Mental Health Varcarolis Ch. 9: Legal and Ethical Issues - PrepUs

When a 23-year-old client, after attempting suicide, asks to speak with the nurse but wants assurance that the conversation will remain confidential, the nurse responds how?

"Will this conversation involve your desire to harm yourself?" Explanation: Asking whether the conversation will involove the client's desire to hurt oneself establishes whether the nurse can keep it confidential. Nurses may find it necessary to reassure a client that confidentiality will be maintained except when the information may be harmful to the client or others and except when the client threatens self-harm. The other options are not necessarily true; if the conversation does not affect the client's health or well-being, there is no reason to share the information with anyone. Further, if the conversation affects the client's health or well-being, it will be shared with the client's health care team. The option regarding the client's trust for the nurse is nursing-centered, not client-centered, and does not address the client's question.

The nurse is assessing whether a room is fit for seclusion of clients. What are the requirements of a seclusion room? Select all that apply.

- The room should not have any sharp objects. - The room should have a bed that is bolted to the floor. - The room should have facility for direct visual monitoring. Explanation: Seclusion requires a psychiatric client to be confined in a room that is specially constructed. The room should not have any sharp objects like knives or pens and pencils, as the client can inflict self-harm or harm to medical personnel. The bed should ideally be bolted to the floor to prevent any kind of danger due to the client's aggression. The nurse should be able to visually monitor the client, using a window or using video cameras. The room should have a locking door to prevent the client from attempting to run away.

Which situations would describe the nurse employing the principles of patient autonomy while providing care? Select all that apply.

- present all options for treatment to the client - explain all risks in a way the client can understand Explanation: Patient autonomy means allowing the client to make choices for him/herself and recognizing their right to choose his/her own health care decisions. Helping a client that is in pain, providing immunizations as scheduled and encouraging the client to stop smoking are not principles of patient autonomy.

What action by a nurse best promotes the ethical principle of justice?

Advocating for enhanced mental health services in an underserved neighborhood Explanation: Justice focuses on the fair and equitable distribution of risks and benefits, such as advocating for necessary care among a population or community. The right to discontinue treatment and the principle of informed consent are related to autonomy. Clearly describing adverse effects is an example of veracity.

A nurse is caring for a voluntary client in the health care facility. The client doesn't show signs of suicidal ideation or pose harm to others. The client states, "I would really like to leave tonight and sleep in my own bed." Although the client wants discharge tonight, the physician at this time. What is the most appropriate response of the nurse?

"You will need to sign a written request for discharge." Explanation: Clients admitted to a health care facility have the right to leave, provided they do not pose a danger to themselves or others. If the client wishes to leave the health care facility, he or she can sign a written request for discharge. It would be a breach of the client's confidentiality to inform the family members or the client's landlord of the discharge. Although the client is voluntary, the nurse cannot simply tell clients they are free to leave at their own will. The written request for discharge provides evidence that the client wanted to leave and was not at risk to the self or others.

As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?

A guardian appointed by the court Explanation: If individuals admitted to a psychiatric facility are judged to be incompetent to make decisions, the court will appoint a guardian to make decisions for them.

Which mental health client meets criteria to be involuntarily committed?

A client diagnosed with borderline personality disorder who is threatening to self-harm Explanation: Involuntary commitment is confined hospitalization of a person without the person's consent but with a court order. Three common elements are found in most statutes for involuntary commitment. The individual must be (1) mentally disordered, (2) dangerous to himself or herself or others, (3) unable to provide for his or her basic needs. The client diagnosed with borderline personality disorder is a danger to the self. The other clients are not in immediate danger to themselves or others.

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 Explanation: Individuals found not guilty of a crime but mentally ill are normally held in a secure psychiatric setting, not a community hospital, prison, or in the community.

A new nursing student is studying ethics in nursing and informs a client who wants to stop medication about its benefits and how the client will continue to feel better only if use of the drug continues. Which concept is the nursing student using?

