Psych: Chapter 9 Legal Issues, Psych CH9

The insanity defense is used in approximately how many criminal cases? a) 1% b) 50% c) 20% d) 10%

A The insanity defense is used approximately in 1% of criminal cases.

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? Justice Autonomy Veracity Beneficence

Autonomy 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 new nursing student correctly identifies which of the following as most essential for guiding psychiatric-mental health nursing actions? a) Federal laws b) Code of Ethics for Nurses c) Personal beliefs d) State laws

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

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'll have to get the client's signed consent before we can send that information to you." "I am unable to acknowledge whether or not this client is a client on this unit." "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." 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.

The nursing ethics committee is reviewing the ethical principle of justice. One committee member states, "What are some examples of justice?" Which statement(s) by the nurse exemplifies justice? Select all that apply. "Nurses should do no harm during the course of care." "Nurses should uphold the ANA's Code of Ethics." "Nurses should make sure that all clients have a meal if they are permitted to eat." "Nurses should encourage clients to stop smoking." "Nurses should be fair when they distribute care among the clients that they are assigned."

"Nurses should be fair when they distribute care among the clients that they are assigned." "Nurses should make sure that all clients have a meal if they are permitted to eat." Justice is the duty to treat all fairly, distributing the risks and benefits equally. Basic goods should be distributed, so that the least advantaged members of society are benefited. The other phrases, "Nurses should do no harm during the course of care," "Nurses should uphold the ANA's Code of Ethics" and "Nurses should encourage clients to stop smoking" are not examples of justice.

A nursing manager is holding a staff meeting and talking about ethical principles. The nurse manager asks, "Which example of an ethical principle is accurately paired with nursing practice?" Which statement by the staff nurse would be correct? "The nurse is always truthful and honest." "The nurse treats all clients fairly." "The nurse encourages clients to make choices about health care." "The nurse takes action to promote clients' health."

"The nurse treats all clients fairly." Justice is the duty to treat all fairly, distributing the risks and benefits equally. Nursing examples include doing equally for all clients and not giving more attention or supplies to one person over another. "The nurse is always truthful and honest" is an example of non-maleficence, "The nurse takes action to promote clients' health" is an example of autonomy and "The nurse encourages clients to make choices about health care" is an example of fidelity. These statements not paired with the correct nursing practice.

When it is discovered that a nurse did not act reasonably when providing care that is compatible with the standard of nursing care, the remaining factor that would confirm that the nurse acted negligently is whether ... a) The nurse was responsible for client injury b) The client's actions played a part in the nurse's reaction c) The injury results in permanent disability d) The client's injury was serious

A 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.

Dr. Smith, a psychotherapist, hears her 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 the woman!" Dr. Smith ... a) must warn the client's wife, based on the Tarasoff rule. b) may be anxious, but since the client did not say he would kill his wife, must hold the client's statements in confidence. c) is bound to hold all psychotherapeutic content under strict confidence. d) must keep this confidential because the client made a disclaimer that he would never do it.

A Confidentiality must be broken if there are viable threats made against another person's safety.

A client 22 years of age with schizophrenia is refusing his antipsychotic medication. He 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 him, "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? a) Autonomy and beneficence b) Justice and nonmaleficence c) Paternalism and veracity d) Autonomy and justice

A 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.

Which of the following rights could the psychiatric client lose when admitted to a locked, inpatient psychiatric treatment facility? a) Right to schedule his or her own time b) Right to safety from harm c) Right to send and receive mail without censorship d) Right to communicate with an attorney

A If a client is admitted to a locked unit, he or she is deemed of harm to self or others. In the case of potential harm to self or others, the client loses the rights to refuse treatment, including attending scheduled activities.

The nurse is caring for a client who has been physically restrained for aggressive behavior. The nurse tells the client's caregiver to remove the restraints temporarily from the limbs after every hour. What is the most appropriate reason for this? a) Removing the restraints will facilitate blood supply. b) Removing the restraints will increase client comfort c) Removing the restraints would reduce the aggression in the client. d) Removing the restraints will increase client activity.

A If a client is physically restrained, the restraints are removed hourly to exercise the limbs. This will facilitate the blood supply of the limb which may have been impeded because of using restraints. The purpose of removing the physical restraints is not to make the client comfortable. Removal of restraints would not be useful to reduce the aggression in the client. The restraints are applied because of the client's hyperactivity (aggression) thus removing the restraints is not useful to increase client activity.

As a result of the increasing severity of her 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) A guardian appointed by the court b) The client's primary nurse c) A hospital-appointed interdisciplinary committee d) The client's psychiatrist

A 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.

