Psych Nursing Quiz 3

Which response made by the nurse provides appropriate information about the civil rights afforded to a legally insane client? Select all that apply. · "The client has the right to refuse antipsychotic medications." · "The client is hospitalized for up to 5 months without an interim court appearance." · "The client has a right to file a petition for a writ of habeas corpus." · "The client must be certified as legally insane by a primary health care provider." · "The client must be able to provide informed consent for hospitalization.

· "The client has the right to refuse antipsychotic medications." · "The client has a right to file a petition for a writ of habeas corpus." Rationale A client who is considered to be legally insane is admitted to the hospital through an involuntary admission procedure. This client has the same civil rights as clients who are not legally insane; therefore, this client has the right to refuse treatment with antipsychotic medications. If the client feels he or she is being held in the hospital without any cause, the client can file a petition for a writ of habeas corpus. The client is held in the hospital for 60 days, not 5 months, with interim court appearances. The client's illness must be certified at least by two primary health care providers; this number may increase depending on that particular state's laws and regulations. Because the client is legally insane, he or she does not have to provide informed consent in order to be hospitalized. pp.100-101

The student nurse is describing characteristics of furniture on the psychiatric unit. Which description is most accurate? · "The furniture for inpatient rooms tends to be lightweight, so if it is thrown it will not cause too much injury." · "The furniture for inpatient rooms has rounded corners so that head injuries do not occur." · "The furniture for inpatient rooms is heavy and durable." · "There is no furniture in the inpatient rooms to prevent injuries."

· "The furniture for inpatient rooms is heavy and durable." Rationale Furniture for inpatient rooms tends to be heavy and durable so that it cannot be thrown or dismantled and used for weapons. Lightweight furniture is not used because it is easier to lift and throw, and it is easy to disassemble and used as weaponry. Furniture edges should be rounded or padded for protection of small children. Seclusion rooms contain no furniture and have padded walls to prevent injury. Inpatient rooms have furniture. p. 56

The nurse working at a Veteran's Administration (VA) clinic assesses a client with posttraumatic stress disorder (PTSD). What is the approximate prevalence of PTSD in veterans of the Iraq and Afghanistan wars? · 3% · 7% · 14% · 24%

· 14% Rationale For veterans of the Iraq and Afghanistan wars, PTSD prevalence is about 14%. More veterans than 3% experienced PTSD. The prevalence of PTSD in the general population is approximately 7%. Fewer veterans than 24% experienced PTSD. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. IN you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. p. 57

Which client may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)? · A 37-year-old client has been hospitalized for 6 days; the health care provider feels 1 more day would benefit the client, but the client doesn't agree and wishes to be discharged · A 75-year-old client with dementia who demands to be allowed to go back to his or her own home · A 21-year-old actively suicidal client on the psychiatric unit who wants to be discharged to home and do outpatient counseling · A 32-year-old female client who wishes to stay in the hospital but whose husband demands that she be discharged into his care

· A 37-year-old client has been hospitalized for 6 days; the health care provider feels 1 more day would benefit the client, but the client doesn't agree and wishes to be discharged Rationale Against medical advice (AMA) discharges are sometimes used when the client does not agree with the health care provider, and as long as the client is not a danger to himself or herself or to others. The client with dementia and the client who is actively suicidal would pose a safety risk and would not be allowed to be discharged AMA. A client who wishes to stay in the hospital can make that decision; a family member's opinion does not impact an AMA discharge.

The clinic nurse is caring for a client with a mental disorder who refuses medication and has attempted suicide. What action by the nurse is helpful in treating the client's condition? · Motivate the client to be admitted to the clinic. · Admit the client in the clinic regardless of consent. · Take written consent from the client for admission. · Seek advice from the primary health care provider for admission.

· Admit the client in the clinic regardless of consent. Rationale Clients in need of psychiatric medications are admitted to mental health care centers without prior consent. These clients may develop a tendency toward homicide or suicide and refuse medication. This form of admission is called an involuntary admission, which involves two health care providers and a mental health care professional designing a treatment protocol for the client. As these clients are cognitively impaired and refuse medication, motivation and written consent are not applicable. Seeking advice from the primary health care provider is also not required, because these clients need to be immediately admitted and should be closely monitored. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

Which health care discipline is becoming a valuable outpatient care provider for psychiatric-mental health care? · Psychologists · Advanced practice registered nurses · Client care attendants · Social service workers

