Mental Health Chapter 9

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

What conclusion can be drawn when a client is involuntary secluded?

All other appropriate measures to manage the client have failed

A client informs the nurse that the client is feeling better and does not want to take antidepressant medication. This client is exhibiting which ethical principle when making this decision?

Autonomy

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 psychiatric mental health facility is undergoing a change from paper-based health records to electronic records. What action should the nurse prioritize in order to ensure client rights are protected?

Being vigilant to identify any potential threats to client confidentiality

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 ethical principle focuses on the duty to do no harm?

Nonmaleficence

Which state allows for an insanity defense?

Iowa

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

Nonmaleficence

A psychiatric-mental health registered nurse (PMH-RN) is considering attending graduate school to become a psychiatric-mental health advanced practice registered nurse (PMH-APRN). What aspect of client care would be within the scope of the PMH-APRN?

psychotherapy

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 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

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 nurse is initiating a relationship with a new client. After meeting, the nurse makes arrangements to visit again around lunchtime. A colleague invites the nurse to go to the gym with them during lunch. The nurse decides to forgo the gym and talk with the client. The nurse's decision reflects which ethical principle?

Fidelity

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

A psychiatric-mental health nurse develops a plan that identifies strategies and alternatives to assist the client in attainment of expected outcomes. Which standard of practice is the nurse utilizing?

planning

A nurse working on a psychiatric unit receives a telephone call from a client's employer. The employer asks for a copy of the client's latest laboratory work and psychological testing results so that client's medical records in employee health can be updated. 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 your the 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 client diagnosed with major depression is prescribed electroconvulsive therapy (ECT) for the treatment. Which statement made by the client would indicate a need for the nurse to follow up with the health care provider?

"It is not really my decision; I have to get these treatments to feel better."

A client diagnosed with anxiety is being assessed by the nurse utilizing the biopsychosocial model. Which question made by the nurse would indicate the social domain is being assessed?

"Who is in your support network?"

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

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

What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)?

A guideline for nurses regarding ethical conduct

A client was brought to the emergency department by police after neighbors reported that the client was loud and disruptive. The client is paranoid and upset and states, "No one can be trusted." Which of the criteria for involuntary admission does this client meet?

Client does not meet any of the necessary criteria

A new nursing student correctly identifies which as most essential for guiding psychiatric-mental health nursing actions?

Code of Ethics for Nurses

A mental health nurse is reviewing the Standards of Practice and the competencies listed for each standard. Which information will the nurse utilize when caring for clients? Select all that apply.

Collection and synthesis of health data Plan for strategies and alternatives for outcome achievement Data analysis to determine focus areas for treatment

A client receives a court order for commitment. Which best exemplifies the concept of "least restrictive environment"?

Involuntary commitment to an outpatient community mental health center

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

A group of psychiatric-mental health nurses are discussing current trends in mental health care. One of the nurses 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 nurse's opinion most closely reflects which ethical principle?

Justice

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

Self

A nurse is looking for information about the parameters of professional psychiatric-mental health nursing practice that provide 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 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.

A client who is involuntarily admitted to the psychiatric facility refuses to take a psychotropic medication. The nurse holds the client down to give the medication. Which statement is true regarding this situation?

The nurse may be held legally liable.

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

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 client who was admitted to a facility voluntarily is requesting to be discharged and allowed to return home, but denied permission. Which explanation will the nurse give to the client related to the denial of discharge?

There is a display of suicidal ideation.

While conducting an interview with a 14-year-old mental health client, the client tells the nurse that the client has a plan to kill students at the client's school because they will not stop picking on the client. The client says, "I have everything I need all set up, including a gun." What would be the nurse's responsibility after hearing this statement?

To break the client's confidentiality because the client has threatened the lives of other people

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 is witnessing a client signing an informed consent form. Which ethical principle does the nurse identify that applies to this situation?

autonomy

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

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

A psychiatric-mental health nurse utilizes ethical provisions while caring for a client diagnosed with a mental illness. Which standard of professional performance is the nurse utilizing?

ethics

A psychiatric-mental health nurse has learned about the 10 standards of professional practice. Which standards are included in psychiatric-mental health nursing? Select all that apply.

ethics quality of practice resource utilization collaboration

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

A nurse is caring for a group of clients with different histories, behaviors, and personalities. Which ethical principle does the nurse identify that applies to distributing mental health services equally among clients?

justice

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

justice

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:

leave even if doing so is against medical advice (AMA).

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 their medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for which of the following?

medical battery

A nurse is caring for a client receiving psychoneuroimmunology-based interventions and does not understand the provider's orders. What is the best way for psychiatric-mental health nurses to stay abreast of new knowledge in the mental health field?

reading journal articles