All but which of the following states have abolished the insanity defense? a) Iowa b) Utah c) Idaho d) Montana

A Iowa has not abolished the insanity defense. Idaho, Montana, and Utah have abolished this defense.

What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)? a) A guideline for nurses regarding ethical conduct b) Information about what to do when confronted with an ethical dilemma c) A description of case studies featuring ethical dilemmas d) Definitions of ethical principles and how they relate to nursing practice

A The ANA's Code of Ethics for Nurses guides ethical decision-making.

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 she was prescribed in the hospital. This nurse may be guilty of what? a) Malpractice b) Assault c) Failure of duty to warn d) Incompetence

A 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.

The goal of seclusion is to a) Give the client the opportunity to gain self-control b) Allow the nurse to monitor for side effects of medications c) Promote thoughtful reflection regarding behavior d) Punish the client for bad behavior

A The goal of seclusion is to give the client an opportunity to regain physical and emotional self-control.

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 The client's psychiatrist The client's primary nurse A guardian appointed by the court

A guardian appointed by the court 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.

The nurse is acting in accordance with the American Nurses Association principles when she does what? Select all that apply a) Shares with the client that discharge is not likely to occur this week b) Makes sure to take the client to the recreation room as promised c) Gets the client extra dessert when she reports that it is her birthday d) Encourages the client to choose when she will call her family e) Notifies the physician when a prescribed medication is not managing the client's anxiety effectively

A, B, D, E The nurse is acting in accordance with the American Nurses Association principles when he or she notifies the physician when a prescribed medication is not managing the client's anxiety effectively; shares with the client that discharge is not likely to occur this week; encourages the client to choose when she will call her family; and takes the client to the recreation room as promised. Getting the client extra dessert when she reports that it is her birthday has nothing to do with the ANA. (less)

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. a) The client would require shorter inpatient stays. b) The client would adapt better to the society. c) The client would respond better to psychotropic drugs. d) The client's risk of self-harm would be reduced. e) The client would be protected from criminal victimization of others.

A, D, E The benefits of the assisted outpatient treatment include shorter inpatient stays, reduced risk of self-harm and protection of the client from criminal victimization of others. The client is not likely to develop more social skills with the assisted outpatient treatment. The client's response to drugs doesn't depend on the client being involved in the assisted outpatient program.

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 Ascertaining the client's privacy Encouraging the client to be self-determined Acting in a beneficent manner

Acquiring informed consent 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.

What conclusion can be drawn when a client is involuntary secluded? All other appropriate measures to manage the client have failed Sedating medication has been administered The client is unaware of their surroundings The seclusion will be terminated in 4 hours or less

All other appropriate measures to manage the client have failed 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.

The nurse recognizes that the difference between a voluntary and an involuntary commitment is what? The voluntarily committed client is usually less aggressive An involuntarily committed client may refuse all treatment The voluntarily committed client usually has good insight into his or her mental health problem An involuntarily committed client may not initiate his or her own discharge

An involuntarily committed client may not initiate his or her own discharge 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 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? Persuade the client to consent, because the new drug has shown promising results. Obtain informed consent when the primary provider cannot be present. Assess the client's legal capacity when that client is asked to give consent. Talk the client out of revoking consent once the study has started.

Assess the client's legal capacity when that client is asked to give consent. 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 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 Paternalism Veracity Justice

Autonomy Autonomy is the right to make decisions for oneself. Paternalism is similar to beneficence in that the intent is to do good. Veracity is a systematic behavior of honesty and truthfulness in speech. The ethical principle of justice in health care is seen commonly as the equitableness of benefits, including the right to access care.

A nurse working on the 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 Mr. Murray's latest laboratory work and psychological testing results so Mr. Murray'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? a) "Sure, give me your address, and I will see that the information is sent to you." b) "I am unable to acknowledge whether or not a Mr. Murray is a client on this unit." c) "I'm sorry; we're not allowed to give out that information about our client." d) "I'll have to get the client's signed consent before we can send that information to you."

B 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 Mr. Murray 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 Mr. Murray is receiving care in a psychiatric hospital.

Which of the following practices places a nurse at risk for being charged with malpractice? a) Constantly working to improve communication skills b) Always attempting to provide the most economically sensitive client care c) Documenting all reasons for any deviation from the applicable standard of care d) Always treating clients with compassion and respect

B Always focusing on economically sensitive care may come into conflict with providing care required by the applicable standard of care; as such, this places a nurse at risk for being charged with malpractice. A diligent and reflective nurse can reduce the risks of malpractice by incorporating several elements into his or her practice: exhibiting excellent communication skills, treating clients with compassion and respect, and documenting reasons for deviating from applicable standards of care.

