NU245- Chapter 9: Legal and Ethical Issues
When it is discovered that a nurse did not act reasonably when providing care in accordance with the standards of professional practice, which factor would confirm the nurse has been negligent?
The nurse was responsible for client injury
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
Client charts are legal documents that can be used in court; therefore, all nursing notes and progress records should above all include which information?
Reflect descriptive, nonjudgmental, and objective statements.
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.
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
A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what?
Battery
The client has been admitted to the hospital involuntarily for the treatment of depression. Which criteria provides legal justification for the client's involuntary admission?
The client poses a threat to the self.
A client with a psychiatric illness has become extremely aggressive and the nurse decides that the client needs to be restrained. Which action would be considered human restraint?
The nurse and a group of paramedics hold the client.
ethical dilemma
a situation in which ethical principles conflict or when there is no one clear course of action in a given situation
utilitarianism
a theory that bases ethical decisions on the "greatest good for the greatest number" primary consideration is on the outcome of the decision
deontology
a theory that states ethical decisions should be based on whether or not an action is morally right with no regard for the result or consequences
malpractice
a type of negligence that refers specifically to professionals such as nurses and physicians
tort
a wrongful act that results in injury, loss, or damage
Which elements are necessary to prove liability in a malpractice lawsuit? a. Client is injured b. Failure to conform to standards of care c. Injury caused by breach of duty d. Injuries must be visible and verified e. Nurse intended to cause harm f. Recognized relationship between client and nurse
a. Client is injured b. Failure to conform to standards of care c. Injury caused by breach of duty f. Recognized relationship between client and nurse
Which elements are essential in a clinician's duty to warn? a. Client makes threatening statements b. History of violence c. Potential victim(s) are identifiable d. Potential victim is easy to locate e. Threat is not a delusion f. Threat of harm is serious
a. Client makes threatening statements c. Potential victim(s) are identifiable f. Threat of harm is serious
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
Which state allows for an insanity defense?
Iowa
Providing milieu therapy is an example of the use of which ethical principle?
beneficence
beneficence
refers to one's duty to benefit or to promote good for others
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."
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"
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."
A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client states:
"When I get out of here, I'm going to kill my neighbor."
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
What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)?
A guideline for nurses regarding ethical conduct
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
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
A physician would like to include a client with schizophrenia in a research study testing a new medication. The nurse's obligation is to do what?
Assess the client's legal capacity when that client is asked to give consent.
A client informs the nurse that the client is feeling better and does not want to take antidepressant medication. This client is exhibiting which ethical principle when making this decision?
Autonomy
A client who has bipolar disorder stops taking medication because the client says the client likes how the client feels in a manic state. The client is exercising which principle?
Autonomy
A client is being seen in the mental health clinic because of relapse. The client has been nonadherent with the medication regimen. The nurse reinforces the advantages of taking medications. The nurse is using which ethical principle?
Beneficence
Which is indicative of a voluntary admission?
Client makes an autonomous decision to seek inpatient treatment
A psychiatric-mental health nurse is reviewing the Standards of Practice and the competencies listed for each standard. Which information would the nurse most likely find? Select all that apply.
Collection and synthesis of health data Plan for strategies and alternatives for outcome achievement Data analysis to determine focus areas for treatment
Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members?
Danger to others.
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
A group of students is preparing a class presentation about negligence. Which would the group include as an element required for proving professional negligence? Select all that apply.
Duty to provide care Predictability Resultant damages Breach of duty Resulting injury
According to the decision in Tarasoff vs. Regents of the University of California, which takes precedence when a client admits to wanting to kill another person?
Duty to warn
Principles that serve as codes of conduct about right and wrong behaviors to guide actions are known as what?
Ethics
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
ethics
a branch of philosophy that deals with values of human conduct related to the rightness or wrongness of actions and to the goodness and badness of the motives and ends of such actions
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
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.
What is the therapeutic goal of seclusion?
Give the client the opportunity to gain self-control
When staff members physically control the client and move him or her to a seclusion room, what form of restraint is being implemented?
Human
A client was brought to the emergency department by police after neighbors reported him being loud and disruptive. The client is agitated and is extremely upset. The client states, "No one can be trusted." Which decision about about whether to involuntarily admit the client would be most appropriate?
Involuntary admission is inappropriate because the client does not meet the necessary criteria.
Which ethical principle is in jeopardy when segments of the mentally ill population do not have access to care?
Justice
One way that nurses can protect themselves against liability from malpractice is to do what?