Beneficence Explanation: Beneficence is the principle of using the knowledge of science and incorporating the art of caring to develop an environment in which individuals achieve their maximal health care potential. It is "doing good."

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 Explanation: False imprisonment is the intentional and unjustifiable detention of a person against his or her will. Detention can occur with the use of physical restraint, barriers, or threats of harm. Battery is unlawful touching of another without consent. Defamation involves injury to a person's reputation or character through oral (slander) or written (libel) communications to a third party. Assault is an act that puts another person in apprehension of being touched or of bodily harm without consent.

Earlier in the shift, the nurse promised to help a client acquire some paper and a pen and draft a letter to a family member later in the day. The nurse became increasingly busy during the shift but has now taken some time to assist the client in this way. What ethical principle has the nurse best exemplified?

Fidelity Explanation: Fidelity involves keeping promises. Veracity is truth-telling while beneficence is doing good and nonmaleficence is avoiding harm.

A nursing student identifies which as the most important tool of psychiatric nursing?

Self Explanation: The most important tool of psychiatric nursing is the self. Through relationship building, clients learn to trust the nurse, who then guides, teaches, and advocates for quality care and treatment.

The nursing instructor is talking to a class of nursing students about the American's with Disabilities Act, and persons having various disabilities that have the right to education in the least restrictive environment. The nursing instructor asks the students, "what is the reason for the least restrictive environment?" Which example should the student nurse choose?

unique needs Explanation: Least restrictive environment means the individual cannot be restricted to an institution when he or she can be successfully treated according to the client's needs, and stay in the community. Budget factors, placement options, and availability of space are not factors related to The American's with Disabilities Act.

A client with depression who is undergoing a colonoscopy tomorrow is receiving preoperative education regarding the procedure. Which nursing task best describes the explanation of the procedure and the associated risks and benefits?

Acquiring informed consent Explanation: In accordance with the ethical principle of veracity, the client can only provide informed consent if the nurse applies the principle of veracity—the duty to be honest and truthful. Informing the client of the risks and benefits of a procedure is best described as obtaining informed consent. Informed consent involves the client's right of self-decision. Client privacy is defined as the right to be left alone and free from intrusion or control by the health care providers. Self-determination allows the client to indicate what treatments the client would accept or refuse. Acting in a beneficent manner encompasses doing good acts by the nurse.

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports him or her in whatever decision he or she makes?

Advocate Explanation: In the advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. The primary caregiving role in mental health settings is the implementation of the therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the client about the medication regimen. In the role of the parent surrogate, the nurse may be tempted to assume a parental role.

The depressed client is deciding which type of treatment would be beneficial. The nurse would document that the client is utilizing which ethical principle in this situation?

Autonomy Explanation: The American Nurses Association identified four primary principles to guide ethical decisions. These principles include the client's right to autonomy, the right to beneficence (doing good) by the nurse, the right to justice or fair treatment, and the right to veracity (the truth) regarding the client's condition and treatment.

A client's plan of care includes revoking privileges for inappropriate behavior, based on a contract between the client and the nurse who wrote the plan. Another nurse decides to ignore this because the client promises that the client will adhere to the contract in the future. The second nurse's behavior may have violated which ethical principle?

Fidelity Explanation: Fidelity is the nurse's faithfulness to duties, obligations, and promises. Autonomy is the client's right to make decisions for himself or herself. Veracity is a systematic behavior of honesty and truthfulness in speech. Beneficence is the principle of doing good, not harm.

A psychiatric-mental health nurse is practicing at the advanced level. Which function would this nurse be able to perform based on the nurse's advanced level of preparation?

Psychotherapy Explanation: Although the advanced level psychiatric-mental health nurse would be able to perform the functions of health promotion, counseling, and intake screening, because of the nurse's advanced level of preparation, the nurse would be able to perform psychotherapy. Health promotion, counseling, and intake screening are basic-level functions in the practice area of psychiatric-mental health nursing.

