Professional Communications Chapter 9-Legal and Ethical Issues (PREPU)
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." "I get really 'turned on' by your appearance." "I think that the federal government is spying on me." "That doctor I had today really made me angry."
"When I get out of here, I'm going to kill my neighbor." Explanation: When there is a judgment that a client has harmed someone or is about to injure someone, a nurse is mandated to breach confidentiality and report this to the authorities. The statement about killing the neighbor is an example. Thinking that the federal government is spying on the person reflects paranoid thinking. The statement about being "turned on" reflects manipulative behavior. The statement about feeling angry about the doctor provides information about the client's feelings. The nurse would be mandated to report this statement only if the client went on to say that he or she was planning to "hurt" the doctor.
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? "Sure, give me your address, and I will see that the information is sent to you." "I am unable to acknowledge whether or not this client is a client on this unit." "I'll have to get the client's signed consent before we can send that information to you." "I'm sorry; we're not allowed to give out that information about our client."
"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? "Client states that he had a good night with no issues." "Reports being unable to sleep because the client heard voices throughout the night." "Had a typical night without incidence of insomnia or nightmares." "Acted crazily throughout the night; kept hearing voices and noises."
"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.
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? Parent surrogate Caregiver Teacher Advocate
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.
What conclusion can be drawn when a client is involuntary secluded? The seclusion will be terminated in 4 hours or less Sedating medication has been administered The client is unaware of their surroundings All other appropriate measures to manage the client have failed
All other appropriate measures to manage the client have failed Explanation: When a client is placed in seclusion it is because all other appropriate measures to manage the client have failed. None of the remaining options suggest correct assumptions.
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? Beneficence Assault Battery Fidelity
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.
A new nursing student correctly identifies which as most essential for guiding psychiatric-mental health nursing actions? Code of Ethics for Nurses State laws Personal beliefs Federal laws
Code of Ethics for Nurses Explanation: Psychiatric-mental health nursing actions are guided by the Code of Ethics for Nurses.
Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members? Extremely aggressive. Unwilling to take medications. Danger to others. Suicidal ideation.
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.
When promoting client safety on an inpatient psychiatric unit, which interventions would be used as the measure of last resort? Room restriction Surveillance Four-point restraint Seclusion
Four-point restraint Explanation: Four-point restraint is the most restrictive of the interventions mentioned above, with surveillance being the least. When promoting safety, the method of last resort would be the most restrictive measure.
What is the therapeutic goal of seclusion? Give the client the opportunity to gain self-control Promote thoughtful reflection regarding behavior Punish the client for bad behavior Allow the nurse to monitor for side effects of medications
Give the client the opportunity to gain self-control Explanation: The goal of seclusion is to give the client an opportunity to regain physical and emotional self-control. Clients are not to be punished for behaviors. The client who meets the criteria for seclusion is not in the emotional state to engage in self-reflection. Seclusion is used for the purpose of assuring client and staff safety.
When staff members physically control the client and move him or her to a seclusion room, what form of restraint is being implemented? Long term Mechanical Human Short term
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
One way that nurses can protect themselves against liability from malpractice is to do what? Request legal consultation from the employer. Carry individual malpractice insurance. Avoid documenting incriminating information. Know the statutory and professional standards.
Know the statutory and professional standards. Explanation: To decrease their chances of liability for malpractice, psychiatric nurses must ensure that their professional practice is within the bounds of 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? Assault Malpractice Failure of duty to warn Incompetence
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 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? Health promotion Counseling Intake screening Psychotherapy
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 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 is considered incompetent. The client can obtain release against medical advice. The client can refuse medication. The client is in need of a public guardian.
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 who was admitted to the facility voluntarily has requested to be discharged and allowed to return home. The health care provider files for a civil commitment to hold the client in the hospital. What is the most likely reason to file this action? The client needs to be monitored regularly for vital signs. The client requires psychotherapy. The client needs medications to be administered on time. The client has suicidal ideation.
The client has suicidal ideation. Explanation: Clients who have voluntarily admitted themselves to the hospital may leave unless they pose a threat to others or themselves. If the client has expressed serious thoughts about committing suicide, the health care provider may file for civil commitment to detain. Psychotherapy sessions can be completed on an outpatient basis so that the client could come for the session and go back home after the sessions. Additionally, the client's vital signs can be monitored on an outpatient basis. The regimen for drug administration can be explained to the caregivers of the client.
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 community health care lectures on the disorder. The client must attend specific group therapy programs. The client can decide whether to join the assisted outpatient treatment program. The client must take prescribed medications as per the dosing schedule.
