Chapter 6 Legal and Ethical Basis for Practice

Which legal issue involves sharing confidential documents with people other than those involved in nursing care? Slander Punitive damages Supervisory liability False imprisonment

Slander Slander is the term used to describe the liability issue of sharing confidential documents with nonmedical staff and people not involved in the medical care of clients. Punitive damages describe intentional damages done by medical professionals for the well-being of a client. Supervisory liability describes the improper delegation of duties among staff members. False imprisonment describes the unnecessary and unwanted seclusion of a client. p. 107

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

Autonomy 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

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

Beneficence. 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

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 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. p. 100

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 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

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 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 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

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. 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. p. 110

What nursing intervention demonstrates an understanding of the concept of client autonomy? Ordering the client to take medication Convincing the client to take medication Respecting the client's decision about medication Asking the family to administer medication to the client

Respecting the client's decision about medication Autonomy is the duty to respect clients' rights to make their own decisions about medical care. Ordering the client to take medication is not an appropriate action; the nurse should acknowledge the client's right to make a decision. Convincing the client to take medication or asking the family to give medications to the client is not respectful of the client and does not reflect autonomy. p. 99

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." 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

Which nursing interventions are focused directly on eliminating the need to restrain a client who has begun to demonstrate aggressive and confused behavior? Turning off the television in the client's room Distracting the client with an offer to get a snack Reviewing the client's medications for possible interactions Secluding the client in the low-stimulation room Monitoring the client's temperature for a fever

-Turning off the television in the client's room -Distracting the client with an offer to get a snack -Reviewing the client's medications for possible interactions -Monitoring the client's temperature for a fever Physical causes of agitation, confusion, and combative behavior include drug interaction, drug side effects, temperature elevation (fever), hypoglycemia, hypoxia, and electrolyte imbalances. Reducing stimulation, diversionary approaches, offering as-needed medications, verbal interventions or asking the client for cooperation, and active listening are considered before using seclusion and restraint. p. 104

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 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

A client has been disruptive to the therapeutic milieu for two days. A certified nursing assistant says to the nurse, "We need to seclude this client because this behavior is upsetting everyone on the unit." What is the nurse's best response? "Seclusion is not part of this client's plan of care." "Let's think of some new ways to help this client be less disruptive." "Thank you for that suggestion. I will discuss it with the health care provider." "Disruptive behavior is expected with mental illness. We must respond therapeutically."

"Let's think of some new ways to help this client be less disruptive." The nursing assistant is part of the health care team and may be able to contribute ideas to help the client be less disruptive. Engaging in this discussion with the nursing assistant is part of the nurse's role of supervision. Seclusion may only be used to ensure the immediate safety of a client, staff members, or others. A written order is required for emergency use of seclusion, so the health care provider must be consulted. The nursing assistant and nurse only need to consult with the health care provider if they plan to alter the client's plan of care. It is incorrect to generalize mental illness to include disruptive behavior. pp. 65-66

Which statement describes an ethical dilemma? "It's so difficult when the client doesn't agree with the treatment team." "The client insists on behaving in a manner that will likely cause him or her injury." "It is difficult to determine who makes decisions for an incompetent client without a medical surrogate." "There are only two treatment choices; both are very painful and neither has a high rate of success."

"There are only two treatment choices; both are very painful and neither has a high rate of success." An ethical dilemma exists when a choice must be made between equally unsatisfactory alternatives. A disagreement does not by itself qualify as an ethical dilemma. The cognitive client has the right to engage in risky behaviors as long as they don't endanger others; therefore, no ethical dilemma exists. Although decision-making for an incompetent client is difficult and may even be a legal issue, such situations seldom are considered ethical dilemmas. p. 99

When considering mental health services, which statement regarding habeas corpus is true? Select all that apply. This is the process to challenge an involuntary admission as being illegal. This is a law that protects an individual's Fifth Amendment rights. This process is associated with "due process" as required by the 14th Amendment. All mental health admissions are dependent upon this legal process. This process supports an individual's right to treatment in the least restrictive form.