· Advanced practice registered nurses Rationale Psychiatric-mental health advanced practice registered nurses are becoming valuable outpatient care providers. These nurses are master's or doctoral level prepared nurse practitioners and clinical nurse specialists whose scope of practice includes assessment, diagnosis, and treatment in all outpatient settings. Psychologists are professionals who study and evaluate behaviors and thought processes. Their scope of practice does not include prescriptive authority. Client care attendants assist clients with basic care needs under the supervision of registered nurses. Social service workers assist clients in identifying and receiving appropriate outpatient care services. p. 54

Which ethical principle refers to the individual's right to make his or her own decisions? · Beneficence · Autonomy · Veracity · Fidelity

· Autonomy Rationale Autonomy refers to self-determination, or the right to make one's own decisions. Beneficence is the duty to act so as to benefit or promote the good of others. Veracity is one's duty to communicate truthfully. Fidelity is maintaining loyalty and commitment to the client and doing no wrong to the client. p. 99

The use of seclusion or restraint to control the behavior of a client who is at risk of harming him- or herself, or others, gives rise to conflict between which ethical principles? · Autonomy and beneficence · Advocacy and confidentiality · Veracity and fidelity · Justice and humanism

· Autonomy and beneficence Rationale Autonomy refers to self-determination and beneficence refers to doing well. When a client is restrained or secluded, the need to do well and prevent harm outweighs the client's autonomy. Advocacy and confidentiality are not ethical principles. Veracity involves a respect for the truth and fidelity involves doing what the nurse promises to do. Justice and humanism are not ethical principles. p. 99

How can the nurse best assure that a psychiatric client's rights are respected and preserved? · Educating each client as to his or her legally protected rights · Being knowledgeable of the state laws that regulate client rights · Participating as a member of the client's multidisciplinary health care team · Referring all issues of a legal nature to the appropriate facility committee

· Being knowledgeable of the state laws that regulate client rights Rationale The legal context of care is important for all psychiatric nurses because it focuses concern on the rights of clients and the quality of care they receive. However, laws vary from state to state, and psychiatric nurses must become familiar with the laws of the state in which they practice. This knowledge enhances the freedom of both the nurse and the client and ultimately results in legally appropriate care. Although client education is an appropriate intervention, it cannot be done without first being knowledgeable of the client's legal rights. Though an appropriate intervention, participating as part of the health care team will not necessarily assure the preservation of client rights but rather holistic care. Though referring legal issues may be correct in some instances, it does not remove the nurse from being responsible for advocating for the client. p. 99

When spending time easing the client's anxiety, in which duty to act is the nurse engaging? · Justice · Fidelity · Autonomy · Beneficence

· Beneficence Rationale Beneficence is the duty to act in a way that benefits others, such as spending additional time to ease the anxiety of a client. Justice is the duty performed to distribute client care and resources equally to all clients. Fidelity is the duty to maintain loyalty and commitment to the client, and also doing no wrong to the client. Autonomy is the duty to respect the client's right to make his or her own decision. p. 99

In what is the client participating when attending group therapy to enhance coping skills? · Cognitive behavior therapy · Occupational therapy · Physical therapy · Recreational therapy

· Cognitive behavior therapy Rationale Coping skills are taught and enhanced by participating in cognitive behavioral groups that focus on symptom management. Occupational therapy provides an opportunity to practice life skills that may have been delayed or altered. Physical therapy focuses on physical conditioning and mobility. Recreational therapy activities are used to improve emotional, physical, cognitive, and social well-being. p. 56

What responsibilities does the psychiatric mental health registered nurse carry out? Select all that apply. · Develop, implement, and evaluate plans of care · Maintain oversight of restraint and seclusion · Coordinate care by the treatment team · Gather data and identify the psychiatric diagnosis · Prescribe psychotropic medications for clients · Monitor behavior, affect, and mood

· Develop, implement, and evaluate plans of care · Maintain oversight of restraint and seclusion · Coordinate care by the treatment team · Monitor behavior, affect, and mood Rationale The responsibilities of the psychiatric mental health registered nurse include developing, implementing, and evaluating plans of care; maintaining oversight of restraint use and seclusion; coordinating care provided for the client by the treatment team; and monitoring behavior, affect, and mood. Psychiatric mental health registered nurses do not diagnose the mental health condition but do identify the nursing diagnosis. Psychiatric mental health registered nurses do not prescribe psychotropic drugs; they do monitor and report drug effectiveness to health care providers. p. 57

A client experiencing an exacerbation of schizophrenia with psychotic features is reluctant to seek help despite family encouragement. What is the most common reason a client may not seek help for a mental illness? · Lack of financial stability results in refusal of care by a health care provider. · Disorganized thoughts impede the ability to recognize the need for care. · Lack of family support results in the client's need for independence. · The client is afraid of accumulating a large hospital bill.