The nurse recognizes that the difference between a voluntary and an involuntary commitment is that ... a) An involuntarily committed client may refuse treatment b) An involuntarily committed client may not initiate their own discharge c) The voluntarily committed client usually has good insight into his or her mental health problem d) The voluntarily committed client is usually less aggressive

B 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 tells a client that she will bring him his pain medicine in 5 minutes after she checks on another client. The nurse returns in 5 minutes and administers the medication as planned. The nurse is practicing which of the following principles by returning as promised? a) Autonomy b) Fidelity c) Nonmaleficence d) Paternalism

B Fidelity is faithfulness to obligations and duties. It is keeping promises and is important in establishing trusting relationships.

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 she will adhere to the contract in the future. The second nurse's behavior may have violated which ethical principle? a) Veracity b) Fidelity c) Autonomy d) Beneficence

B 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.

Which of the following occurs when staff members physically control the client and move him or her to a seclusion room? a) Mechanical restraint b) Human restraint c) Battery d) Abuse

B 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. Battery involves harmful or unwarranted contact with the client.

The depressed client is deciding which type of treatment would be beneficial for him. The nurse would document that the client is utilizing which of the following ethical principles in this situation? a) Justice b) Autonomy c) Beneficence d) Veracity

B 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 psychiatric client informs the nurse that he is feeling better and does not want to take his antidepressive medication. This client is exhibiting which of the following when making this decision? a) Beneficence b) Autonomy c) Veracity d) Justice

B The client is practicing autonomy and the principle that each client has the fundamental right of self-determination.

Which client would the nurse determine to be the most likely candidate for involuntary commitment? a) The client who refuses to participate in the planned therapy b) The client who is screaming in the street disturbing neighbors c) The client with a mental disorder who is homeless d) The client who refuses to take the prescribed medication

B The client who is screaming in the street is more likely to be judged as a danger to himself or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy does not pose an immediate danger to oneself or others.

A client who was deemed to be at high risk for suicide was ordered visual checks every 15 minutes. Nurse K. had been performing these checks since the beginning of her shift but neglected to pass off this responsibility to a colleague before leaving the unit for her scheduled break. As a result, the client made a suicide attempt while Nurse K. was off the unit. Which ethical principle has Nurse K. most clearly violated? a) Beneficence b) Fidelity c) Autonomy d) Veracity

B The ethical principle of fidelity implies that the nurse is faithful to duties, obligations, and promises when providing care for the client. Autonomy is related to independence in decision making, while beneficence is doing good and veracity is telling the truth.

The psychiatric nurse is particularly concerned about securing informed consent for an invasive procedure from a ... a) 25-year-old Caucasian male who has just completed alcohol withdrawal therapy b) 45-year-old Asian male who is diagnosed with antisocial personality disorder c) 60-year-old female visiting from England who experienced a panic attack d) 21-year-old African American female with a history of both physical and sexual abuse

B Violations of the ethical principles of informed consent are committed when a consenting client is not fully informed of the details of the treatment; a 45-year-old Asian male who is diagnosed with antisocial personality disorder may not be able to fully understand the details, due both to his disorder and his possible inability to understand the language. The other clients do not face such barriers and should be fully able to understand all information provided to them.

The nurse is explaining the responsibilities to a client's legal guardian. Which statements by the nurse are correct? Select all that apply. a) "You are supposed to monitor the client all the time." b) "You have to make healthcare decisions for the client." c) "You are supposed to write checks for the client." d) "You, not the client, should sign legal documents." e) "You have to make the client stay with you."

B, C, D Clients with severe mental illness are usually appointed a legal guardian or a conservator. The functions of the legal guardian include writing checks for the client, giving informed consent (making healthcare decision for the client), and entering contracts. The legal guardian need not make the client stay with himself or herself. The legal guardians are not expected to monitor the client all the time.

The nurse has used wrist and ankle restraints for a client who was extremely aggressive. What assessments should the nurse perform on a regular basis after restraining the client? Select all that apply. a) Memory b) Emotional well-being c) Skin condition d) Side effects of medication e) Peripheral circulation

B, C, D, E The nurse should perform routine assessments for the client who has been physically restrained. The assessments should include the skin condition of the client and the circulation of the client. The use of restraints could impede the peripheral blood supply and cause skin breakdown. The client should be monitored for side effects of medication. The client's emotional well-being (stability) should also be assessed to determine if the restraints can be removed. The client is physically restrained thus it would be inappropriate to assess the memory.