A psychiatric-mental health nurse is providing care to several clients. Some of the clients have been voluntarily admitted while others have been involuntarily admitted. Which description about voluntary admissions demonstrates that the nurse understands thedifferences between these two types of admissions?

They have agreed to the hospitalization. Explanation: Clients who are voluntarily admitted have certain rights that differ from those of other hospitalized clients. Specifically, they are are willing to seek treatment and agree to be hospitalized. Therefore, they have the absolute right to refuse treatment, including psychotropic medications, unless they are dangerous to themselves or others, as in a violent destructive episode within the treatment unit.

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. Explanation: Mental health clinicians have a duty to warn identifiable third parties of threats made by clients even if the threats were discussed during a therapeutic session otherwise protected by client-therapist privilege.

A client with depression tells the nurse, "I want to stop taking my antidepressant medication because I don't like taking medications." The nurse discusses the benefits of adhering to the medication plan and strongly urges the client to use the medication. The nurse interprets the client's statement as reflecting which ethical principle?

autonomy Explanation: Autonomy reflects the fundamental right of all persons for self-determination, to make independently make choices. Autonomy is reflected by the client's statement to stop taking the medication. The nurse's urging the client to continue to use the medication because of the medication's benefits reflects the principle of beneficence, that is, the nurse is using scientific knowledge and incorporating that knowledge to promote the client's maximum health potential. In this case, the medication would help to control the client's depressive symptoms. Justice reflects the duty to treat all fairly; paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

The client has not been on speaking terms with the client's parents for several years. The parents have expressed a desire to reunite with the client. At first, the client agreed to a family meeting, and then decided not to meet with the parents. The nurse has encouraged the client to attend the family meeting knowing that the family's support would be valuable. What ethical principles are in conflict in this situation?

autonomy and beneficence Explanation: According to the principle of autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. The client has the right to decide whether to go to a family meeting or not, and the nurse urges the client to go to the meeting because the nurse knows that the family will be a great support to the client. The ethical principles that are not in conflict in this situation are justice and beneficence, non-maleficence and autonomy, and veracity and fidelity.

After spending 45 minutes talking with an assigned patient, the student nurse promises to visit again after lunch. After lunch, the nursing student returns and talks with her client. The student's action reflects which ethical principle?

fidelity Explanation: Fidelity is faithfulness to obligations and duties, as well as keeping promises. Fidelity is important in establishing trusting relationships. Beneficence, non-maleficence, and veracity do not describe the ethical principle of keeping promises, obligations, and duties. Non-maleficence is inflicting the least harm possible to reach a beneficial outcome. Veracity is the quality of being true or the habit of telling the truth. Beneficence is the action of doing something for the benefit of others.

Which ethical principles become an issue in mental health when a segment of a population does not have access to health care?

justice Explanation: Justice is the duty to treat all fairly, distributing the risk and benefits equally. Justice becomes an issue in mental health when a segment of a population does not have access to health care. Basic good should be distributed so the least advantaged members of society benefit. Nonmaleficence, fidelity, and veracity are not being used in this situation.

A psychiatric-mental health client has an advance care directive on the client's medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for:

medical battery. Explanation: Failure to respect a client's advance care directive is considered medical battery. Assault is the threat of unlawful force to inflict bodily injury on another. Battery is intentional and unpermitted contact with another. False imprisonment is detention or imprisonment contrary to the provision of law.

The nurse is caring for a client that is confused. The nurse, while giving the client a bed bath leaves the room to get supplies. The nurse returns to find the client on the floor with the bed in high position, and side rails down. What law has been broken?

negligence Explanation: Negligence is an unintentional tort that is a breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries. Assault, beneficence, and non-maleficence do not demonstrate the law that has been broken. Assault is a threat of imminent harmful or offensive contact with a person. Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. Non-maleficence, beneficence, and assault have not been breached.