· Disorganized thoughts impede the ability to recognize the need for care. Rationale A client with a mental illness such as schizophrenia with psychotic features often experiences disorganized thinking that impedes the ability to recognize the need for care. Lack of financial stability is unlikely to cause a health care provider not to treat the client. Nonprofit hospitals accept any client regardless of the ability to pay. There is no indication that the client has lack of family support or is fearful of owing money for health care. p. 52

A client is admitted to a locked unit in the mental health facility. In addition to offering privacy, what do locked units prevent? · Psychoses · Visitation · Elopement · Stigma

· Elopement Rationale Locked units provide clients with privacy and also prevent elopement (leaving before discharged). Locked units do not prevent psychoses. Psychoses are serious mental disorders with features such as delusions or hallucinations and are often treated on a locked unit. Locked units do not prevent visitation. Stigma is a negative perception of individuals with mental illness. p. 54

A day shift nurse telephones a nurse scheduled for night shift and says, "Our unit is full and there are eight clients in the emergency department waiting for a bed." The night shift nurse replies, "Thanks for telling me. I will call the supervisor to report I am sick so I don't have to deal with that work load." Which type of problem is illustrated by the night shift nurse's reply? · Ethical problem of fidelity · Legal problem of negligence · Legal problem of an intentional tort · Violation of the clients' right to treatment

· Ethical problem of fidelity Rationale Fidelity is the maintenance of loyalty and commitment to the client and doing no wrong to the client. Knowingly leaving clients waiting in the emergency room is an ethical problem of fidelity. The nurse is not violating any laws having to do with negligence or tort law by calling out sick. The nurse is also not violating the clients' right to treatment by calling in sick; though the nurse is showing a lack of loyalty to client care, the clients are still able to receive treatment. p. 62

If a client is placed in seclusion and held there for 24 hours without a written prescription or examination by a health care provider, what has the client experienced? · Battery · Defamation of character · False imprisonment · Assault

· False imprisonment Rationale False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is prescribed, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without medical prescription, the measure cannot be proven as instituted for medically sound reasons. Battery is the harmful, nonconsensual touching of another's person. Defamation of character harms the client's reputation. Assault refers to the threat to cause harm. p. 107

Which court affirmed that involuntarily hospitalized clients have the right to make treatment decisions? · U.S. Supreme Court · Federal District Court · Federal Court of Appeals · Massachusetts Supreme judicial Court

· Federal Court of Appeals Rationale The Federal Court of Appeals affirmed that involuntarily hospitalized clients have the right to make treatment decisions because they are competent enough to make decisions for themselves. The U.S. Supreme Court had set the judgment of the Court of Appeals aside with instructions to consider the effect of an intervening court case at the state level. The Federal District Court ruled that medical staff have substantial discretion in an emergency situation. The Massachusetts Supreme judicial Court ruled that involuntarily hospitalized clients have the right to make treatment decisions as they are competent, unless they are judicially proven to be incompetent. p. 102

If a nurse is charged with leaving a suicidal client unattended, it is suggested that the nurse's behavior has violated which ethical principle? · Autonomy · Veracity · Fidelity · Justice

· Fidelity Rationale Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity. Respecting the rights of others to make their own decisions is the ethical principle of autonomy. Veracity is one's duty to communicate truthfully. justice is the duty to distribute resources or care equally. p. 99

What is the most common method of inpatient suicide? · Drowning · Self-inflicted gunshot · Hanging · Cutting wrists

· Hanging Rationale The most common method of inpatient suicide is hanging. Drowning is unlikely in the health care setting. Clients are searched for weapons such as knives or firearms upon entry into the organization, so suicide by gunshot or cutting wrists is unlikely. p. 56

An inpatient psychiatry facility provides unique passwords to each nurse to allow access to the selected client records. A nurse administrator forgets the password and wants to access the records using a co-worker nurse's password. What is the most appropriate action by the co-worker nurse? · Allow the nurse administrator to use the password to access the records. · Help the nurse administrator retrieve the password using appropriate sources. · Access the client records and provide required information to the nurse administrator. · Get permission from the nursing supervisor to share the password.