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? Associate's degree Master's degree Bachelor's degree Doctoral degree

Bachelor's degree 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 Assault Fidelity Beneficence

Battery 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 nurse is caring for a client in the healthcare facility. The client doesn't show signs of suicidal ideation or pose harm to others. The client wishes to leave the facility and go home. What is the most appropriate response of the nurse? a) "You could leave. I would inform the health care provider." b) "You inform the healthcare provider and leave the facility." c) "You could sign a written request for discharge." d) "The healthcare provider should assess you again before allowing your request."

C Clients admitted to a healthcare 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. Informing the health-care provider before leaving is not sufficient to obtain a discharge. Advising the client to leave and stating that the nurse would inform the health-care provider is an inappropriate suggestion. According to the law, the client has the right to be discharged even against medical advice.

The inappropriate use of restraints or seclusion is considered ... a) Battery b) Assault c) False imprisonment d) Causation

C 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.

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? a) Paternalism b) Nonmaleficence c) Justice d) Veracity

C 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.

Which ethical principle focuses on the duty to do no harm? a) Autonomy b) Beneficence c) Nonmaleficence d) Justice

C 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.

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? a) The nurse ties the client's wrist using wrist restraints. b) The nurse asks the client to calm down. c) The nurse and a group of paramedics hold the client. d) The nurse sedates the client with morphine.

C 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 client diagnosed with schizophrenia insists on stopping her medication because it causes her to gain weight. The client is exercising which ethical principle? a) Veracity b) Justice c) Autonomy d) Beneficence

C The client is exercising autonomy and is making her own decision to stop taking the medication. Although it is probably not in her best interest, she 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.

One way that nurses can protect themselves against liability from malpractice is to do which of the following? a) Avoid documenting incriminating information. b) Carry individual malpractice insurance. c) Know the statutory and professional standards. d) Request legal consultation from the employer.

C 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.

A new nursing student correctly identifies which as most essential for guiding psychiatric-mental health nursing actions? Personal beliefs Federal laws Code of Ethics for Nurses State laws

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

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 which of the following? a) Fidelity b) Beneficence c) Assault d) Battery

D All clients have the right to give informed consent before healthcare 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.

An adolescent client has refused to wash or change his clothes for several days. He smells and looks filthy. Three male staff members approach him to escort him to the shower. The client resists and becomes combative when staff members insist. They place the client in seclusion and restraints and tell him that they will release him when he is calm and willing to shower. The client's rights have been ... a) Violated, primarily because he shouldn't be forced to shower b) Not violated, because his combative behavior warranted seclusion and restraint to protect others c) Not violated, because a degree of cleanliness is important d) Violated, primarily because of the inappropriate use of restraints

D 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 healthcare professionals can initiate more or less restrictive treatment alternatives based on the client's evolving needs.

A psychiatric-mental health client has an advance care directive on his medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for which of the following? a) False imprisonment b) Battery c) Assault d) Medical battery

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

Ensuring that the client has informed consent before agreeing to a treatment regimen displays which of the following ethical principles? a) Nonmaleficence b) Fidelity c) Justice d) Autonomy

D The nurse respects the client's autonomy through client's rights, informed consent, and encouraging the client to make choices about his or her health care. The nurse has a duty to take actions that promote the client's health (beneficence) and that do not harm the client (nonmaleficence). The nurse must treat all clients fairly (justice), be truthful and honest (veracity), and honor all duties and commitments to clients and families (fidelity).

From a legal standpoint, clients hospitalized as voluntary admissions differ from other types of admissions which of the following ways? a) They cannot refuse treatment. b) They can leave the hospital whenever they want. c) They are not considered a danger to themselves or others. d) They are considered competent.

D Voluntary clients have certain rights that differ from those of other hospitalized clients. Specifically, they are considered competent (unless otherwise adjudicated) and therefore 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 is explaining the distinction between confidentiality and privacy. Which of the following would the nurse include as reflecting privacy? a) Ethical duty for nondisclosure b) Involvement of two individuals c) Knowledge of treatment costs and benefits d) Part of personal life not governed by society's laws

D Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Confidentiality refers to an ethical duty of nondisclosure. Confidentiality also involves two people: the individual who discloses the information, and the person with whom the information is shared. Informed consent is a legal procedure to ensure that the client knows the benefits and costs of treatment.

Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members? Extremely aggressive. Suicidal ideation. Unwilling to take medications. Danger to others.

Danger to others. 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.

The inappropriate use of restraints or seclusion is considered which form of intentional tort? Assault Battery Causation False imprisonment

False imprisonment 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.