-This is the process to challenge an involuntary admission as being illegal. -This is a law that protects an individual's Fifth Amendment rights. -This process is associated with "due process" as required by the 14th Amendment. -This process supports an individual's right to treatment in the least restrictive form. The writ of habeas corpus is the procedural mechanism used to challenge unlawful detention by the government (such as involuntary mental health commitments). This right derived from the Fifth Amendment of the United States Constitution, which states that "no person shall ... be deprived of life, liberty, or property without due process of law." The 14th Amendment explicitly prohibits states from depriving citizens of life, liberty, and property without due process of law. The writ of habeas corpus and the least restrictive alternative doctrine are two of the most important concepts applicable to civic commitment cases. The courts have recognized that involuntary admissions result in a "massive curtailment of liberty" requiring due process protection in the civil commitment procedure. A voluntary commitment does not raise the same degree of concern. p. 100

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. 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. p. 100

A client who presents no danger to him- or herself, or to others, is forced to take medication against his or her will by the nurse. For what is the nurse legally liable? Assault Battery Defamation Invasion of privacy

Battery Battery is the harmful, nonconsensual touching of another's person. Forceful administration of medication constitutes battery. Assault refers to the threat to cause harm. Defamation harms the client's reputation. Invasion of privacy happens when someone breaks a client's confidence or takes photographs without permission. 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. 107

A nurse colleague tells the staff nurse, "I have not been able to sleep for the past three days, and now I feel like a robot." What is the staff nurse's best action? Direct the colleague to leave the facility immediately. Observe the colleague closely for evidence of impaired practice. Offer to administer medications to clients assigned to the colleague. Confer with the supervisor about the nurse's ability to safely deliver care.

Confer with the supervisor about the nurse's ability to safely deliver care. If a colleague may be practicing irresponsibly, the nurse has an obligation to protect the rights of all clients who could potentially be harmed by reporting the concern to a supervisor. The nurse does not have the authority to direct a colleague to leave, and it may not be safe for the colleague to do so. Observation of the colleague should be done by the supervisor, not the nurse. Offering to assist the colleague may lighten that colleague's workload, but it does not address the issue of potential danger to clients. p. 70

In the course of psychiatric hospitalization, a client reports an incident of sexual harassment from a health care professional. What should be the initial step taken by the nurse in caring for this client? Prepare a public relations plan. Report the incident to the authorities. Listen to the client with utmost attention. Involve family members in caring for the client.

Listen to the client with utmost attention. Issues such as sexual harassment by medical professionals are examples of abuse of the therapist-client relationship in psychiatric care. The nurse should first listen to the client attentively in order to assess the client's mental status. Preparing a public relations plan is not the nurse's responsibility and the client should be the first priority. If it was witnessed or reported by other staff, the nurse has a professional duty to submit documented evidence of the incident to the authorities, but this can happen after the nurse attends to the client. The nurse can then inform the family members afterward about their roles in caring for the client to help the client recover. This helps in providing moral support to the client for effective crisis management. pp. 107-108

Which statement is true regarding mail sent to an involuntarily admitted client residing on a psychiatric inpatient unit? The client can receive mail from only family and legal sources. Mail must first be opened and inspected by staff. Receipt of mail is considered a privilege accorded the client for compliance. Mail is a form of social interaction and so receiving mail is a client's civil right.

Mail is a form of social interaction and so receiving mail is a client's civil right. The client's civil rights are intact, despite hospitalization. The right to communicate with those outside the hospital is ensured. The client may receive mail from anyone. It is not necessary nor ethical for the staff to open the client's mail. It is also unethical to use mail as a reward for compliance. p. 100

Which intervention will be most effective in preventing a nurse from making decisions that will lead to legal difficulties? Asking a peer to review nursing intervention-related decisions Balancing the rights of the client and the rights of society Maintaining currency in state laws affecting nursing practice Seeking value clarification about fundamental ethical principles

Maintaining currency in state laws affecting nursing practice Each nurse's practice is governed by the Nurse Practice Act of the state in which the nurse practices. The nurse should always be aware of its provisions. Asking a peer to review his or her decisions is a safety provision, but it won't necessarily limit legal difficulties. Balancing the rights of the client and the rights of society may address ethical, not legal, difficulties as will seeking value clarification about fundamental ethical principles. pp. 108-109