· Help the nurse administrator retrieve the password using appropriate sources. Rationale Some facilities provide unique passwords to the staff members to allow access to select client records. These passwords should not be shared. Staff members are responsible for changes done to records accessed through their password. If a colleague forgets the password, the nurse may help by retrieving the password from appropriate sources. The nurse should never share the password, because it can be misused. The nurse should not access the client's record on the colleagues' behalf, because it is not legal. Getting permission from the nursing supervisor is inappropriate, because the passwords are not shared.

When discussing the trend of treating mental health clients in community care environments, the nurse identifies which treatment- related event as the trigger for the shift away from traditional hospitalization? · Increase in available psychopharmacological agents · Increase in voluntary commitments to traditional hospital settings · Increased diagnosis of clients with serious and persistent mental illnesses · Increase in Medicare and Medicaid coverage for clients in psychiatric hospitals

· Increase in available psychopharmacological agents Rationale The treatment-related event that triggered the shift away from traditional hospitalization was the increased availability of psychopharmacological agents. Gradually, more psychopharmacological agents were added to treat psychosis, depression, anxiety, and other disorders. The treatment of mental illness expanded from specialists in psychiatry to general practitioners. Increased voluntary commitment to traditional hospital settings did not occur. There was no increase in clients being diagnosed with mental illness. Medicare and Medicaid did not provide coverage for clients in psychiatric hospitals during this time. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 53

The client tells the nurse, "I just don't want to live anymore. I am a burden to my family ever since my injury. I just want to die, and I know what I will do. I am going to wait until my wife goes to church then cut my wrists." Which mental health care setting is most appropriate for this client? · General hospital admission · Patient-centered medical home (PCMH) · Primary care physician's office · Inpatient psychiatric care facility

· Inpatient psychiatric care facility Rationale The safest setting for a client with suicidal ideation is an inpatient psychiatric care facility. Here, the client will receive 24-hour nursing care in a safe and structured setting protected from suicidal ideation. A general hospital admission does not fully address the client's need for psychiatric care nor will it provide the safest environment for a suicidal client. Expert care by experienced mental health providers is warranted. Outpatient management such as PCMH or referral to the primary care physician does not protect the client with suicidal ideation. pp. 54-55

The nurse educator is teaching a group of student nurses about the 1999 Olmstead decision. What was the main outcome of the Olmstead decision? · It declared psychiatric clients must be deemed incompetent to receive care. · It suggested that psychiatric clients be mandated into residential treatment centers. · It deemed that mental institutions were safe and effective treatment options. · It described mental illness as a disability and institutionalization as a violation of the client's rights.

· It described mental illness as a disability and institutionalization as a violation of the client's rights. Rationale In the 1999 Olmstead decision, the Supreme Court ruled that institutionalizing clients with mental illness was in violation of the Americans with Disabilities Act. Institutionalization was described as "unjustified isolation." Clients who are declared incompetent receive care despite objections. The Olmstead decision did not mandate clients into residential treatment centers or describe mental institutions as safe and effective treatment options. Test-Taking Tip: Multiple choice questions can be challenging, because students think they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. p. 53

The nurse is making care decisions based on what concept when first speaking with an agitated client in private about the reason he or she is being verbally aggressive? · Writ of habeas corpus · Least restrictive alternative doctrine · Veracity · Bioethics

· Least restrictive alternative doctrine Rationale The least restrictive alternative doctrine is described as using the least drastic means of achieving a specific goal. By doing the actions described, the nurse is possibly preventing the more restrictive setting of seclusion or restraints. Writ of habeas corpus is a legal term meaning a written order "to free the person." Veracity is one of the five ethical principles or guidelines. Bioethics refers to ethics in a health care setting.

Which intervention implemented by a community health nurse demonstrates the unique skills required for the position? · Prescribing medications · Advocating for a community clinic · Making a referral to a neighborhood food bank · Providing spiritual counseling for client and his or her family

· Making a referral to a neighborhood food bank Rationale Community mental health nurses need to be very knowledgeable about community resources such as shelters for abused women, food banks for people with severe financial limitations, and agencies that can provide various other forms of support. Prescribing is outside a nurse's scope. Advocacy is a generalized nursing responsibility, and spiritual counseling is not within the scope of general nursing practice. p. 54

The nurse admits a client experiencing hallucinations and delusional thinking to an inpatient mental health unit. The plan of care will require which service to occur first? · Social history · Psychiatric history · Medical assessment · Psychological evaluation

· Medical assessment Rationale Medical assessment is the first step of inpatient care to first rule out comorbid conditions. Social history and psychiatric history should be taken after the client has been deemed physiologically stable. The appropriate member of the treatment team should conduct a full psychological evaluation after admission. p. 56

What is the difference between intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs)? · Only IOPs function as intermediate steps between inpatient and outpatient care. · More time is spent with clients in PHPs than in IOPs. · Only PHPs are located within hospitals. · Clients are more closely monitored for relapse in IOPs than in PHPs.