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 Nonmaleficence Veracity Beneficence

Fidelity 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 Nonmaleficence Paternalism

Fidelity 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: Not accept the client's request. File for a civil commitment to detain. Allow the client to go home. Ask the caregivers of the client for consent.

File for a civil commitment to detain. 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.

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

Human 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.

When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what? Self-determination Informed consent Nonmaleficence Pro-choice

Nonmaleficence 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? Nonmaleficence Justice Beneficence Autonomy

Nonmaleficence 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 ethical principle requires a nurse to prevent clients from harming themselves or others? Justice Autonomy Nonmaleficence Beneficence

Nonmaleficence 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.

Which are functions of assertive community treatment? Select all that apply. Decreases availability of services Increases the stability of people with serious mental illnesses Reduces inpatient service use Increases the likelihood of relapse Promotes continuity of outpatient care

Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses Assertive community treatment reduces inpatient service use, promotes continuity of outpatient care, and increases the stability of people with serious mental illness. Assertive community treatment does not increase the likelihood of relapse or decrease the availability of services.

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 respond better to psychotropic drugs. The client would be protected from criminal victimization of others. The client would require shorter inpatient stays. The client's risk of self-harm would be reduced. The client will need to provide proof of illness when not attending programs.

The client would require shorter inpatient stays. The client's risk of self-harm would be reduced. The client would be protected from criminal victimization of others. The benefits of the assisted outpatient treatment include shorter inpatient stays, reduced risk of self-harm, and protection of the client from criminal victimization of others. With assisted outpatient treatment, all care providers to the client are connected by ongoing communication about the client's mental and physical health status. Should the client's condition change to prevent the client from being able to attend groups to which he or she is expected to attend, the issue is further explored with an assessment by the involved health care provider. 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 and a group of paramedics hold the client. The nurse asks the client to calm down. The nurse sedates the client with morphine. The nurse ties the client's wrist using wrist restraints.

The nurse and a group of paramedics hold the client. 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.

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 client asks, "If I take this medication, will the cancer go away?" The nurse tells the truth. The nurse provides information the client needs to make a decision. The client asks questions about surgery and the nurse answers the questions completely.

The nurse tells the client, "I will return to give you pain medication in 1 hour." The nurse returns in 1 hour. Fidelity is faithfulness to obligations and duties, such as telling a client you will do something and returning to complete the task. The client asking questions about surgery and the nurse answering the questions completely, the nurse giving information the client needs to make a decision and the nurse telling the complete truth are not examples of fidelity.

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 have facility for direct visual monitoring. The room should not have any sharp objects. The room should have a bed that is bolted to the floor. The room should not have locked doors. The room should have pens or pencils.

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. 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.

Professional regulations and laws that govern nursing practice are in place for what reason? To ensure that practicing nurses have strong interpersonal skills To limit the number of nurses in practice To ensure that enough new nurses are always available To protect the safety of the public

To protect the safety of the public 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.

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: patient rights advance directive durable power of attorney informed consent

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

autonomy 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.

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 justice autonomy and beneficence justice and nonmaleficence fidelity and Veracity

autonomy and 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. 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.

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? non-maleficence and autonomy justice and beneficence veracity and fidelity autonomy and beneficence

autonomy and 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. 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.

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? justice and nonmaleficence autonomy and justice paternalism and veracity autonomy and beneficence

autonomy and beneficence 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.

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 non-maleficence veracity beneficence

fidelity 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.

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? beneficence fidelity autonomy veracity

fidelity 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.

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

justice 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 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? nonmaleficence veracity paternalism justice

justice 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 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? assault non-maleficence negligence beneficence

negligence 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 nurse manager is reviewing ethical principles at a staff meeting. The manager asks, "What examples of non-maleficence can you provide?" Which response(s) by the staff nurse are most appropriate? Select all that apply. "Performing chest compressions for a client with no pulse" "Giving the client an injection for a sexually transmitted infection (STIs)" "Assisting with the client's bone marrow transplant" "Teaching the client about medications" "Encouraging the client to quit smoking"

"Giving the client an injection for a sexually transmitted infection (STIs)" "Assisting with the client's bone marrow transplant" "Performing chest compressions for a client with no pulse" Non-maleficence is the requirement to do no harm to others either intentionally or unintentionally. Examples include: "Performing chest compressions for a client with no pulse" even though doing chest compressions may facilitate broken ribs; "Assisting with the client's bone marrow transplant" even though doing this may cause pain; "Giving an injection for sexually transmitted infections" even though the injection may cause pain. Teaching the client about medications and encouraging the client to quit smoking or not examples of non-maleficence.

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 Health promotion Intake screening Counseling

Psychotherapy 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.