
blurred
✔✔countertransferene - ✔✔refers to the nurse's behavioral & emotional response to the
client, not therapeutic and boundaries are blurred, patient can get too attached to the
nurse or have bad feelings toward them
✔✔professional boundaries - ✔✔self disclosure, gift giving, touch & role crossing
(friendship, romatic), not therapeutic when boundaries are blurred
,✔✔summary of intro - ✔✔-therapeutic use of self requires diligence in self awareness
-psychiatric mental health nurses use "special" skills or interpersonal techniques to
assist clients in adapting to difficulties or changes in life experiences
-mutual respect
-all nurses need these skills in any clinical setting
✔✔ANA code of ethics for nurses - ✔✔-In all professional relationships, practices with
compassion & respect
-Primary commitment is to patient, family, group, community
-Promotes, advocates, protects health, safety, & rights of patients
-Responsible & accountable for his/her own patient care practice
-Owes same duty to self...integrity, competence, growth
-Participates in improving health care environments
-Participates in advancement of profession
-Collaborates with other health professionals & public to meet health care needs
-Profession of nursing, as represented by associations/members...responsible for
values & integrity & shaping social policy
✔✔specific to psychiatric nursing - ✔✔-pt bill of rights
-right to refuse treatment.. medication
-medical consequences may include steps as involuntary commitment (IVC), legal
competency hearing, or pt discharge
-ex. right to use phone
✔✔rights of persons with mental illness - ✔✔-privacy
-receive mail, phone calls, visits
-confidentiality
-individualized treatments
-right to receive or refuse treatment
-no verbal or physical abuse
-*chemical or physical restraints are considered abusive*- specific policies must be in
place regarding both forms of restraints
-families are given a security code that tells them to say yes they are here they will call
you but still can't give any info
-confidentiality is heightened
-every pt has different plan of care
-only time restraints are okay if when pt i sin immediate danger of hurting themselves or
someone else
✔✔when can medication be forced on a pt - ✔✔-behavior dangerous to self or others
-medication prescribed has a reasonable chance to provide help
-judged incompetent to evaluate benefits of treatment (have to go to court and judge
and doctor have to agree they will continue to decompensate if they do not take it)
-only meds that can be forced are shots
, ✔✔right to least restrictive treatments - ✔✔-involuntary chemical intervention, seclusion
& mechanical restraints
-talking to them is first thing you do
-remove them from the situation
-seclusion
-then restraints
-if they go straight to hurting someone then you can do restraints
✔✔seclusion and restraints - ✔✔-Only use S/R when less restrictive measures have
failed
-"1-hour rule" - requires a "face to face" evaluation by a licensed independent
practitioner within 1 hour of the restraint
-Physical, Chemical, Seclusion, Observation, need 1:1 supervision
-Nurse can make the judgment call to move to seclusion or restraints if they are in
danger of harming themselves or someone else
-HAVE TO GET ORDER WITHIN AN HOUR
-If they haven't called you back, then you go up the chain of command to get the order
until you can get someone to do it
-If you can't get an order then you have to let them out, but continue to find someone if
you can't let them out
-Some nurses can be certified to do the face to face assessment in a small hospital with
limited doctors
-They have to be observed continuously
-If they are quiet, calm, cooperative for 30 min then you have to let them out
-Medical restraint orders are good for 24 hours
-For adult you have to get an order for every 4 hours
-Behavior, readiness for release, and circulation every 15 min document
-Every 2 hr need to do vitals, also right after you put them in, its okay to document they
are too violent to take vs but can always get resp
-Have to offer food and toileting, ROM every 2 hr
-On admission need to know if any medical conditions could affect restraints
✔✔legal considerations - ✔✔-congress passes mental health systems act 1980, bill of
rights for psychiatric pts
-individual state nurse practice acts
-confidentiality & right to privacy (HIPAA)
-privileged communication (state regulations)
-EXCEPTION: duty to warn (trarsoff case, 1974)
-state statutes- NC mandatory report of suspected child or elder abuse or incompetent
adult (MR)
-informed consent- esp ECT
-one hour rule after initiation of restraint or seclusion, every 4 hr adults, 2 hr children
-false imprisonment
-no one intoxicated can give informed consent
✔✔commitment issues - ✔✔-Over 1 million admitted each year for psychiatric treatment
AND SOLUTIONS GUARANTEE A+
✔✔principles of communication: specific techniques - ✔✔-ask open ended questions
-ask close ended questions for specific information such as dates (don't want them to
feel interrogated)
-clarify
-paraphrase
-restate
-reflect
-explore
-use silence (if pt is emotional allowing time for them to regroup before asking
something else)
-active listening (don't let mind wander)
✔✔principles of communication: guidelines for initial interviews - ✔✔-speak briefly
-when you don't know what to say, say nothing at all
-avoid advice- do not suggest things, let them come to them on their own- their fault if it