· More time is spent with clients in PHPs than in IOPs. Rationale The difference between IOPs and PHPs is the amount of time spent with the clients. Both groups tend to be Monday through Friday. IOPs are usually half a day, while PHPs are longer (about 6 hours per day). Both function as intermediate steps between inpatient and outpatient care. Both are usually located within general hospitals, psychiatric hospitals, or in community settings. Clients are closely monitored for relapse in both programs. p. 54

What does the concept of "least restrictive environment" mean? · Mobility is discouraged, and the client is restrained. · Restraints are only used with the client's permission. · Necessary care is provided while permitting personal freedom. · Necessary care is provided in the outpatient setting only.

· Necessary care is provided while permitting personal freedom. Rationale The "least restrictive environment" means the client receives necessary care while being allowed the greatest personal freedom. Mobility is not discouraged; rather, the focus and intent are on client safety. As such, a client may be restrained for safety and continually assessed for readiness to remove them. Client permission is not required for restraint use. The "least restrictive environment" addresses clients in an inpatient setting, such as a hospital, or an outpatient setting, such as a nursing home. P.52

When does discharge planning for the inpatient client begin? · Once symptoms are under control · On the first day of admission · 48 hours after medications are initiated · 1 week after admission

· On the first day of admission Rationale Discharge planning begins on the first day of admission based on the client's unique needs. Waiting until symptoms are under control may not allow time needed for individual assessment for discharge planning. Many medications and group therapies take longer than 48 hours to affect the client. One week after admission may not be enough time for needed inpatient treatment, and discharge is based on individual client stabilization and readiness. p. 56

In order to reduce fragmented care and improve services, patient- centered medical homes (PCMHs) were developed and received strong support from the Affordable Care Act of 2010. What are the key characteristics of PCMHs? Select all that apply. · Patient-centered care · Comprehensive care · Duplicated services · Coordination of care · Improved access to care · Continuous evidence-based care

· Patient-centered care · Comprehensive care · Coordination of care · Improved access to care · Continuous evidence-based care Rationale PCMHs have five key characteristics: 1) patient-centered care, 2) comprehensive care, 3) coordination of care, 4) improved access to care and needed services, and S) a systems approach making use of evidence-based practice, provided in a continuous feedback loop of evaluation and quality improvement. PCMHs are intended to eliminate fragmented or duplicated care by using a patient-centered approach providing access to physical health, behavioral health, and supportive community and social services.

What individuals with mental illness are paid or volunteer to use their experiences to provide recovery-oriented services and support others with mental illness? · Recreation therapists · Art therapists · Peer specialists · Licensed professional counselors

· Peer specialists Rationale Peer specialists are individuals with serious mental illness who receive training to use their experience to provide recovery-oriented services and support others with mental illness. Recreation therapists are typically bachelor's prepared and may be licensed by the state or be nationally certified. Recreational therapists provide activities used to improve emotional, physical, cognitive, and social well-being. Art therapists are prepared at the master's level in art therapy and registered through a professional organization. Licensed professional counselors possess a master's degree in psychology, counseling, or a related field and are licensed by the state. They assess and diagnose psychiatric conditions and provide individual, family, and group counseling.

A client diagnosed with major depressive disorder tells the community mental health nurse, "I usually spend all day watching television. If there's nothing good to watch, I just sleep or think about my problems." What is the nurse's most appropriate action? · Suggest that the client instead call some friends. · Refer the client for counseling with a recreation therapist. · Refer the client for counseling with an occupational therapist. · Tell the client that watching television and thinking about problems worsens depression

· Refer the client for counseling with a recreation therapist. Rationale A recreation therapist can help the client find activities to do during free time that may better improve emotional, physical, cognitive, and social well-being. Suggesting that the client call friends could make the client feel worse if this is not possible given the client's support system or level of motivation for social engagement. Occupational therapists work with clients to develop the practical and necessary skills of daily independent living. Advising the client that watching television and thinking about problems will only make depression worse conveys judgment without helping the client find better health-promoting activities. p. 55

