CMH - Week 1 - Psych Success Ch. 5 Legal and Ethical Considerations - Exam 1

Which situation may put a nurse on an in-patient unit in legal jeopardy for battery? 1. A nurse threatens a client with bodily harm if the client refuses medications. 2. A client is injured while being forcibly placed in four-point restraints because of low staffing. 3. A nurse gives three times the ordered medication dosage because of a calculation error and does not report the incident, resulting in harm to the client. 4. A client is held against his or her will because of medication noncompliance.

2. A client is injured while being forcibly placed in four-point restraints because of low staffing. This is an example of battery. Battery is the touching of another person without consent.

The right to determine one's own destiny is to autonomy as the duty to benefit or pro-mote the good of others is to: 1. Nonmaleficence. 2. Justice. 3. Veracity. 4. Beneficence.

4. Beneficence. Beneficence is the duty to benefit or pro-mote the good of others.

The nurse is having a therapeutic conversation with a client in a locked in-patient psychiatric unit. The client states, "Please don't tell anyone about my sexual abuse."Which is the appropriate nursing response? 1. "Yes, I will keep this information confidential." 2. "All of the health-care team is focused on helping you. I will bring information to the team that can assist them in planning your treatment." 3. "Why don't you want the team to know about your sexual abuse? It is significant information." 4. "Let's talk about your feelings about your history of sexual abuse."

2. "All of the health-care team is focused on helping you. I will bring information to the team that can assist them in planning your treatment." The nurse is being honest and open with the client and giving information about the client focus of the treatment team.This builds trust and sets limits on potentially manipulative behavior by the client.

On an in-patient locked psychiatric unit, a newly admitted client requests to leave against medical advice (AMA). What should be the initial nursing action for this client? 1. Tell the client that, because the client is on a locked unit, the client cannot leave AMA. 2. Check the admission status of the client, and discuss the client's reasons for wanting to leave. 3. In a mater-of-fact way, initiate room restrictions. 4. Place the client on one-on-one observation.

2. Check the admission status of the client, and discuss the client's reasons for wanting to leave. It is important for the nurse to know the admission status of this client. If the client is involuntarily admitted, the client is unable to leave the facility. If the client is voluntarily admitted, the client may leave AMA, unless the treatment team has determined that the client is a danger to self or others.

A nursing student observes an incorrect dosage of medication being given to a client receiving electroconvulsive therapy. To observe the ethical principle of veracity, which action would the nursing student take? 1. Keep the information confidential to avoid harm to others. 2. Inform the student's instructor and the client's primary nurse, and document the situation. 3. Tell only the client about the incident because the decision about actions would be determined only by the client. 4. Because the client was not harmed, the incident would not need to be reported.

2. Inform the student's instructor and the client's primary nurse, and document the situation. By applying the ethical principle of veracity, the student should tell the truth, and report and document the incident. The only limitation to the ethical principle of veracity is when telling the truth would knowingly produce harm. Veracity must be in the context of hospital policy and procedures and within the chain of command.

Walking down the aisle of a local grocery store, a nurse encounters a client the nurse has recently cared for in an in-patient psychiatric setting. Which is the appropriate reaction by the nurse? 1. Inquire how the former client is doing since discharge. 2. Ignore the client to protect confidentiality. 3. Talk to the client, but refrain from using names. 4. Make eye contact with the client, and if the client responds, respond back.

4. Make eye contact with the client, and if the client responds, respond back. By making eye contact and waiting for a response from the client, the nurse has placed the control of the encounter with the client. The client then decides if any communication should occur, and the client decides confidentiality issues.

In which situation is there the potential for an advanced directive not to be honored? Select all that apply. 1. In an emergency situation where the advanced directive document is not readily available. 2. When the advanced directive states that there "will be no heroic measures used." 3. When the health-care proxy is unsure of the client's wishes. 4. When a client can no longer make rational decisions about his or her health care. 5. When a state does not recognize the advanced directive or durable power of attorney.

1, 2, 3 1. In an emergency situation where the advanced directive document is not readily available. 2. When the advanced directive states that there "will be no heroic measures used." 3. When the health-care proxy is unsure of the client's wishes. 1. If the advanced directive document is not readily available, it may not be honored by the health-care team caring for the client. 2. Advanced directives must be specific in the directions related to care. Stating that there "will be no heroic measures used" is vague and may be challenged by the health-care team caring for the client. 3. If the health-care proxy (the individual assigned by the client to carry out the client's wishes) is unsure of the client'swishes, the advanced directive can be challenged.