The client must take prescribed medications as per the dosing schedule. The client must attend specific group therapy programs. The client must attend the follow ups as per the schedule. Explanation: The assisted or mandated outpatient treatment program requires that the client attend all the follow-up sessions and join specific group therapy sessions that could help the client to function better in the community. The client must also take prescribed medications as per the dosing schedule. The assisted outpatient treatment does not require that the client has to attend all community health care lectures on the disorder. The assisted outpatient treatment is a mandatory program; the client has to attend the program irrespective of his or her willingness.
A nurse is teaching about assisted outpatient treatment to the caregivers of the client in the psychiatric facility. What are the benefits of this treatment program? Select all that apply. The client would be accepting treatment voluntarily. The client would require shorter inpatient stays. The client would respond better to psychotropic drugs. The client would be protected from criminal victimization of others. The client's risk of self harm would be reduced.
The client would require shorter inpatient stays. The client would be protected from criminal victimization of others. The client's risk of self harm would be reduced. Explanation: The benefits of assisted outpatient treatment include shorter inpatient stays, reduced risk of self harm, and protection of the client from criminal victimization of others. Assisted outpatient treatment allows the client to participate in treatment on an involuntary basis after his or her release from hospital into the community. The client's response to drugs doesn't depend on the client being involved in the assisted outpatient program.
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 sedates the client with morphine. The nurse asks the client to calm down. The nurse and a group of paramedics hold the client. The nurse ties the client's wrist using wrist restraints.
The nurse and a group of paramedics hold the client. Explanation: Restraint is the direct application of physical force to restrict the client's freedom of movement. The nurse and a group of paramedics holding the client is an example of human restraint. The nurse does not apply force while telling the client to calm down. Sedating the client is an example of chemical restraint. Applying a wrist cuff to control the aggression of the client indicates the use of mechanical restraints.
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 nonmaleficence paternalism veracity
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.
A nursing student identifies which as the most important tool of psychiatric nursing? Plan of care Reflection Clinical reasoning Self
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.
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 client's actions played a part in the nurse's reaction The nurse was responsible for a client injury that resulted in permanent disability The nurse was responsible for a client's injury and it was serious The nurse was responsible for client injury
The nurse was responsible for client injury Explanation: After it is determined that the nurse did not act responsibly in providing care in accordance with established standards of care, the remaining issue is to confirm that injury occurred as a result of the nurse's actions. That the client's injury was serious, resulted in permanent disability, and is the result of the client's actions are not part of the decision.
Which ethical principles become an issue in mental health when a segment of a population does not have access to health care? nonmaleficence fidelity veracity justice
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.
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 hospital-appointed interdisciplinary committee A guardian appointed by the court The client's primary nurse The client's psychiatrist
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.
What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)? A guideline for nurses regarding ethical conduct Pathways to follow for each of the ethical principles A description of case studies featuring ethical dilemmas Information about what to do when confronted with an ethical dilemma
A guideline for nurses regarding ethical conduct Explanation: The ANA's Code of Ethics for Nurses guides ethical decision-making.
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? Ascertaining the client's privacy Acquiring informed consent Encouraging the client to be self-determined Acting in a beneficent manner
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.
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? Obtain informed consent when the primary provider cannot be present. Talk the client out of revoking consent once the study has started. Persuade the client to consent, because the new drug has shown promising results. Assess the client's legal capacity when that client is asked to give consent.
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.
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 Veracity Beneficence Justice
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 nurse recruiter is interviewing 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? Master's degree Doctoral degree Associate's degree Bachelor's degree
Bachelor's degree Explanation: The preferred educational preparation is at the baccalaureate level with credentialing by the American Nurses Credentialing Center.
A psychiatric mental health facility is undergoing a change from paper-based health records to electronic records. What action should the nurse prioritize in order to ensure client rights are protected? Being vigilant to identify any potential threats to client confidentiality Ensuring clients know that they have the right to opt out of the proposed system Educating clients and families about the potential benefits of the new system Teaching clients that they may lose the right to view their health records under the new system
Being vigilant to identify any potential threats to client confidentiality Explanation: Electronic health records present potential threats to confidentiality that must be addressed. It would not be possible for a client to opt out of a documentation system. Teaching clients about the benefits of health records does not directly address client rights. Clients never lose the right to view their health records.
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 Veracity Justice Autonomy
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 people achieve their maximal health care potential. According to the principle of autonomy, each person has the fundamental right of self-determination. Justice is the duty to be treated fairly. Veracity is the duty to tell the truth.