Following the death of his spouse, an elderly client presents to the emergency room with chest pain, sweaty palms, and dizziness. What is the priority of care in this situation? · Administer an antianxiety medication · Obtain an order for an antidepressant medication · Rule out possible cardiac disease · Ask the client if he has a suicide plan

· Rule out possible cardiac disease Rationale The priority of care in this situation is to rule out cardiac disease. Once the client is medically cleared, depression and anxiety should be addressed. Administering an antianxiety medication may be beneficial but is not the priority in this situation. There is not enough information to indicate the need for an antidepressant medication. The client should be assessed for suicide risk after he is medically cleared. p. 52

Identify the goals of inpatient psychiatric care. Select all that apply. · Reduction of hallucinations · Prevention of delusions · Regulation of repetitive behaviors · Safety · Stabilization · Crisis intervention

· Safety · Stabilization · Crisis intervention Rationale The goals of inpatient psychiatric care include client safety, stabilization, and crisis intervention. Reduction in hallucinations may be an individual client goal. Prevention of delusions, although desirable, may not be a realistic goal for some clients. Regulation of repetitive behaviors may be an individual goal. pp. 54, 56

A nurse's sibling says, "I want to introduce you to my fiancé. We're getting married in six months." The nurse has encountered the fiancé in a clinical setting and is aware of the fiancé's diagnosis of schizophrenia. What is the nurse's most appropriate response? · In private, tell the sibling about the fiancé's diagnosis. · Encourage the sibling to postpone the wedding for at least a year. · Ask the fiancé, "Have you told my sibling about your mental illness?" · Say to the sibling and fiancé, "I hope you will be very happy together."

· Say to the sibling and fiancé, "I hope you will be very happy together." Rationale The psychiatric client has a right to privacy and confidentiality. It is the nurse's responsibility to protect this right. Wishing the couple happiness is the best response for the nurse to give to maintain the client's privacy. Telling the sibling about the fiance's diagnosis is in direct violation of the client's right to privacy. Encouraging the sibling to postpone the wedding and asking the fiancé if the sibling has been told also compromise the client's privacy and are inappropriate responses. p. 66

The quality of care provided by state hospitals has improved dramatically. What is the clinical role of state hospitals? · Provide services for homeless clients · Limit exposing the community to the client · Extend services once provided in early mental institutions · Serve the most seriously ill clients

· Serve the most seriously ill clients Rationale The clinical role of state hospitals is to serve the most seriously ill clients. Providing services for homeless clients is not the focus or intent of state hospitals. Limiting exposure to the community is not consistent with providing high quality health services, and it violates the Americans with Disabilities Act. Services provided at present day psychiatric hospitals are not intended to become an extension of the early institutions. p. 56

As a community mental health nurse prepares to administer a regularly scheduled antipsychotic medication injection to a client diagnosed with schizophrenia, the client stands and says, "I'm leaving. I don't want any more of that medicine." Which initial action by the nurse is appropriate? · Postpone the injection and reschedule the client's visit in one week. · Confer with the pharmacist about preparing the medication in oral form. · Stop with the procedure and say to the client, "I'd like to talk with you about how you are feeling about this matter." · Say to the client, "You have been taking this medication for two years and have never had any problems with it in the past."

· Stop with the procedure and say to the client, "I'd like to talk with you about how you are feeling about this matter." Rationale Clients have the legal right to self-determination as well as an ethical right to autonomy. Clients have the right to receive treatment and the right to refuse it, including medication in most instances. The nurse should stop the procedure and discuss the client's feelings before taking any other action to discuss the importance to the medication. Postponing the injection does not address why the client is refusing it. There is nothing to suggest the client would prefer the medication in an oral form. Pointing out that the client has been taking the medication undermines the client's autonomy. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. pp. 99, 102-103

The nurse educator is teaching a group of nursing students about the president's vision for mental health care in America. The nurse educator discusses the President's New Freedom Commission on Mental Health. What was the purpose of this group? · Studying the relationship between mental illness and physical symptoms · Studying the mental health system and making recommendations for its transformation · Examining the number of people with mental illness in the United States · Collecting data on the prevalence of mental illness in homeless Americans

· Studying the mental health system and making recommendations for its transformation Rationale The President's New Freedom Commission on Mental Health was charged with studying the mental health system and making recommendations for its transformation. The groups did not study the relationship between mental illness and physical symptoms, examine the number of people with mental illness, or collect data on the number of homeless people with mental illness. pp. 58-59

A client reports to the nurse, "I want treatment to be stopped, and I want to be discharged immediately." Following interaction with the health professional, the nurse is instructed to prolong the client's treatment plan. Which condition is likely responsible for the present situation? · The client has suicidal tendencies. · The client is admitted informally. · The client is under 18 years of age. · The client is placed in a secluded area.

