Behavioral Health Concepts Nurse 3060 Mary Anne Boyd: Essentials of Psychiatric Nursing Unit 1 Section 3 Patient Rights and Legal Issues PrepU Questions

What can help prevent negative outcomes of malpractice litigations in psychiatric mental health care? (Select all that apply.)

"-Evaluate risks to the client. -Involve the family in important decisions. -Adhere to the agency's policy and procedure. -Seek consultation and record input." Evaluating the risk to the client, involving the family in important decisions, adhering to the agency's policy and procedure, seeking consultation, and recording the input are all activities that help decrease the likelihood of litigation. All client care and treatment decisions should and must be documented to ensure protection of client rights.

The nurse has a physician's order for haloperidol (Haldol) 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response? -Accept the client's decision. -Obtain a discharge order for noncompliance. -Tell the client that he is too sick to refuse.

"Accept the client's decision." Clients have the right to refuse medication even when they are psychotic. The client cannot be discharged just because he refuses to take his medications.

A psychiatric-mental health nurse is admitting a client to the facility. How should the nurse best apply the principles of the Patient Self-Determination Act (PSDA) during this process? -Ask the client about any advance care directives that that the client has established -Inform the client that no information will be provided to his or her insurer without explicit permission

"Ask the client about any advance care directives that that the client has established." The PSDA specifies the need to recognize the presence of any advance care directives that the client may have established.

Which element of malpractice occurs when the nurse does not act as a reasonable, prudent person would have acted in a similar circumstance? -Duty -Breach of duty -Injury or damage -Causation

"Breach of Duty." Breach of duty occurs when the nurse does not act as a reasonable, prudent person would have acted in a similar circumstance.

A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which would be the most appropriate action by the nursing staff? -Calling security and asking them to detain the client -Allowing the client to leave with community resources for follow-up care -Contacting the psychiatrist for initiation of commitment proceedings -Contacting the client's family to request they convince the client to stay

"Contacting the psychiatrist for initiation of commitment proceedings." If a voluntary client who is dangerous to himself or herself or to others signs a request for discharge, the psychiatrist may file for a civil commitment to detain the client against his or her will until a hearing can take place to decide the matter.

When is a nurse legally obligated to breach confidentiality? -At any time a client is threatening -If threats are made to an outside party -Whenever the client becomes aggressive -When the client violates the nurse's boundaries

"If threats are made to an outside party." The duty to warn a third party exists when a client threatens harm to that third party; the client's confidentiality is overridden.

Although competency is a legal determination, it is not clearly defined across states. What is a true statement regarding competence? -It is decision specific. -Competent clients may not refuse all aspects of the treatment plan. -Competency is the same as rationality. -Health care providers can overrule an irrational decision made by a competent person.

"It is decision specific."

Which is an accurate statement regarding an advance care directive? -It must be witnessed by two people and notarized. -It needs to be written by an attorney. -It applies to those who can make their own decisions. -It needs to be signed by an attorney.

"It must be witnessed by two people, and notarized." An advance care directive does not need to be written, reviewed, or signed by an attorney. It must be witnessed by two people and notarized, and applies only if the individual is unable to make his or her own decisions as a result of being incapacitated or if, in the opinion of two physicians, the person is otherwise unable to make decisions for him- or herself.

One way that nurses can protect themselves against liability from malpractice is to do what? -Know the statutory and professional standards. -Carry individual malpractice insurance. -Request legal consultation from the employer.

"Know the statutory and professional standards." To decrease their chances of liability for malpractice, psychiatric nurses must ensure that their professional practice is within the bounds of statutory and professional standards.

A nurse is reviewing information about legal and ethical aspects of psychiatric-mental health nursing. The nurse demonstrates understanding of the information by identifying which aspect as having the most significant influence in determining malpractice? Standards of care Laws

"Laws." The practice of psychiatric nursing is regulated by law and guided by standards of care. States and provinces grant legal authority. Professional nursing organizations set professional standards of care.

A client who had agreed to be hospitalized for depression has decided that he/she wants to leave the hospital. The mental health staff caring for the client realizes that at present the client can legally: -Be discharged if evaluated through administrative hearings. -Be retained in the hospital against the client's will. -Leave the hospital after giving written notice of the client's intent to do so. -Leave even if doing so is against medical advice (AMA).