The client asks about a new medication, it's side effects, cost and if the drug is compatable with the other medication the client takes. The nurse answers all questions the client asks without withholding information. The nurse is guided by which ethical principle?

veracity Explanation: Veracity is the duty to be honest or truthful. The nurse is exercising veracity when fully answering any questions the client is answering without withholding information. Justice, beneficence and fidelity are not the ethical principle described in this question.

A nurse working on a psychiatric unit receives a telephone call from the employer of one of the clients on the unit. The employer asks to be sent a copy of the client's latest laboratory work and psychological testing results so the client's medical records in employee health can be kept up to date. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate?

"I am unable to acknowledge whether or not this client is a client on this unit." Explanation: A breach of confidentiality is the release of client information without the client's consent in the absence of legal compulsion or authorization to release information. Acknowledging that this client is a client on the unit would be such a breach. Even if the nurse explains that he or she cannot give the information without the client's consent, the explanation lets the employer know that the client is receiving care in a psychiatric hospital.

A nurse is providing care to a male client who is hospitalized with a diagnosis of schizophrenia. Which would be appropriate for the nurse to include in the client's medical record?

"Reports being unable to sleep because the client heard voices throughout the night." Explanation: The most appropriate statement to be recorded is, "Reported being unable to sleep because he heard voices throughout the night." This statement clearly depicts the client's problem and the reason why. The nurse should avoid jargon and stereotypical statements, such as having a good night with no issues or acting crazily. Only meaningful, accurate, objective descriptions of the behavior should be used.

The nursing instructor is discussing the Individuals with Disabilities Education Act and various disablities that have the right to education in the least restrictive environment. The instructor asks whom this applies to, clients with which problems? Which examples should the student nurse choose? Select all that apply.

- autism - traumatic brain injury - orthopedic impairment Explanation: The right to be treated in the least restrictive environment means that an individual cannot be restricted to an institution when he or she can be successfully treated in the community. Disabilities include autism, orthopedic impairments, and traumatic brain injuries. Flu, and pneumonia are not among the problems included in the Individuals with Disabilities Education Act.

After teaching a group of nursing students about the least restrictive environment, the instructor determines that the education was successful when the group identifies which as the most restrictive setting?

Acute inpatient care Explanation: Of the settings listed, acute inpatient hospitalization and care involves the most intensive treatment and is considered the most restrictive setting in the continuum.

A psychiatric-mental health nurse interested in joining a professional organization asks the psychiatric-mental health clinical nurse specialist about these organizations. Which organization would the clinical nurse specialist describe as the largest professional nursing organization focusing on mental health care?

American Psychiatric Nurses Association Explanation: The American Psychiatric Nurses Association (APNA) and the International Society of Psychiatric Nursing (ISPN) are two organizations for psychiatric nurses that focus on mental health care. The APNA is the largest psychiatric-mental health nursing organization, with the primary mission of advancing psychiatric-mental health nursing practice; improving mental health care for culturally diverse individuals, families, groups, and communities; and shaping health policy for the delivery of mental health services. The ISPN consists of four specialist divisions: The Association of Child and Adolescent Psychiatric Nurses, International Society of Psychiatric Consultation Liaison Nurses, Society for Education and Research in Psychiatric-Mental Health Nursing, and Adult and Geropsychiatric-Mental Health Nurses. Although a large professional nursing organization, the American Nurses Association (ANA) focuses on addressing the emergent needs of nursing in general. The ANA supports psychiatric-mental health nursing practice through liaison activities and working closely with psychiatric-mental health nursing organizations.

The nurse recognizes that the difference between a voluntary and an involuntary commitment is what?

An involuntarily committed client may not initiate his or her own discharge Explanation: An involuntary commitment prevents a client from initiating his or her own discharge, so this is the correct answer. A voluntarily committed client is not necessarily less aggressive than a client committed involuntarily. Both voluntarily and involuntarily committed clients may refuse treatment. And, while insight may be a factor that leads to a voluntary commitment, the voluntarily committed client may or may not possess this.