Know the statutory and professional standards.
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
When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what?
Nonmaleficence
Which ethical principle focuses on the duty to do no harm?
Nonmaleficence
A client is being discharged but still needs close supervision. Which type of involuntary commitment would be appropriate for this client?
Outpatient
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
A nursing student identifies which as the most important tool of psychiatric nursing?
Self
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
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
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.
A nurse is explaining assisted outpatient treatment to a client who is being discharged from the hospital. Which instructions should the nurse give the client regarding the assisted outpatient treatment? Select all that apply.
The client must attend the follow-ups as per the schedule. The client must attend specific group therapy programs. The client must take prescribed medications as per the dosing schedule.
Which situations depict a nurse employing the principles of fidelity while providing care? Select all that apply.
The nurse tells the client, "I will return to give you pain medication in 1 hour." The nurse returns in 1 hour.
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.
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.
Professional regulations and laws that govern nursing practice are in place for what reason?
To protect the safety of the public
The client who is involuntarily committed to an inpatient psychiatric unit loses which right? a.Right to freedom b.Right to refuse treatment c.Right to sign legal documents d.The client loses no rights
a. Right to freedom
A client has a prescription for haloperidol, 5 mg orally two times a day, as ordered by the physician. The client is suspicious and refuses to take the medication. The nurse says, "If you don't take this pill, I'll get an order to give you an injection." The nurse's statement is an example of a. assault. b. battery. c. malpractice. d. unintentional tort.
a. assault
causation
action that constitutes a breach of duty and was the direct cause of the loss, damage, or injury in other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner
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
negligence
an unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances
standards of care
authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable the care that nurses provide to clients meets set expectations and is what any nurse in a similar situation would do
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
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
A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which ethical principle?
autonomy
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
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
A nurse is reviewing the Standards of Professional Performance. Which area would the nurse most likely find being addressed?
communication
A hospitalized client is delusional, yelling, "The world is coming to an end. We must all run to safety!" When other clients complain that this client is loud and annoying, the nurse decides to put the client in seclusion. The client has made no threatening gestures or statements to anyone. The nurse's action is an example of a. assault. b. false imprisonment. c. malpractice. d. negligence.
b. false imprisonment
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
Which would indicate a duty to warn a third party? a. A client with delusions states, "I'm going to get them before they get me." b. A hostile client says, "I hate all police." c. A client says he plans to blow up the federal government. d. A client states, "If I can't have my girlfriend back, then no one can have her."
d. A client states, "If I can't have my girlfriend back, then no one can have her."
The nurse gives the client quetiapine (Seroquel) in error when olanzapine (Zyprexa) was ordered. The client has no ill effects from the quetiapine. In addition to making a medication error, the nurse has committed which? a. Malpractice b. Negligence c. Unintentional tort d. None of the above
d. None of the above
duty
existence of a legally recognized relationship, that is, physician to client, nurse to client
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
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
assault
involves any action that causes a person to fear being touched, without consent or authority, in a way that is offensive, insulting, or physically injurious
battery
involves harmful or unwarranted contact with a client actual harm or injury may or may not have occurred
Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who:
is screaming in the street and disturbing neighbors.
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
Which ethical principles become an issue in mental health when a segment of a population does not have access to health care?
justice
A psychiatric-mental health nurse is reviewing the medical record of a client who was involuntarily committed to the mental health unit of the hospital. The nurse determines that the client was most likely involuntarily committed for which reason?
ranting and waving a loaded gun in a crowded mall
justice
refers to fairness, or treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs
fidelity
refers to the obligation to honor commitments and contracts
injury or damage
the client suffered some type of loss, damage, or injury
restraint
the direct application of physical force to a person, without his or her permission, to restrict his or her freedom of movement
veracity
the duty to be honest or truthful
duty to warn
the exception to the client's right to confidentiality when health care providers are legally obligated to warn another person who is the target of the threats or plan by the client, even if the threats were discussed during therapy sessions otherwise protected by confidentiality
seclusion
the involuntary confinement of a person in a specially constructed, locked room equipped with a security window or camera for direct visual monitoring
breach of duty
the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty the nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances
autonomy
the person's right to self-determination and independence
nonmaleficence
the requirement to do no harm to others either intentionally or unintentionally
false imprisonment
the unjustifiable detention of a client, such as the inappropriate use of restraint or seclusion
least restrictive environment
treatment appropriate to meet the client's needs with only necessary or required restrictions
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
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
