Ch 9 Prepu - Legal and Ethics

When it is discovered that a nurse did not act reasonably when providing care in accordance with the standards of professional practice, which factor would confirm the nurse has been negligent?

The nurse was responsible for client injury

A nursing student identifies which as the most important tool of psychiatric nursing?

Self

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

A psychiatric-mental health client has an advance care directive on the client's medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for:

medical battery.

The nurse is caring for a client that is confused. The nurse, while giving the client a bed bath leaves the room to get supplies. The nurse returns to find the client on the floor with the bed in high position, and side rails down. What law has been broken?

negligence

When the nurse promotes good, prevents harm, and promotes maximal health care potential the nurse is exercising which ethical principle(s)? Select all that apply.

non-maleficence beneficence

Which ethical principles become an issue in mental health when a segment of a population does not have access to health care?

justice

Which intervention does not meet the standard of care for the client in seclusion?

Documented assessment by the nurse every 3 to 4 hours

A psychiatric-mental health nurse is working with local government officials in establishing programs that allow access to services for all individuals in the community. The nurse is integrating which ethical principle?

Justice

The nurse is explaining the responsibilities to a client's legal guardian. Which statements by the nurse are correct? Select all that apply.

"You are supposed to write checks for the client." "You have to make health care decisions for the client." "You, not the client, should sign legal documents."

A nurse working on a psychiatric unit receives a telephone call from the employer of one of the clients on the unit. The employer asks to be sent a copy of the client's latest laboratory work and psychological testing results so the client's medical records in employee health can be kept up to date. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate?

"I am unable to acknowledge whether or not this client is a client on this unit."

The nurse is complaining about a client that has dementia. The client is mobile and slaps the nurse on the gluteus maximus each time he passes by. The nurse tells the client, "If you don't behave yourself, I am going to throw you out and you won't have anywhere to go." The charge nurse overhears the nurse, and states "Do you realize what your statement could be construed as?" What is the best statement for the nurse to respond?

"It could be construed as assault"

A nurse is providing care to a male client who is hospitalized with a diagnosis of schizophrenia. Which would be appropriate for the nurse to include in the client's medical record?

"Reports being unable to sleep because the client heard voices throughout the night."

Which statements made by the nurse demonstrate a need for additinal education regarding the use of seclusion? Select all that apply.

"Seclusion helps the client to be more active." "Seclusion minimizes the use of psychotropic drugs."

The mental health nurse is talking to nursing students in an Ethics class and asks, "Which example of an ethical principle is correctly paired with nursing practice?" Which statement by the student would be correct?

"Telling the client that you will come in to help with dressing in 15 minutes, then returning in 15 minutes."

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?"

A nurse is caring for a voluntary client in the health care facility. The client doesn't show signs of suicidal ideation or pose harm to others. The client states, "I would really like to leave tonight and sleep in my own bed." Although the client wants discharge tonight, the health care provider recommends against it at this time. What is the most appropriate response of the nurse?

"You will need to sign a written request for discharge."

Which client of a forensic nurse has most likely been found not guilty but mentally ill (not guilty by reason of insanity) following the commission of a serious crime?

A client who is being held involuntarily in a secure psychiatric setting

As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?

A guardian appointed by the court

A client with depression who is undergoing a colonoscopy tomorrow is receiving preoperative education regarding the procedure. Which nursing task best describes the explanation of the procedure and the associated risks and benefits?

Acquiring informed consent

After teaching a group of nursing students about the least restrictive environment, the instructor determines that the education was successful when the group identifies which as the most restrictive setting?

Acute inpatient care

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports him or her in whatever decision he or she makes?

Advocate

What action by a nurse best promotes the ethical principle of justice?

Advocating for enhanced mental health services in an underserved neighborhood

A psychiatric-mental health nurse interested in joining a professional organization asks the psychiatric-mental health clinical nurse specialist about these organizations. Which organization would the clinical nurse specialist describe as the largest professional nursing organization focusing on mental health care?

American Psychiatric Nurses Association

The nurse recognizes that the difference between a voluntary and an involuntary commitment is what?

An involuntarily committed client may not initiate his or her own discharge

A client with schizophrenia will not take medication because the client is gaining weight. This client is exercising which ethical principle?

Autonomy

The depressed client is deciding which type of treatment would be beneficial. The nurse would document that the client is utilizing which ethical principle in this situation?

Autonomy

A nurse recruiter is interveiwing a nurse for a psychiatric-mental health nursing position at the community clinic. When reviewing the applicant's educational background, the recruiter would identify which as the preferred level of preparation?

Bachelor's degree

A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what?

Battery

A client is being seen in the mental health clinic because of relapse. The client has been nonadherent with the medication regimen. The nurse reinforces the advantages of taking medications. The nurse is using which ethical principle?

Beneficence

A new nursing student is studying ethics in nursing and informs a client who wants to stop medication about its benefits and how the client will continue to feel better only if use of the drug continues. Which concept is the nursing student using?