Which action should be taken by the clinician when there is reasonable certainty that a client is going to harm someone? Select all that apply. 1. Assess the threat of violence toward another. 2. Identify the person being threatened. 3. Notify the identified victim. 4. Notify only law enforcement authorities to protect confidentiality. 5. Consider petitioning the court for continued commitment.

1, 2, 3, 5 1. Assess the threat of violence toward another. 2. Identify the person being threatened. 3. Notify the identified victim. 5. Consider petitioning the court for continued commitment. 1. It is important and necessary to assess the client's potential for violence toward others. 2. It is necessary to confirm the identification of the intended victim. 3. The Tarasoff ruling makes it mandatory to notify an identified victim. 5. Because the client is a danger toward others, the court should be petitioned for continued involuntary commitment.

The treatment team is recommending disulfiram (Antabuse) for a client who has had multiple admissions for alcohol detoxification. Which nursing question directed to the treatment team would protect this client's right to informed consent? 1. "Does this client have the cognitive ability to be prescribed this medication?" 2. "Will this client be compliant with this medication?" 3. "Will the team be liable if this client is harmed by this medication?" 4. "Is this the least restrictive means of meeting this client's needs?"

1. "Does this client have the cognitive ability to be prescribed this medication?" The ability to take disulfiram (Antabuse) safely depends on a client's understanding of the effects of ingesting alcohol while taking disulfiram (Antabuse). If the client does not have the cognitive ability to understand the teaching related to disulfiram (Antabuse), the client could be placed at high risk for injury.

Which statement reflects the ethical principle of utilitarianism? 1. "The end justifies the means." 2. "If you mean well you will be justified." 3. "Do unto others as you would have them do unto you." 4. "What is right is what is best for me."

1. "The end justifies the means." Utilitarianism is the theoretical perspective that bases decisions on the view point that looks at the results of the decision.Action would be taken based on the results that produced the most good (happiness) for the most people.

Which of the following clients retains the right to give informed consent? 1. A 21-year-old client who is hearing and seeing things that others do not. 2. A 32-year-old voluntarily admitted client who is severely mentally retarded. 3. A 65-year-old client declared legally incompetent. 4. A 14-year-old client with attention-deficit disorder (ADD).

1. A 21-year-old client who is hearing and seeing things that others do not. A diagnosis of psychosis does not mean that a client is unable to consent to treatment.

A nurse is pulled from a medical/surgical floor to the psychiatric unit. Which client would the nurse manager assign to this nurse? 1. A chronically depressed client. 2. An actively psychotic client. 3. A client experiencing paranoid thinking. 4. A client diagnosed with cluster B traits.

1. A chronically depressed client. Because there is no indication that this client is suicidal, of the four clients presented, this client is most appropriate to assign to the medical/surgical nurse.

On which client would a nurse on an in-patient psychiatric unit appropriately use four-point restraints? 1. A client who is hostile and threatening the staff and other clients. 2. A client who is intrusive and demanding and requires added attention. 3. A client who is non-compliant with medications and treatments. 4. A client who splits staff and manipulates other clients.

1. A client who is hostile and threatening the staff and other clients. When a client is hostile and threatening the staff and other clients, that client is a danger to others and, after attempts at de-escalation have failed, should be secluded and restrained.

A nursing student states to the instructor, "I'm afraid of mentally ill clients. They are all violent." Which statement would the instructor use to clarify this perception for the student? 1. "Even though mentally ill clients are often violent, there are ways to deescalate these behaviors." 2. "A very few clients with mental illness exhibit violent behaviors." 3. "There are medications that can be given to clients to avoid violent behaviors." 4. "Only paranoid clients exhibit violent behaviors."

2. "A very few clients with mental illness exhibit violent behaviors." It is true that a very few clients with mental illness exhibit violent behaviors.

The phone rings at the nurse's station of an in-patient psychiatric facility. The caller asks to speak with Mr. Hawkins, a client in room 200. Which nursing response protects this client's right to autonomy and confidentiality? 1. "I am sorry you cannot talk to Mr. Hawkins." 2. "I cannot confirm or deny that Mr. Hawkins is a client admitted here." 3. "I'll see if Mr. Hawkins wants to talk with you." 4. "I'm sorry, Mr. Hawkins is not taking any calls."

2. "I cannot confirm or deny that Mr. Hawkins is a client admitted here." This statement gives no information related to the presence of the client at the facility. This statement maintains the client's right to confidentially.

A nursing student uses a client's full name on an interpersonal process recording submitted to the student's instructor. What is the instructor's priority intervention? 1. Reinforce the importance of accurate documentation, including the client's name. 2. Correct and remind the student of the importance of maintaining client confidentiality. 3. Tell the student that because the client has been deemed incompetent, confidentiality is not an issue. 4. Tell the student that because the client is involuntarily committed, confidentiality is not an issue.