A nurse recruiter is interveiwing a nurse for a psychiatric-mental health nursing position at the community clinic. When reviewing the applicant's educational background, the recruiter would identify which as the preferred level of preparation?

Bachelor's degree Explanation: The preferred educational preparation is at the baccalaureate level with credentialing by the American Nurses Credentialing Center.

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 Explanation: All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client's informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove they did not consent to the procedure, providers did not give adequate information for a decision, or the treatment exceeded the scope of the consent.

Which is the most important reason for psychiatric nurses to understand law, legislation, and legal processes that relate to professional nursing practice?

Because doing so gives the nurse the ability to provide quality care that will safeguard the rights and safety of clients. Explanation: Nurses practice under the Code of Ethics and the Scope of Practice. Nurses must learn to value, respect, and develop knowledge about laws, legislation, and the legal processes that regulate, impede, and facilitate professional nursing practice.

A client with persistent depression is considering electroconvulsive therapy (ECT). The nurse has seen ECT be effective in other cases. When the client expresses fear and doubt about undergoing ECT, the nurse tries to talk the client into it, because the nurse truly believes it will help the client. Which two ethical concepts are in conflict?

Beneficence and autonomy Explanation: Beneficence and autonomy are in conflict. Beneficence is practicing with the intent to do good; however, professionals define how to do good, which may override the wishes and self-determination of the client. Autonomy is the client's right to make decisions for himself or herself. Justice refers to fairness; that is, treating all people fairly and equally without regard for social and economic status, race, sex, marital status, religion, ethnicity and cultural beliefs. Fidelity is the nurse's faithfulness to duties, obligations, and promises.

A new nursing student correctly identifies which as most essential for guiding psychiatric-mental health nursing actions?

Code of Ethics for Nurses Explanation: Psychiatric-mental health nursing actions are guided by the Code of Ethics for Nurses.

The inappropriate use of restraints or seclusion is considered which form of intentional tort?

False imprisonment Explanation: False imprisonment is defined as the unjustified detention of a client, such as the inappropriate use of restraint or seclusion. Battery involves harmful or unwarranted contact with the client. Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Causation occurs when a breach of duty was the direct cause of loss, damage, or injury.

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

Human Explanation: *Human restraint* is when staff members physically control the client and move him or her to a seclusion room. A *mechanical restraint* is a device, usually ankle or wrist restraints, fastened to a bed frame to curtail the client's physical aggression. *Long- and short-term restraint* refers to the time frame for the use of the restraint.

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

Involuntary commitment to an outpatient community mental health center Explanation: An example of the concept of "least restrictive environment" is the involuntary commitment of a client to an outpatient mental health center. Medications cannot be given unnecessarily, such as to keep a client in bed. An individual cannot be restrained or locked in a room unless all other "less restrictive" interventions are attempted first. Placing a client in a locked inpatient unit would also not be considered the "least restrictive."

Which statement accurately describes the insanity defense?

It is rarely successful Explanation: In actuality, this defense can be used only when the person meets the criteria for an insanity defense. So it is used infrequently and is not usually successful.

While performing the admission assessment of a new client, the nurse observed that the client brought a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or remove the medication from the room. Subsequently, the client experienced a serious adverse drug reaction as a result of the interaction between this drug and one of the drugs that the client was prescribed in the hospital. This nurse may be guilty of what?

Malpractice Explanation: The four elements of nursing malpractice are evident in this scenario. Assault is an act that puts another person in apprehension of being touched (or of bodily harm without consent), and failure of duty to warn surrounds a client's threat to harm another person. Incompetence, in the legal sense, surrounds a client's right to autonomy.

A client is being discharged but still needs close supervision. Which type of involuntary commitment would be appropriate for this client?