· The client has suicidal tendencies. Rationale Clients with chronic mental conditions like suicidal tendencies are prone to self-harm or suicide. Such clients require attentive medical care without their own consent; they are hospitalized for a prolonged period until recovery is complete. Clients who are admitted informally, or those who are under 18 years of age, need not be hospitalized for a longer time if they are not willing. Clients admitted informally are free to make decisions regarding continuing or discontinuing the treatment regimen. Minor clients are given a written consent as a part of voluntary admission. It is unnecessary and unethical to place this client in seclusion.

The right to refuse treatment is a typical item included in hospital statements of a client's rights. What is the only exception to the right to refuse treatment? · The client is over 75 years of age. · The client is declared incompetent. · The client has a neurological condition affecting cognition. · The client has a long-standing history of schizophrenia.

· The client is declared incompetent. Rationale The only situation in which a client cannot refuse treatment is if he or she is declared incompetent by the legal system. Being over 75 years old, having a neurological condition affecting cognition, or having a long-standing history of schizophrenia does not exclude the right to refuse treatment. p. 56

Which mentally ill individual demonstrates behavior that meets the criteria for an emergency or involuntary hospitalization for mental health treatment? · The individual who sees visions of angels dancing on the television screen · The individual who throws a lamp at the owner of a local department store · The individual who resumes using cocaine after one year of being clean · The individual who stops taking prescribed antipsychotic medications

· The individual who throws a lamp at the owner of a local department store Rationale When the effects of the client's mental illness result in an immediate risk of self-harm or harm to others, an emergency commitment is appropriate; this is the case when an individual throws a lamp at the owner of a store. Although hallucinations, cocaine use, and not adhering to a medication plan can be dangerous, these scenarios do not indicate emergency or involuntary hospitalization criteria.

Which rights of mentally ill clients are protected by most state laws? Select all that apply. · The right to vote · The right to medical treatment · The right to financial support from the government · The right to freedom of religion · The right to social interaction

· The right to vote · The right to medical treatment · The right to freedom of religion · The right to social interaction Rationale Mentally ill clients have the same rights as any healthy person, and state laws are designed to protect these rights. These rights include the right to vote, the right to seek medical treatment for illness, the right to practice any religion, and the right to social interaction. Mentally ill clients do not necessarily have the right to financial support from the government. pp. 99-100

In the role of advocate, the nurse ensures that clients being considered for a clinical trial of a new antidepressant medication are well informed before signing the informed consent. Which information should be provided to the clients before obtaining informed consent? · The risk and benefits of the treatment · The availability of alternative treatment options · The 100% safety of the treatment · The inability to withdraw from the study after enrolling

· The risk and benefits of the treatment Rationale The nurse ensures that the client sign the informed consent form after being explained all details of the clinical trial. The nurse informs the clients about any alternative treatment options, and the client has the right to choose the appropriate treatment. The nurse does not give false assurance about the new drug being 100% safe, because no medication is 100% safe. The nurse indicates the probability of side effects and the success rate of the treatment. The client has the right to refuse the treatment and can withdraw from the study at any time.

Which statement accurately describes characteristics of an ethical dilemma? Select all that apply. · There is no clear solution to the dilemma. · There are two or more possible ways to resolve the dilemma. · There is a disagreement regarding beliefs among those involved in the dilemma. · The possible solutions to the dilemma rarely involve unpopular consequences. · The values of the facility and those of the care provider can at times be in conflict.

· There is no clear solution to the dilemma. · There are two or more possible ways to resolve the dilemma. · There is a disagreement regarding beliefs among those involved in the dilemma. · The values of the facility and those of the care provider can at times be in conflict. Rationale An ethical dilemma results when there is no clear solution to the dilemma, and also when there a conflict between two or more courses of action, each carrying favorable and unfavorable consequences. The response to these dilemmas is based partly on morals (beliefs of right or wrong) and values and may involve unpopular consequences. At times, the nurse's values may be in conflict with the value system of the institution. Solving ethical dilemmas does often involve unpopular consequences. p. 99