2. Correct and remind the student of the importance of maintaining client confidentiality. It is the priority intervention of the instructor to correct and remind the student of the importance of maintaining client confidentiality. The instructor should advise the student to use only client initials on any student paperwork.

Which is an example of a situation that may lead to a nurse's being sued for slander? 1. Documentation in the client's record that the client "has no moral or ethical principles and is probably stealing company material." 2. Discussion with the client's family, who are unaware of the information, about a DUI that the client has recently received. 3. Talking about the client's behaviors in a crowded elevator on the way to lunch. 4. Threatening a calm client with seclusion if the client does not take medications.

2. Discussion with the client's family, who are unaware of the information, about a DUI that the client has recently received. This is an example of slander. Slander is sharing of information orally that could be detrimental to the client's reputation.

A client has been deemed a danger to self by a court ruling. Which might the court mandate for this client? 1. Voluntary commitment to a locked psychiatric facility. 2. Involuntary commitment to an out-patient mental health clinic. 3. Declaration of incompetence with mandatory medication administration. 4. Declaration of emergency seclusion.

2. Involuntary commitment to an out-patient mental health clinic. Involuntary commitment to an out-patient mental health clinic is an option of the court when a client has been declared a danger to self. If the client fails to appear at regularly scheduled appointments, the client can be seized and involuntarily committed to an in-patient psychiatric unit.

A client has been involuntarily committed to the acute care psychiatric unit. During the delivery of the evening dinner trays, the client elopes from the unit, gets on a bus, and crosses into a neighboring state. Which nursing intervention is appropriate in this situation? 1. Call the psychiatric facility located in the neighboring state and have them try to involuntarily admit the client to their facility. 2. Notify the client's physician, document the incident, and review elopement precautions. 3. Send a therapeutic assistant out to relocate the client and bring him or her back to the facility. 4. Notify the police in the neighboring state and have them pick the client up and readmit the client to the facility.

2. Notify the client's physician, document the incident, and review elopement precautions. Elopement occurs when a client leaves the hospital without permission. In this situation, all the nurse can do is notify the client's physician and document the incident. Elopement precautions should be reviewed and actions taken to prevent a future occurrence.

A client's husband is visiting his wife during visiting hours. A nurse walking by hears him verbally abuse the client. Which nursing response is appropriate? 1. Ask the client to ask her husband to leave the unit. 2. Remind the client's husband of the unit rules. 3. Ask the husband to come to the nurse's station to talk about his feelings. 4. Sit with the client and her husband to begin discussing anger issues.

2. Remind the client's husband of the unit rules. Reminding the client's husband of the rules of the unit addresses the inappropriate behavior. If the husband's behavior continues, it is the nurse's responsibility to ask the visitor to leave. The incident should be documented, and the treatment team should be notified.

Which determines the scope of practice for a registered nurse employed in a psychiatric in-patient facility? 1. National Alliance of the Mentally Ill (NAMI). 2. State law, which may vary from state to state. 3. Federal law, which applies nationwide. 4. National League of Nursing (NLN)

2. State law, which may vary from state to state. The legal parameters of professional nursing are defined within each state by the state's nurse practice act.

A client on an in-patient psychiatric unit has been admitted involuntarily. The nurse is about to administer the client's anti anxiety medication, when the client strikes the nurse, curses, and states, "I'm going to kill you!" Which nursing action is most appropriate at this time? 1. The nurse decides not to administer the medication. 2. The nurse initiates the ordered, forced medication protocol. 3. The nurse initiates legal action to get the client declared incompetent. 4. The nurse teaches the client the pros and cons of medication compliance.

2. The nurse initiates the ordered, forced medication protocol. Because this client is an imminent danger to others, it is the duty of the nurse to initiate a forced medication protocol to protect the nurse and other clients in the milieu.

The nurse on an in-patient psychiatric unit documents the following in a client's chart:"Seems to have no regard for legal or ethical standards. A problem client who needs constant limit-setting." Which response by the nurse manager reflects the potential liability related to this charting entry? 1. "Documenting this breeches the client's right to confidentiality." 2. "Documenting this puts you at risk for malpractice." 3. "Documenting this puts you at risk for defamation of character." 4. "Documenting this breeches the client's right to informed consent."

3. "Documenting this puts you at risk for defamation of character." When information is shared that could be detrimental to a client's reputation, the nurse may be at risk for defamation of character. Information documented in a chart should reflect objective findings, not the nurse's perception of a client.