Outpatient Explanation: An outpatient involuntary commitment would be appropriate for this client. The client is stable enough for discharge but still needs to be closely monitored. An emergency, observational, or extended involuntary commitment would not be appropriate for this client.

To care for clients in the least restrictive environment, treatment is usually delivered in which care setting?

Outpatient Explanation: Treatment is usually delivered in the community (as opposed to a hospital or institution) and, ideally, in an outpatient setting.

A hospital client has attributed the long-standing struggle with depression to the fact that the client was sexually abused by the client's father as a child and early adolescent. The client has admitted to the nurse that the client intends to seek out the father and "do some justice." What is the nurse's primary responsibility in response to the client's threat?

Report the client's threat to the appropriate authorities. Explanation: Nurses have a duty to report threats of harm so that appropriate action may be taken. This action may vary from state to state, but the duty to report threats of violence supersedes the client's right to privacy.

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 Explanation: In Tarasoff v. Regents of the University of California, the high court said that psychotherapists have a duty to warn the foreseeable victims of their clients' violent actions. The acts listed do not specify a duty to warn.

A client with bipolar disorder has been following the prescribed medication regimen. The client indicates to the nurse a desire to stop the medication now that the client is feeling better. The nurse tells the client that most likely the client will have to remain on the medication for life to keep the condition under control. The nurse is practicing which principle?

Veracity Explanation: Veracity is the duty to tell the truth. In this case, the client wants to hear that the client can stop medication, but the nurse is honest and tells the client that the client will need to continue it to stay healthy.

A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which ethical principle?

autonomy Explanation: Self-determinism can be defined as being empowered or having the free will to make moral judgments. Autonomy is the right to make one's own decisions. Personal autonomy and avoidance of dependence on others are key values of self-determinism. Veracity is truthfulness. Justice encompasses equal treatment for all. Beneficence is doing no harm.

The nurse is teaching a client about the importance of adhering to a medication regimen. The client does not believe that it is important. The nurse is communicating which ethical principle?

beneficence Explanation: According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximum health care potential. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is the duty to tell the truth. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

The nurse is caring for a client after having various diagnostic tests. The client discusses a proxy being in attendance for the health care provider's diagnosis. The nurse requests a copy for the file, and allows the proxy to be in attendance with what type of document?

durable power of attorney Explanation: A durable power of attorney for health care appoints a proxy, usually a relative or trusted friend, to make health care decisions on an individual's behalf. The living will, patient rights, and informed consent are not included in the durable power of attorney. A living will is a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.

A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

justice Explanation: Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue when some portion of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth.

The client just received a diagnosis of end-stage renal disease. After hearing options, the client visited a lawyer and documented what treatment is to be held in the event that the client is unable to make decisions. The nurse asks for a copy of this document for the chart. The name of this document is:

living will Explanation: A *living will* states what treatment should be omitted or refused in the event that a person is unable to make those decisions. *Informed consent* is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. *Patient rights* are those basic rules of conduct between patients and medical caregivers as well as the institutions and people that support them. *A durable power of attorney* means that the document stays in effect if you become incapacitated and unable to handle matters on your own.

A psychiatric-mental health nurse is reading a journal article about different professional organizations and their missions. When reading a synopsis about the American Psychiatric Nurses Association, which information would the nurse expect to find? Select all that apply.

- Improves mental health care for culturally diverse persons - Helps shape health policy involving mental health services - Advance psychiatric-mental health nursing practice. Explanation: The American Psychiatric Nurses Association (APNA) is the largest psychiatric-mental health nursing organization, with the primary mission of advancing psychiatric-mental health nursing practice; improving mental health care for culturally diverse individuals, families, groups, and communities; and shaping health policy for the delivery of mental health services. The purpose of the International Society of Psychiatric Nurses (ISPN) is to unite and strengthen the presence and the voice of psychiatric-mental health nurses and to promote quality care for individuals and families with mental health problems.