A client informs the nurse of a strong urge to physically assault one particular staff member. The nurse, who is busy, finishes the shift and leaves. The next day, the nurse learns that the client did indeed beat up the staff member. Which nursing action could have prevented the incident? · Timely and accurate communication of the client's intent · Adequate treatment of the client's psychiatric condition · Increase in the number of the staff working the facility · Recruitment of staff members who are careful of their security

· Timely and accurate communication of the client's intent Rationale Timely and accurate communication is crucial for providing effective nursing care and preventing mishaps in a health care facility. This particular incident could have been prevented if the nurse had documented the client's intent, so that all team members could be informed of it. Preventive actions might have been taken as a result. Adequacy of the treatment is not related to the client's violent behavior. The increased number of staff members or recruitment of careful staff members could not have prevented the incident because no one knew of the client's i ntent.

How is a client's medical record used in legal cases? Select all that apply. · To support a claim that medical or nursing treatment has resulted in personal injury · To determine the extent of injuries resulting from physical or sexual abuse · To identify the amount of existing mental disability to determine competency · To determine the rehabilitative potential in workers' compensation cases · To support reimbursement claims for services provided by facilities

· To support a claim that medical or nursing treatment has resulted in personal injury · To determine the extent of injuries resulting from physical or sexual abuse · To identify the amount of existing mental disability to determine competency · To determine the rehabilitative potential in workers' compensation cases Rationale Medical records find their way into a variety of legal cases for a variety of reasons. Some examples of its use include determining the extent of the client's damages and pain and suffering in personal injury cases, such as when a psychiatric client attempts suicide while under the protective care of a hospital; the nature and extent of injuries in child abuse or elder abuse cases; the nature and extent of physical or mental disability in disability cases; and the nature and extent of injury and rehabilitative potential in workers' compensation cases. The medical record is not used to support claims for services provided.

Which discharge procedure involves the release of a client from the hospital based on a court order? · Conditional · Unconditional · Release against medical advice (AMA) · Involuntary outpatient commitment

· Unconditional Rationale The client-institution relationship is terminated in the process of unconditional release. The discharge procedure is generally by an order of the court or an order of the medical authorities, like an administrative officer. Conditional release, release against medical advice, and involuntary outpatient commitment do not involve discharge based on court order. Conditional release is given to those clients for whom outpatient treatment would suffice and inpatient treatment is not necessary. Release against medical advice (AMA) is for those who demand hospitalization after recovery from illness. Involuntary outpatient commitment is the admission procedure based on the court order. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a New seconds ago had seemed completely forgotten.

The nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rules. This information implies the client was admitted under which condition? · Per legal requirements · For a nonemergency · Voluntarily · Involuntarily

· Voluntarily Rationale Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules. Even if the client had been admitted involuntarily, it is not necessarily illegal. There is no information indicating that the client was admitted for an emergency or not. Because the client agreed to receive treatment, he or she was not admitted involuntarily.

When is it appropriate to seclude or restrict a client with a severe mental illness? · When the client is extremely aggressive · When the client is diagnosed with serotonin syndrome · When the client is experiencing impaired cognitive function · When the client is experiencing severe suicidal intentions

· When the client is extremely aggressive Rationale If the client is extremely aggressive and can cause harm to him- or herself, or others, then the client should be secluded or restricted. Seclusion helps in protecting the client and others against harm or injury. However, seclusion must be avoided if the client has adverse reactions or side effects due to medications, because it can be fatal. Seclusion must also be avoided if the client has impaired thoughts and delusions, because the client loses the ability to tolerate the stimulations and stressors. It may confuse the client and make him or her more aggressive. Seclusion is also avoided if the client has severe suicidal intentions, because the client may feel rejected.

An assessment reveals that a person who is recently unemployed, is moderately depressed but without intent or thoughts about self-harm. Which action demonstrates application of the least restrictive alternative doctrine? · Hospitalize the person as a temporary admission. · Contact the person's prior employer for additional information. · With the person's agreement, arrange for immediate outpatient counseling. · Admit the person involuntarily to an inpatient mental health treatment unit.

· With the person's agreement, arrange for immediate outpatient counseling. Rationale The least restrictive alternative doctrine mandates that the least drastic means be taken to achieve a specific purpose; outpatient counseling is the least restrictive intervention. With the person's agreement, this intervention will provide services. Temporary admission is used for people who are so confused or demented they cannot make decisions on their own, or are so ill they need emergency admission. Contacting the person's prior employer violates confidentiality. Involuntary admission is necessary when a person is in need of psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs. This scenario does not fulfill those criteria.