doesn't work, not yours
-avoid relying on questions
-pay attention to nonverbal cues
-keep focus on the client
✔✔influences on communication - ✔✔-values, beliefs, attitudes
-culture & religion
-social status
-gender
-age or developmental level
-environment of transaction
-70-90% of effective communication is non-verbal
-physical appearance & dress (body adornments such as piercings, tattoos, jewelry)
-body movement & posture
-touch
✔✔transference - ✔✔occurs when client unconsciously attributes or transfers feelings
toward the nurse from previous relationships, not therapeutic and boundaries are
blurred
✔✔countertransferene - ✔✔refers to the nurse's behavioral & emotional response to the
client, not therapeutic and boundaries are blurred, patient can get too attached to the
nurse or have bad feelings toward them
✔✔professional boundaries - ✔✔self disclosure, gift giving, touch & role crossing
(friendship, romatic), not therapeutic when boundaries are blurred
,✔✔summary of intro - ✔✔-therapeutic use of self requires diligence in self awareness
-psychiatric mental health nurses use "special" skills or interpersonal techniques to
assist clients in adapting to difficulties or changes in life experiences
-mutual respect
-all nurses need these skills in any clinical setting
✔✔ANA code of ethics for nurses - ✔✔-In all professional relationships, practices with
compassion & respect
-Primary commitment is to patient, family, group, community
-Promotes, advocates, protects health, safety, & rights of patients
-Responsible & accountable for his/her own patient care practice
-Owes same duty to self...integrity, competence, growth
-Participates in improving health care environments
-Participates in advancement of profession
-Collaborates with other health professionals & public to meet health care needs
-Profession of nursing, as represented by associations/members...responsible for
values & integrity & shaping social policy
✔✔specific to psychiatric nursing - ✔✔-pt bill of rights
-right to refuse treatment.. medication
-medical consequences may include steps as involuntary commitment (IVC), legal
competency hearing, or pt discharge
-ex. right to use phone
✔✔rights of persons with mental illness - ✔✔-privacy
-receive mail, phone calls, visits
-confidentiality
-individualized treatments
-right to receive or refuse treatment
-no verbal or physical abuse
-*chemical or physical restraints are considered abusive*- specific policies must be in
place regarding both forms of restraints
-families are given a security code that tells them to say yes they are here they will call
you but still can't give any info
-confidentiality is heightened
-every pt has different plan of care
-only time restraints are okay if when pt i sin immediate danger of hurting themselves or
someone else
✔✔when can medication be forced on a pt - ✔✔-behavior dangerous to self or others
-medication prescribed has a reasonable chance to provide help
-judged incompetent to evaluate benefits of treatment (have to go to court and judge
and doctor have to agree they will continue to decompensate if they do not take it)
-only meds that can be forced are shots
, ✔✔right to least restrictive treatments - ✔✔-involuntary chemical intervention, seclusion
& mechanical restraints
-talking to them is first thing you do
-remove them from the situation
-seclusion
-then restraints
-if they go straight to hurting someone then you can do restraints
✔✔seclusion and restraints - ✔✔-Only use S/R when less restrictive measures have
failed
-"1-hour rule" - requires a "face to face" evaluation by a licensed independent
practitioner within 1 hour of the restraint
-Physical, Chemical, Seclusion, Observation, need 1:1 supervision
-Nurse can make the judgment call to move to seclusion or restraints if they are in
danger of harming themselves or someone else
-HAVE TO GET ORDER WITHIN AN HOUR
-If they haven't called you back, then you go up the chain of command to get the order
until you can get someone to do it
-If you can't get an order then you have to let them out, but continue to find someone if
you can't let them out
-Some nurses can be certified to do the face to face assessment in a small hospital with
limited doctors
-They have to be observed continuously
-If they are quiet, calm, cooperative for 30 min then you have to let them out
-Medical restraint orders are good for 24 hours
-For adult you have to get an order for every 4 hours
-Behavior, readiness for release, and circulation every 15 min document
-Every 2 hr need to do vitals, also right after you put them in, its okay to document they
are too violent to take vs but can always get resp
-Have to offer food and toileting, ROM every 2 hr
-On admission need to know if any medical conditions could affect restraints
✔✔legal considerations - ✔✔-congress passes mental health systems act 1980, bill of
rights for psychiatric pts
-individual state nurse practice acts
-confidentiality & right to privacy (HIPAA)
-privileged communication (state regulations)
-EXCEPTION: duty to warn (trarsoff case, 1974)
-state statutes- NC mandatory report of suspected child or elder abuse or incompetent
adult (MR)
-informed consent- esp ECT
-one hour rule after initiation of restraint or seclusion, every 4 hr adults, 2 hr children
-false imprisonment
-no one intoxicated can give informed consent
✔✔commitment issues - ✔✔-Over 1 million admitted each year for psychiatric treatment