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. Explanation: The nurse serves as the client's advocate, the team's colleague, and the facility's excellent employee by continually evaluating the client's ability to give informed consent and his or her willingness to participate and continue with a treatment modality. Unless serving as the primary provider, the nurse is not responsible for obtaining informed consent. That is the role of the primary provider.

A client admitted with a psychiatric disorder has a problem sharing private thoughts and innermost feelings with the nurse. The client says that there still is societal stigma about mental illness and the client fears the nurse might be tempted to breach what?

Confidentiality Explanation: Many clients are concerned about their right to privacy. There still is a stigma attached to mental illness. These issues lead to concerns of clients regarding their confidentiality.

Malpractice is proven when certain criteria have been met. Which list includes the correct criteria?

Duty of care, professional performance, injury related to the nurse's action, action foreseeably could have caused the injury, and proven injury Explanation: Malpractice includes the following elements of nursing negligence: - the nurse professional had a duty of due care toward the plaintiff; - the nurse professional's performance fell below the standard of care and was, therefore, a breach of that duty; - as a result of the failure to meet the standard of care, the plaintiff consumer was injured, and the nurse's action was the proximate cause of the injury; - the plaintiff consumer must prove his or her injuries.

Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members?

Danger to others. Explanation: Duty to warn refers to the responsibility of the nurse or the health care provider to warn identifiable third parties of threats made by clients. If the client is dangerous to any other member, the nurse is supposed to notify the person in danger immediately about the client's ideation. This law is not applicable to the client who has suicidal ideation, is extremely aggressive, or is unwilling to take medications. Client confidentiality is a very strict policy that should be abided by the nurses in any other circumstances.

A client in a psychiatric facility has ideations about killing the client's spouse. This client requests to be discharged from the facility. Which represents the most appropriate action? The health care provider should:

File for a civil commitment to detain. Explanation: Every client in a health care facility has a right to request to be discharged. If a client has suicidal ideations or is a danger to others, then the client should be under close supervision at all times. The health care provider should file a civil commitment to detain the client against the client's will until a hearing takes place to decide the matter. The caregivers may not understand the situation of the client and the danger that the client poses for the family. Thus, it would be inappropriate for the health care provider to ask the caregivers for consent.

A client was admitted to a psychiatric facility because the client was found walking around naked and talking incoherently. The client has no known next of kin and has been adjudicated incompetent. The client refuses any antipsychotic medications but has not been harmful to the self or others. What action should the facility take?

Initiate court proceedings to have a guardian named. Explanation: When a client cannot give informed consent due to mental illness, health care providers must obtain substituted consent for necessary treatments or procedures. Substituted consent is authorization that another person gives on behalf of a client who needs a procedure or treatment but who cannot provide such consent independently. Substituted consent can come from a court-appointed guardian or, in some instances, from the client's next of kin. If the client has not previously been adjudicated incompetent and no next of kin are available to give substituted consent, if the law so permits, the health care agency may initiate a court proceeding to appoint a guardian so that treatment professionals can carry out the procedure or treatment.

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

Justice Explanation: Justice becomes an issue in mental health when a segment of a population does not have access to health care. Fidelity is faithfulness to obligations and duties. Autonomy is the fundamental right of self-determination. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

A client comes to the emergency department with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which principle is being ignored by discharging this client?

Justice Explanation: Justice is the duty to treat all clients fairly. It can become an ethical issue in mental health when a segment of the population does not have access to care, as in this case, in which access to inpatient care is warranted but denied.

A psychiatric-mental health nurse is working with local government officials in establishing programs that allow access to services for all individuals in the community. The nurse is integrating which ethical principle?

Justice Explanation: Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue in mental health when a segment of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individual and for all. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties, that is, keeping promises.

Which ethical principle requires a nurse to prevent clients from harming themselves or others?

Nonmaleficence Explanation: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Beneficence refers to one's duty to benefit or promote good for others. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness.