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 Autonomy Veracity Justice
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."
The inappropriate use of restraints or seclusion is considered which form of intentional tort? False imprisonment Battery Causation Assault
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.
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? Defamation False imprisonment Assault Battery
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? Veracity Beneficence Nonmaleficence Fidelity
Fidelity Explanation: Fidelity involves keeping promises. Veracity is truth-telling while beneficence is doing good and nonmaleficence is avoiding harm.
A nurse tells a client that the nurse will bring the client pain medicine in 5 minutes after checking on another client. The nurse returns in 5 minutes and administers the medication as planned. The nurse is practicing which principle by returning as promised? Fidelity Autonomy Paternalism Nonmaleficence
Fidelity Explanation: Fidelity is faithfulness to obligations and duties. It is keeping promises and is important in establishing trusting relationships.
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: Ask the caregivers of the client for consent. File for a civil commitment to detain. Allow the client to go home. Not accept the client's request.
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? Give the client medications by depot injection. Contact social services to find outpatient housing. Continue custodial care. Initiate court proceedings to have a guardian named.
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 Fidelity Autonomy Paternalism
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.
When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what? Informed consent Nonmaleficence Self-determination Pro-choice
Nonmaleficence Explanation: Nonmaleficence is the principle of creating no harm. It refers to preventing or minimizing harm to an individual. The other options do not represent the situation presented in the question.
Which ethical principle focuses on the duty to do no harm? Autonomy Beneficence Nonmaleficence Justice
Nonmaleficence Explanation: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness. Beneficence refers to one's duty to benefit or promote good for others.
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 Public Law 99-319, The Protection and Advocacy for Mentally Ill Individuals Act of 1986 The Patient Self-Determination Act The Mental Health Systems Act of 1980
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.
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 World Health Organization Guidelines for Nursing Practice The American Nurses Association Standards of Practice The policies and procedures manual of the institution The recognized norms in the jurisdiction where the team is working
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 22-year-old client has voluntarily sought treatment for an eating disorder at a rural residential facility. Despite a promising start, the client has been involved in recent conflicts with staff members and insists that the client wants to leave the facility. Staff members have refused to facilitate the client's transportation from the facility and have stated that they will not return the client's money and identification that were held when the client was admitted. Staff at the treatment facility may be guilty of false imprisonment due to what? The client's diagnosis is not psychiatric in etiology. The client voluntarily admitted for treatment. The client's diagnosis is not terminal. The facility is in an inaccessible location.
The client voluntarily admitted for treatment. Explanation: False imprisonment is the intentional and unjustifiable detention of a person against his or her will. The client voluntarily sought treatment and is not a physical threat to the self or others. The client's prognosis and the location of facility are not among the criteria for false imprisonment. Eating disorders are psychiatric illnesses.
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 the differences between these two types of admissions? They cannot refuse treatment. They are not considered a danger to themselves or others. They have agreed to the hospitalization. They can leave the hospital whenever they want.
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.
Professional regulations and laws that govern nursing practice are in place for what reason? To limit the number of nurses in practice To ensure that practicing nurses have strong interpersonal skills To protect the safety of the public To ensure that enough new nurses are always available
To protect the safety of the public Explanation: Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.
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 Fidelity Justice Autonomy
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.
An adolescent client has refused to wash or change clothes for several days. The client's hair is greasy, the client's clothes are stained, and the client has a strong malodor. Three male staff members approach the client to escort the client to the shower. The client resists and becomes combative with staff members. The client is placed in seclusion and is told the client will be released when the client is calm and willing to shower. Which is an accurate statement of the client's rights in this situation? Violated, primarily because showering is a personal preference Not violated, because the client's combative behavior warranted seclusion and restraint to protect others Not violated, because hygiene is an important aspect of treatment Violated, primarily because of the inappropriate use of restraints
Violated, primarily because of the inappropriate use of restraints Explanation: Clients have the right to treatment in the least restrictive environment. No staff can confine a person with mental illness who is not a threat to self or others. Nurses must assess a client's condition and status constantly so that health care professionals can initiate more or less restrictive treatment alternatives based on the client's evolving needs.
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. Offer the client medication to help with anxiety and impulsive feelings. Have the client sign a safety contract. Hold all psychotherapeutic content under strict confidence.
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 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? paternalism and veracity autonomy and justice autonomy and beneficence justice and nonmaleficence
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.
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? veracity fidelity autonomy beneficence
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.
