PrepU Chapter 9 Legal and Ethical Issues

Reflect descriptive, nonjudgmental, and objective statements.

Client charts are legal documents that can be used in court; therefore, all nursing notes and progress records should above all include which information?

False imprisonment

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?

The American Nurses Association Standards of Practice

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?

beneficence

The nurse is advocating for justice for all clients with a mental illness and is addressing stigma, improving clients' access to care, and educating clients and the community regarding mental illnesses. Which ethical principle is the nurse demonstrating?

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.

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.

Autism, Traumatic Brain Injury, Orthopedic impairment

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.

"Will this conversation involve your desire to harm yourself?"

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?

Nonmaleficence

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

The nurse was responsible for client injury

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?

Human Restraint

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

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

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?

Non-maleficence

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

Justice

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

It is rarely successful

Which statement accurately describes the insanity defense?

"Who is in your support network?"

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?

Involuntary commitment to an outpatient community mental health center

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

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

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:

Autonomy

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?

Justice

A nurse is advocating for improved mental health services to be available in the community. Which ethical principle is the nurse demonstrating?

Communication

A nurse is reviewing the Standards of Professional Performance. Which area would the nurse most likely find being addressed?

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?

To protect the safety of the public

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

Negligence

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?

Malpractice

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?

Beneficence and autonomy

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?

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

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?

Fidelity

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?

Standards of Practice

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?

The client must be injured physically as a result of the nurse's action.

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?

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

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?

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

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?

Assess the client's legal capacity when that client is asked to give consent.

A physician would like to include a client with schizophrenia in a research study testing a new medication. The nurse's obligation is to do what?

Being vigilant to identify any potential threats to client confidentiality

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?

Medical Battery

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?

Justice

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?

Ethics

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?

Psychotherapy

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?

Tarasoff Rule

The Tarasoff rule arose from the case of Tatiana Tarasoff, who was murdered by her stalker, after he told his therapist he was going to kill her. It set the precedent that therapists are obligated to warn a victim if a patient threatens harm to them, even in the context of a private and confidential therapy session.

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?

Durable power of attorney

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?

"I like to make my own decisions." "I make choices based on my personal goals." "I like having my own space and independence in my relationships."

The nurse is caring for a group of clients in a treatment and recovery facility. Which client statement(s) does the nurse determine best shows motivation for recovery? Select all that apply.