The interdisciplinary team is discussing the best approach to planning the care for a client with complex psychiatric-mental health needs. When determining which tasks can be performed by the psychiatric-mental health registered nurse (PMH-RN) and which must be performed by the psychiatric-mental health advanced practice registered nurse (PMH-APRN), the team should prioritize guidelines from what source?

The American Nurses Association Standards of Practice Explanation: The American Nurses Association standards outline the scope of practice for PMH-RNs and PMH-APRNs. These standards override institutional policies and local norms. There is no World Health Organization Guidelines for Nursing Practice.

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. Explanation: Competent clients have the right to refuse medication. Even thought the client is an involuntary admission, the client is competent and able to be involved in treatment planning. Because the client was admitted involuntarily, the client is not able to obtain release. The client who is legally declared incompetent is given a court appointed guardian or representative who is responsible for giving consent. A client is considered competent unless the court has declared that the client is incompetent. The client who is incompetent is not able to give or refuse consent for treatment.

A client with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the way it makes me feel, I feel like I'm under water when I take it." The nurse explains, "schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. Your symptoms will get better if you take the medication." This conversation reflects conflict between which ethical principles?

autonomy and beneficence Explanation: According to the principle of autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. The client has the right to decide whether or not to take the medication. The nurse knows that the medication will help the chemical imbalance and thus help with the manifestations of schizophrenia. There is no conflict between the ethical principles of Justice and nonmaleficence, autonomy and justice, and fidelity and veracity.

A nursing student is initiating a relationship with an assigned client. After meeting and spending approximately 20 minutes talking with the client, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of clients to play volleyball. The student starts to go with them but then remembers the promise to meet with the client. The student decides to forgo volleyball and talk with the client. The student's decision reflects which ethical principle?

fidelity Explanation: Fidelity is faithfulness to obligations and duties. It is keeping promises. Fidelity is important in establishing trusting relationships. With autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, a health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Veracity is the duty to tell the truth.

The client is brought to the hospital in a coma. The nurse understands that when a person is incapacitated, the document used to dictate the patient's written instructions for health care is called:

advance directive Explanation: Advance care directives are written instructions for health care when individuals are incapacitated. Informed consent, durable power of attorney, and patient rights are not instructions for health care when individuals are incapacitated. A durable power of attorney means that the advance care directives stays in effect if you become incapacitated and unable to handle matters on your own. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them.

A client diagnosed with schizophrenia insists on stopping medication because it causes the client to gain weight. The client is exercising which ethical principle?

autonomy Explanation: The client is exercising autonomy and is making the client's own decision to stop taking the medication. Although it is probably not in the client's best interest, the client does have that right. According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is faithfulness to obligation and duties.

A 22-year-old client with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it." The nurse explains to the client, "Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better." This conversation reflects a conflict between which two types of ethical principles?

autonomy and beneficence Explanation: Ethical conflicts can occur when the client is being guided by the principle of autonomy and the nurse by the principle of beneficence. According to the principle of autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, the health care provider uses knowledge of science, and incorporates the art of caring, to develop an environment in which individuals achieve their maximal health care potential. Justice involves a duty to treat all fairly. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client. Veracity is the duty to tell the truth. Nonmaleficence is the duty to cause no harm.

The nurse is complaining about a client that has dementia. The client is mobile and slaps the nurse on the gluteus maximus each time he passes by. The nurse tells the client, "If you don't behave yourself, I am going to throw you out and you won't have anywhere to go." The charge nurse overhears the nurse, and states "Do you realize what your statement could be construed as?" What is the best statement for the nurse to respond?

"It could be construed as assault" Explanation: *Assault* involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Battery, negligence, and intentional harm do not involve actions that make a person to fear being touched or physically injured without consent. *Battery* is the intentional act of causing physical harm to someone. *Negligence* is when a nurse who is fully capable of caring does not care in the way a reasonably prudent nurse would, and as a result the patient suffers unnecessarily. *Unintentional harm* is used to refer to injuries that were unplanned.