Chapter 3 Legal Rights
Which element of malpractice occurs when the nurse does not act as a reasonable, prudent person would have acted in a similar circumstance?
Breach of duty
What can help prevent negative outcomes of malpractice litigations in psychiatric mental health care? (Select all that apply.)
Evaluate risks to the client. Involve the family in important decisions. Adhere to the agency's policy and procedure. Seek consultation and record input.
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 nurse is detaining the client from leaving the hospital by refusing to allow him to take his personal items. This is an example of which of the following?
False imprisonment
A client was brought to the emergency department by police after neighbors complained 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?
He does not meet any of the necessary criteria
A client was brought to the emergency department by police after neighbors complained he 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?
He does not meet any of the necessary criteria.
A mental health nurse is caring for a client with an anxiety and substance use disorder. The family is requesting to see the client's records. The nurse understands that this would be a violation of which law?
Health Insurance Portability and Accountability Act (HIPAA)
Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is false?
If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights.
When is a nurse legally obligated to breach confidentiality?
If threats are made to an identifiable third party.
When is a nurse legally obligated to breach confidentiality?
If threats are made to an outside party
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
An adolescent client has refused to wash or change clothes for several days. The client's hair is greasy, the client's clothes are stained, and the client has a strong malodor. Three male staff members approach the client to escort the client to the shower. The client resists and becomes combative with staff members. The client is placed in seclusion and is told the client will be released when the client is calm and willing to shower. Which is an accurate statement of the client's rights in this situation?
Violated, primarily because of the inappropriate use of restraints
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.
An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is:
inappropriate; room restriction is not treatment in the least restrictive environment.
Although competency is a legal determination, it is not clearly defined across states. What is a true statement regarding competence?
It is decision specific.
All of the following are civil rights afforded to all people receiving mental health care except which of the following?
Right to leave the hospital when involuntarily committed
A psychiatric-mental health nurse is conducting a class for a community group about the rights of individuals with mental health problems. As part of the program, the nurse is describing the concept of self-deterrminism. The nurse determines that the program was successful when the group identifies which idea as exemplifying self-determination? (Select all that apply.)
Right to refuse treatment Right to obtain other opinions Right to choose other forms of treatment
Which of the following rights could the psychiatric client lose when admitted to a locked, inpatient psychiatric treatment facility?
Right to schedule his or her own time
The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which is the appropriate response by the nurse to the caller?
"I cannot confirm or deny the existence of any client here."
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
The Tarasoff decision has resulted in the mental health clinician having a responsibility to do what?
A duty to warn
Which client situations urgently requires the nurse to break confidentiality and warn a third party?
A jealous man states, "I am getting my gun and going to shoot my wife's lover!"
The nurse has a physician's order for haloperidol (Haldol) 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response?
Accept the client's decision.
A psychiatric-mental health nurse is admitting a client to the facility. How should the nurse best apply the principles of the Patient Self-Determination Act (PSDA) during this process?
Ask the client about any advance care directives that that the client has established
The nurse is threatening to give the client an injection in order to restrain the client for inappropriate behavior. This is an example of
Assault
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?
Assess the client's legal capacity when that client is asked to give consent.
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
The nurse is reading a journal article that describes legal action brought against a nurse because the nurse touched a client without consent. The nurse interprets this legal action as an example of which tort?
Battery
A client has just been explained the reason that he must undergo an MRI. When the nurse asks the client if he understands the explanation, he correctly describes what has been said to him. The client is said to be what?
Competent
A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which would be the most appropriate action by the nursing staff?
Contacting the psychiatrist for initiation of commitment proceedings
A nurse is teaching a client newly diagnosed with a mental disorder and their family. Which is an important aspect of a psychiatric advance directive (PAD)?
During periods of competency, PADs can be revoked.
A psychiatric-mental health nurse is conducting a review class about legal liability and psychiatric-mental health nursing. Which element would the nurse most likely include as being required to prove negligence on the part of a health care professional? Select all that apply.
Duty Cause in fact Damages Cause in proximity
The nurse is caring for a client who is legally competent and who has been receiving outpatient treatment for schizophrenia. The client has been responding favorably to treatment but has now declared her intention to exclusively pursue alternative medicine. What is the nurse's most appropriate response?
Educate the client about the benefits of continuing the existing treatment
Which is an accurate statement regarding an advance care directive?
It must be witnessed by two people and notarized.
One way that nurses can protect themselves against liability from malpractice is to do what?
Know the statutory and professional standards.
Placing a client in restraints before using other methods of intervention violates the client's right to ...
Receive treatment in the least restrictive environment
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
A client who is depressed and suicidal is scheduled for electroconvulsive therapy, which requires consent. After the physician has explained the procedure, the nurse knows that legally, who should sign the consent for this treatment?
The client
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.
Following an assault, a client with mental illness has been declared unfit to stand trial. The nurse should draw what conclusion from this fact?
The client cannot comprehend the legal proceedings
A psychiatric-mental health client has been admitted to the emergency department following an episode of psychotic behavior. The client has presented a written psychiatric advance directive (PAD) that exhaustively details many aspects of her desired care. What factor should prompt the care team to disregard the provisions of the PAD?
The client had been deemed legally incompetent when she created the document
Which nursing intervention constitutes false imprisonment?
The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion.
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 malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful?
The nurse did not breach duty.
A student nurse is assigned to administer oral medications to a client. Which of these actions should a student nurse take if a client refuses to take prescribed oral medications?
ask the client's reason for refusing and report it to the primary care nurse
Disclosure of client information beyond the interdisciplinary team without consent of the client is a breach of ...
confidentiality
A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although she is not dangerous to herself or others, she has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but she consistently refuses "any drugs." The staff realizes that legally this client can ...
continue to refuse treatment
A client has been admitted to the psychiatric facility for the treatment of depression. The client has told the emergency department staff that she would like a close friend to make decisions surrounding her care until she "feels better." In order to identify the legal basis for the client's preference, the nurse should:
determine whether a durable power of attorney has been established.
A nurse in the emergency department is planning for a client with mental illness to be placed in an inpatient hospitalization. Which is a condition of this type of admission?
present a clear danger to self or others
A client with a longstanding history of depression created a psychiatric advance directive (PAD) several months ago that explicitly ruled out the use of electroconvulsive therapy (ECT). After dialoguing with the care team, the client has changed his mind and is willing to consider ECT. The nurse should inform the client that:
the PAD can be cancelled, providing the client is legally competent.
A client was brought to trial after being arrested for a sexual assault and was found guilty but mentally ill. The client's subsequent plan of care will most likely include:
treatment in a prison setting.