A group of in-patient psychiatric clients on a public elevator begin discussing an out-of-control client who is now in seclusion. Which is the appropriate nursing response? 1. "I know you are very upset by the conflict on the unit. I'm glad you can talk about it" 2. "Well now you know what happens when you can't control your temper." 3. "It is inappropriate to discuss another client's situation in public." 4. "Let's just not talk about this now."

3. "It is inappropriate to discuss another client's situation in public." This statement addresses the client's right to confidentiality and sets limits on client behaviors.

Which client does not have the ability to refuse medications or treatments? 1. An involuntarily committed client. 2. A voluntarily committed client. 3. A client who has been deemed incompetent by the court. 4. A client who has an Axis II diagnosis of antisocial personality disorder.

3. A client who has been deemed incompetent by the court. When a client is declared incompetent,the client has a mental disorder resulting in a defect in judgment, and this defect makes the client incapable of handling personal affairs. A guardian is appointed.The guardian makes decisions for the client, and the client loses the right to refuse medications.

A client has been placed in seclusion because the client has been deemed a danger to others. Which is the priority nursing intervention for this client? 1. Have little contact with the client to decrease stimulation. 2. Provide the client with privacy to maintain confidentiality. 3. Maintain contact with the client and assure the client that seclusion is a way to maintain the client's safety. 4. Teach the client relaxation techniques and effective coping strategies to deal with anger.

3. Maintain contact with the client and assure the client that seclusion is a way to maintain the client's safety. It is important to maintain contact with the client and assure the client that seclusion is a way to maintain the client's safety. Seclusion, when appropriate,should be implemented in a matter-of-fact manner, focusing on the client's behavior and the consequences of the behavior.

An unconscious client is admitted to the emergency department with a self-inflicted gunshot wound to the head. Family members state that they know of the existence of a living will in which the client insists that life support not be implemented. What is the legal obligation of the health-care team? 1. Follow the family's wishes because of the family's knowledge of the living will. 2. Follow the directions given in the living will because of mandates by state law. 3. Follow the ethical concept of non maleficence, and place the client on life support. 4. Follow the ethical concept of beneficence by implementing life-saving interventions.

4. Follow the ethical concept of beneficence by implementing life-saving interventions. Beneficence is the duty to benefit or pro-mote the good of others. Because no legal document has been produced that would indicate the client's wishes to the contrary, it is the legal responsibility of the health-care team to initiate life support measures.

When a client makes a written application to be admitted to a psychiatric facility, which statement about this client applies? 1. The client may retain none, some, or all of his or her civil rights depending on state law. 2. The client cannot make discharge decisions. These are initiated by the hospital or court or both. 3. The client has been determined to be a danger to self or others. 4. The client makes decisions about discharge, unless he or she is determined to be a danger to self or others.

4. The client makes decisions about discharge, unless he or she is determined to be a danger to self or others. A voluntarily admitted client can make decisions about discharge, unless the client has been determined to be a danger to self or others. If the treatment team determines that a voluntarily admitted client is a danger to self or others, the client is held for a court hearing, and the client's admission status is changed to involuntary.

In which situation does a health-care worker have a duty to warn a potential victim? 1. When clients manipulate and split the staff and are a danger to self. 2. When clients curse at family members during visiting hours. 3. When clients exhibit paranoid delusions and auditory or visual hallucinations. 4. When clients make specific threats toward someone who is identifiable.

4. When clients make specific threats toward someone who is identifiable. When a client makes specific threats toward someone who is identifiable, it is the duty of the health-care worker to warn the potential victim. The nurse should bring this information to the treatment team and document the report.

A client has the right to treatment in the least restrictive setting. Number the following restrictive situations in the order of hierarchy from least restrictive to most restrictive. 1. Restriction of the ability to use money and control resources. 2. Restriction of emotional or verbal expression (censorship). 3. Restriction of decisions of daily life (what to eat, when to smoke). 4. Restriction of body movement (four-point restraints). 5. Restriction of movement in space (seclusion rooms, restrictions to the unit).

The order of hierarchy from least restrictive to most restrictive is 2, 1, 3, 5, 4. (1) The least restrictive situation would be the censorship of emotional or verbal expression. (2) The second-higher restrictive situation would be limitations on the ability to use money and control resources. (3) The third-higher restrictive situation would be limitations of the ability to make decisions of daily life such as what to eat and when to smoke.(4) The fourth-higher restrictive situation would include room seclusion or restriction to the unit or both. (5) The highest restrictive situation would involve the limitation of body movement by the application of four-point restraints.