Beneficence

A client with persistent depression is considering electroconvulsive therapy (ECT). The nurse has seen ECT be effective in other cases. When the client expresses fear and doubt about undergoing ECT, the nurse tries to talk the client into it, because the nurse truly believes it will help the client. Which two ethical concepts are in conflict?

Beneficence and autonomy

Which is indicative of a voluntary admission?

Client makes an autonomous decision to seek inpatient treatment

Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members?

Danger to others.

A client with a diagnosis of depression has been referred to a support group led by an advanced practice psychiatric-mental health nurse. What action by the nurse best demonstrates the ethical principle of nonmaleficence?

Discontinuing the client's participation in the group because it causes the client intense anxiety

An agitated client has been put in restraints against the client's will because of inadequate staffing. The nurse determines this as which form of malpractice?

False imprisonment

The inappropriate use of restraints or seclusion is considered which form of intentional tort?

False imprisonment

A client's plan of care includes revoking privileges for inappropriate behavior, based on a contract between the client and the nurse who wrote the plan. Another nurse decides to ignore this because the client promises that the client will adhere to the contract in the future. The second nurse's behavior may have violated which ethical principle?

Fidelity

A nurse tells a client that the nurse will bring the client pain medicine in 5 minutes after checking on another client. The nurse returns in 5 minutes and administers the medication as planned. The nurse is practicing which principle by returning as promised?

Fidelity

Earlier in the shift, the nurse promised to help a client acquire some paper and a pen and draft a letter to a family member later in the day. The nurse became increasingly busy during the shift but has now taken some time to assist the client in this way. What ethical principle has the nurse best exemplified?

Fidelity

A client in a psychiatric facility has ideations about killing the client's spouse. This client requests to be discharged from the facility. Which represents the most appropriate action? The health care provider should:

File for a civil commitment to detain. p 142

When promoting client safety on an inpatient psychiatric unit, which interventions would be used as the measure of last resort?

Four-point restraint

What is the therapeutic goal of seclusion?

Give the client the opportunity to gain self-control

When staff members physically control the client and move him or her to a seclusion room, what form of restraint is being implemented?

Human p 143

A psychiatric-mental health nurse is reading a journal article about different professional organizations and their missions. When reading a synopsis about the American Psychiatric Nurses Association, which information would the nurse expect to find? Select all that apply

Improves mental health care for culturally diverse persons Helps shape health policy involving mental health services Advance psychiatric-mental health nursing practice.

A client was admitted to a psychiatric facility because the client was found walking around naked and talking incoherently. The client has no known next of kin and has been adjudicated incompetent. The client refuses any antipsychotic medications but has not been harmful to the self or others. What action should the facility take?

Initiate court proceedings to have a guardian named.

Which ethical principle is in jeopardy when segments of the mentally ill population do not have access to care?

Justice

A client comes to the emergency department with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which principle is being ignored by discharging this client?

Justice

One way that nurses can protect themselves against liability from malpractice is to do what?

Know the statutory and professional standards.

While performing the admission assessment of a new client, the nurse observed that the client brought a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or remove the medication from the room. Subsequently, the client experienced a serious adverse drug reaction as a result of the interaction between this drug and one of the drugs that the client was prescribed in the hospital. This nurse may be guilty of what?

Malpractice

A client asks if the medication has any possible negative side effects. The nurse considers the client highly suggestible, believes the medication will benefit the client, and, since the client has no history of cardiovascular disease, does not tell the client of the potential for cardiac dysrhythmias. The nurse's actions involve a conflict between veracity and which other ethical principle?

Nonmaleficence

When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what?

Nonmaleficence

Which ethical principle focuses on the duty to do no harm?

Nonmaleficence

Which ethical principle requires a nurse to prevent clients from harming themselves or others?

Nonmaleficence

A client is being discharged but still needs close supervision. Which type of involuntary commitment would be appropriate for this client?

Outpatient

A psychiatric-mental health nurse is practicing at the advanced level. Which function would this nurse be able to perform based on the nurse's advanced level of preparation?

Psychotherapy

A psychiatric-mental health nurse is looking for information about the parameters of professional psychiatric-mental health nursing practice, specifically information that provides the framework for nursing practice. The nurse would most likely seek out which source?

Standards of Practice

Which court decision or act states that psychotherapists have a duty to exercise reasonable care in protecting the foreseeable victims of their clients' violent actions?

Tarasoff v. Regents of the University of California

The interdisciplinary team is discussing the best approach to planning the care for a client with complex psychiatric-mental health needs. When determining which tasks can be performed by the psychiatric-mental health registered nurse (PMH-RN) and which must be performed by the psychiatric-mental health advanced practice registered nurse (PMH-APRN), the team should prioritize guidelines from what source?

The American Nurses Association Standards of Practice

A psychiatric treatment team is planning care for a client who was involuntarily admitted for treatment of depression and suicide ideation. When planning care, of what legal parameters of care must the nurse be aware?