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." 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

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

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 few seconds ago had seemed completely forgotten. p. 101

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 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

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 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 intent. p. 110

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. 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. p. 100

Which conditions are implemented when a client receiving mental health treatment is given a conditional release? Select all that apply. To follow the court order To document it is against medical advice (AMA) Assessment of the client's adherence to medications Verification of the client's ability to rehabilitate in society Confirmation of the client's ability to meet his or her basic needs

-Assessment of the client's adherence to medications -Verification of the client's ability to rehabilitate in society -Confirmation of the client's ability to meet his or her basic needs Conditional release is performed in order to assess the client's adherence to medications and prescribed protocol. The client would be called for follow up to determine if he or she is improving and following the prescribed medications. It also helps to verify the client's ability to integrate into society, and to meet his or her basic needs. Conditional release helps a client to live in his or her home environment while recovering from a mental illness. Conditional release may help a client gradually return to a normal life. Releasing in order to follow court order is performed in an unconditional release. Releasing the client against medical advice (AMA) is performed when the client is fit to carry out daily activities and poses no threat to self or to others. p. 101

Which nursing interventions are examples of the basic principles of bioethics? Select all that apply. Spending extra time orienting a newly admitted client to the unit Encouraging the client to determine how he or she will contribute to the care plan Assuring that all clients are given an opportunity to speak at a unit grievance meeting Providing a client with privileges in order to easily manage his or her aggressive behavior Explaining the purpose of a client's newly prescribed medication

-Spending extra time orienting a newly admitted client to the unit -Encouraging the client to determine how he or she will contribute to the care plan -Assuring that all clients are given an opportunity to speak at a unit grievance meeting -Explaining the purpose of a client's newly prescribed medication The five basic principles of bioethics are: beneficence, which is the duty to act to benefit or promote the good of others (e.g., spending extra time to help calm an anxious client); autonomy, which is respecting the rights of others to make their own decisions (e.g., acknowledging the client's right to make decisions about the care plan); justice, or the duty to distribute resources or care equally, regardless of personal attributes (e.g., providing all clients with an opportunity to participate in a unit meeting); veracity, or one's duty to communicate truthfully (e.g., describing the purpose and side effects of psychotropic medications in a truthful and nonmisleading way). Fidelity (nonmaleficence) is maintaining loyalty and commitment to the client and doing no wrong to the client; maintaining rules and awarding privileges to manage behavior without concern for therapeutic consequences is not an appropriate example of fidelity. p. 99

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 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. p. 111

Which individual has not met the criteria for involuntary commitment to a mental health facility? A male teenager who has threatened to shoot himself if his girlfriend leaves him A young adult who is 20% below normal weight as a result of dramatically restricting food An older adult found wandering in the mall who is unable to provide his or her name An adult who reports drinking too much in order to forget the abuse he or she has endured

An adult who reports drinking too much in order to forget the abuse he or she has endured Most state laws permit involuntary commitment of mentally ill clients if pose a true danger to themselves or are in need of treatment, or are unable to provide for their own basic needs. Although drinking too much to forget incidences of abuse is an indication of a need for mental health treatment, it is not severe enough to qualify for involuntary admission to mental health facility. Most state laws permit involuntary commitment of the mentally ill if they pose a true danger to themselves or others as in a suicide threat, as being voluntarily malnourished, or if they are unable to provide for their own basic needs, such as in the case of a disoriented individual. p. 100

Which statement describes an unintentional tort? An unplanned act that causes injury or harm to another person The lack of ordinary care in a professional situation An act that results in the breaching of professional duty A purposeful act that violate a person's rights

An unplanned act that causes injury or harm to another person An unintentional tort is the unintended act of causing injury or harm to another person. The injury is caused because the person was not careful enough to prevent the injury. The inability to use ordinary care in a professional situation is called negligence. An act of breaching professional duty is called malpractice. Intentional acts that violate a person's rights are called intentional torts. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. p. 108

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. 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. p. 103

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 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. p. 101

Which statement accurately describes characteristics of an ethical dilemma? 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. 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

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 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. p. 103