"Leave even if doing so is against medical advice (AMA)." Clients who are not dangerous to themselves or others can leave the hospital against medical advice. The client could not be legally detained in the hospital, or even detained until he/she provides written intent, because there is no indication the client was treated involuntarily. Administrative hearing are unnecessary for a voluntary client to leave the treatment setting.

The client just received a diagnosis of end-stage renal disease. After hearing options, the client visited a lawyer and documented what treatment is to be held in the event that the client is unable to make decisions. The nurse asks for a copy of this document for the chart. The name of this document is: -Living will -Durable power of attorney -Patient rights -Informed consent

"Living will." A living will states what treatment should be omitted or refused in the event that a person is unable to make those decisions. Remember, a living will is a type of an advanced directive.

A nurse in the emergency department is planning for a client with mental illness to be placed in an inpatient hospitalization. Which is a condition of this type of admission? -Is non-compliant with medication at home -Presents a clear danger to self or others -Develops new symptoms of the illness -Has no support systems in the community

"Presents a clear danger to self or others." Hospitalization is justified when the client is a danger to self or others. Medication noncompliance, new symptoms, or no community support would require in hospital treatment.

A psychiatric-mental health nurse is conducting a class for a community group about the rights of individuals with mental health problems. As part of the program, the nurse is describing the concept of self-determinism. The nurse determines that the program was successful when the group identifies which idea as exemplifying self-determination? (Select all that apply.) -Right to refuse treatment -Right to obtain other opinions -Right to choose other forms of treatment -Right to participate in experimentation without informed consent -Right to refuse treatment during an emergency situation

"Right to refuse treatment." "Right to obtain other opinions." "Right to choose other forms of treatment." The right to self-determination entitles all clients to refuse treatment (except during an emergency situation), to obtain other opinions, and to choose other forms of treatment. A client has a right not to participate in experimentation in the absence of the client's informed, voluntary, written consent.

Which of the following rights could the psychiatric client lose when admitted to a locked, inpatient psychiatric treatment facility? -Right to communicate with an attorney -Right to schedule his or her own time -Right to send and receive mail without censorship

"Right to schedule his or her own time." If a client is admitted to a locked unit, he or she is deemed of harm to self or others. In the case of potential harm to self or others, the client loses the rights to refuse treatment, including attending scheduled activities.

A client with schizophrenia has a psychiatric advance directive (PAD) which rules out the use of anti-psychotics. The care team would be justified in disregarding the provisions of the PAD in which circumstance? -The client requires inpatient treatment. -The client is 20 years old. -The PAD is verbal, not written. -The PAD contradicts the client's best interests.

"The PAD is verbal, not written."

A client has been voluntarily admitted to the hospital. The nurse knows that which of the following statements is inconsistent with this type of hospitalization? -The client can sign a written request for discharge. -The client cannot be released without medical advice. -The client retains all of his or her rights. -The client has a right to leave if not a danger to self or others.

"The client cannot be released without medical advice." When a client is involuntarily admitted to the hospital, the client cannot be released without medical advice. This client was admitted VOLUNTARILY, therefore they are able to leave without medical consent.

A nurse is reviewing a journal article about malpractice and the elements required to prove negligence. The nurse demonstrates a need for additional review when the nurse identifies which element as being necessary?

"The client must be injured physically as a result of the nurse's action." While proof of injury must established, the injury DOES NOT necessarily have to be physical.

A nurse is reading a journal article that describes a civil wrong that does not involve a contract in which one person causes injury to another. The nurse is reading about which concept? -Negligence -Tort -Malpractice -False imprisonment

"Tort." A tort is a civil wrong not based on contract committed by one person that causes injury to another.

When a 23-year-old client, after attempting suicide, asks to speak with the nurse but wants assurance that the conversation will remain confidential, the nurse responds how?

"Will this conversation involve your desire to harm yourself?" Asking whether the conversation will involve the client's desire to hurt oneself establishes whether the nurse can keep it confidential. Nurses may find it necessary to reassure a client that confidentiality will be maintained except when the information may be harmful to the client or others and except when the client threatens self-harm.

How Long Does An Involuntary Admission Last?

96 hours.

How Often Does The Joint Commission Normally Audit?

Every 3 years.

Since Courts Are Only Open From 9-5 On Weekends, What Happens If A Patient's 96 Hours Ends On The Weekend?

They have to stay in the mental facility for the duration of the weekend until the courts open that Monday. The weekend hours DO NOT count towards the 96 hours.