The client can refuse medication.

Short-term use of restraints is permitted only in which situation?

The client is imminently aggressive and a danger to the self or others.

A nurse is explaining assisted outpatient treatment to a client who is being discharged from the hospital. Which instructions should the nurse give the client regarding the assisted outpatient treatment? Select all that apply.

The client must attend the follow-ups as per the schedule. The client must attend specific group therapy programs. The client must take prescribed medications as per the dosing schedule.

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.

A client with a psychiatric illness has become extremely aggressive and the nurse decides that the client needs to be restrained. Which action would be considered human restraint?

The nurse and a group of paramedics hold the client.

Which situations depict a nurse employing the principles of fidelity while providing care? Select all that apply.

The nurse tells the client, "I will return to give you pain medication in 1 hour." The nurse returns in 1 hour.

The nurse is assessing whether a room is fit for seclusion of clients. What are the requirements of a seclusion room? Select all that apply.

The room should not have any sharp objects. The room should have a bed that is bolted to the floor. The room should have facility for direct visual monitoring.

A psychiatric-mental health nurse is providing care to several clients. Some of the clients have been voluntarily admitted while others have been involuntarily admitted. Which description about voluntary admissions demonstrates that the nurse understands thedifferences between these two types of admissions?

They have agreed to the hospitalization.

Professional regulations and laws that govern nursing practice are in place for what reason?

To protect the safety of the public

A client with bipolar disorder has been following the prescribed medication regimen. The client indicates to the nurse a desire to stop the medication now that the client is feeling better. The nurse tells the client that most likely the client will have to remain on the medication for life to keep the condition under control. The nurse is practicing which principle?

Veracity

A nurse sitting with a client in a therapy session with the psychotherapist hears the client state, "I have had it with this marriage. I'm telling you, and not that I ever would do it, but I feel like hiring a hit man to kill my spouse!" Which action is the nurse obligated to take?

Warn the client's spouse, based on the Tarasoff rule.

A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client states:

When I get out of here, I'm going to kill my neighbor."

The client is brought to the hospital in a coma. The nurse understands that when a person is incapacitated, the document used to dictate the patient's written instructions for health care is called:

advance directive

The nursing instructor is discussing the Individuals with Disabilities Education Act and various disablities that have the right to education in the least restrictive environment. The instructor asks whom this applies to, clients with which problems? Which examples should the student nurse choose? Select all that apply.

autism traumatic brain injury orthopedic impairment

A client with depression tells the nurse, "I want to stop taking my antidepressant medication because I don't like taking medications." The nurse discusses the benefits of adhering to the medication plan and strongly urges the client to use the medication. The nurse interprets the client's statement as reflecting which ethical principle?

autonomy

A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which ethical principle?

autonomy

A 22-year-old client with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it." The nurse explains to the client, "Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better." This conversation reflects a conflict between which two types of ethical principles?

autonomy and beneficence

The client has not been on speaking terms with the client's parents for several years. The parents have expressed a desire to reunite with the client. At first, the client agreed to a family meeting, and then decided not to meet with the parents. The nurse has encouraged the client to attend the family meeting knowing that the family's support would be valuable. What ethical principles are in conflict in this situation?

autonomy and beneficence

Providing milieu therapy is an example of the use of which ethical principle?

beneficence

The nurse is teaching a client about the importance of adhering to a medication regimen. The client does not believe that it is important. The nurse is communicating which ethical principle?

beneficence

The nurse is caring for a client after having various diagnostic tests. The client discusses a proxy being in attendance for the health care provider's diagnosis. The nurse requests a copy for the file, and allows the proxy to be in attendance with what type of document?

durable power of attorney

A nursing student is initiating a relationship with an assigned client. After meeting and spending approximately 20 minutes talking with the client, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of clients to play volleyball. The student starts to go with them but then remembers the promise to meet with the client. The student decides to forgo volleyball and talk with the client. The student's decision reflects which ethical principle?

fidelity

After spending 45 minutes talking with an assigned patient, the student nurse promises to visit again after lunch. After lunch, the nursing student returns and talks with her client. The student's action reflects which ethical principle?

fidelity

Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who:

is screaming in the street and disturbing neighbors.

A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

justice

A psychiatric-mental health nurse is reviewing the medical record of a client who was involuntarily committed to the mental health unit of the hospital. The nurse determines that the client was most likely involuntarily committed for which reason?

ranting and waving a loaded gun in a crowded mall

The nursing instructor is talking to a class of nursing students about the American's with Disabilities Act, and persons having various disabilities that have the right to education in the least restrictive environment. The nursing instructor asks the students, "what is the reason for the least restrictive environment?" Which example should the student nurse choose?

unique needs

The client asks about a new medication, it's side effects, cost and if the drug is compatable with the other medication the client takes. The nurse answers all questions the client asks without withholding information. The nurse is guided by which ethical principle?

veracity