CH. 4 psych

Which client would most likely be mandated outpatient treatment? A> A client who is addicted to alcohol who has two driving under the influence offenses B. A client with schizophrenia who lives in a single family home with siblings C. A client with bipolar disorder who has quit three jobs in the last 6 months D. A homeless client who has been arrested for petty theft of groceries from a convenience store.

A> A client who is addicted to alcohol who has two driving under the influence offenses

A nurse is talking with a psychiatric-mental health nurse practitioner and says, "I know I need to maintain a client's privacy and confidentiality, but is there a difference between these two?" Which response by the nurse practictioner would be most appropriate? A. "Actually, in most cases, privacy and confidentiality are the same issue." B. "Confidentialilty protects an individual from intrusion." C. "Confidentiality affords the client privacy." D. "Privacy is governed by the laws of the state."

C. "Confidentiality affords the client privacy."

The nurse is threatening to give the client an injection in order to restrain the client for inappropriate behavior. This is an example of A. Abuse B. False imprisonment C. Assault D. Battery

C. Assault

The nurse is reading a journal article that describes legal action brought against a nurse because the nurse touched a client without consent. The nurse interprets this legal action as an example of which tort? A. Causation B. False imprisonment C. Battery D. Assault

C. Battery

A psychiatric-mental health nurse is providing outpatient care to a patient with a history of anxiety. Which behavior would the nurse interpret as reflecting self-determinism?

Client seeks a second opinion about condition and proposed treatment.

A client made threats to harm the client's parents if they come too close to the client. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for what?

Right to freedom

Which of the following rights could the psychiatric client lose when admitted to a locked, inpatient psychiatric treatment facility?

Right to schedule his or her own time

When determining the existence of malpractice, which factor is not considered? A. Injury B. Duty C. Causation D. Intent

D. Intent

A depressed, suicidal client is scheduled for electroconvulsive therapy (ECT), which requires consent. Legally, who should sign the consent for this treatment?

The client

Following an assault, a client with mental illness has been declared unfit to stand trial. The nurse should draw what conclusion from this fact?

The client cannot comprehend the legal proceedings

The inappropriate use of restraints or seclusion is considered which form of intentional tort? A. False imprisonment B. Battery C. Assault D. Causation

A. False imprisonment

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? A. Initiate court proceedings to have a guardian named. B. Contact social services to find outpatient housing. C. Continue custodial care. D. Give the client medications by depot injection.

A. Initiate court proceedings to have a guardian named.

Which is an accurate statement regarding an advance care directive? A. It must be witnessed by two people and notarized. B. It needs to be written by an attorney. C. It applies to those who can make their own decisions. D. It needs to be signed by an attorney.

A. It must be witnessed by two people and notarized.

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? A. Malpractice B. Assault C. Failure of duty to warn D. Incompetence

A. Malpractice

Samuel has been committed involuntarily to a psychiatric-mental health facility to allow time to determine an appropriate diagnosis. What is this type of involuntary commitment known as? A. Observational B. Emergency C. Outpatient D. Extended

A. Observational

A client is being discharged but still needs close supervision. Which type of involuntary commitment would be appropriate for this client? A. Outpatient B. Emergency C. Extended D. Observational

A. Outpatient

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 communicate with an attorney C. Right to safety from harm D. Right to send and receive mail without censorship

A. Right to schedule his or her own time

Which action is a violation of a psychiatric client's rights? A. Staff members confiscate letters written by a committed client that are addressed to a local newspaper. B. A client is paid minimum wage for working in the hospital kitchen. C. The nurse removes an expensive watch from the client's room and tells the client it is being locked in the hospital safe. D. A paranoid client with delusions about his family is told that if he makes a will, it might not be valid.

A. Staff members confiscate letters written by a committed client that are addressed to a local newspaper.

A client with schizophrenia has a psychiatric advance directive (PAD) which rules out the use of antipsychotics. The care team would be justified in disregarding the provisions of the PAD in which circumstance? A. The PAD is verbal, not written. B. The client is 20 years old. C. The PAD contradicts the client's best interests. D. The client requires inpatient treatment.

A. The PAD is verbal, not written.

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? A. The client can refuse medication. B. The client can obtain release against medical advice. C. The client is in need of a public guardian. D. The client is considered incompetent.

A. The client can refuse medication. *

A client has been admitted to the psychiatric facility for the treatment of depression. The client has told the emergency department staff that she would like a close friend to make decisions surrounding her care until she "feels better." In order to identify the legal basis for the client's preference, the nurse should: A. determine whether a durable power of attorney has been established. B. explain the provisions of the Patient Self-Determination Act (PSDA) to the client and the friend. C. refer the case to the facility's ethics review board. D. assess the competency and motivations of the friend in order to protect the client's interests.

A. determine whether a durable power of attorney has been established.

A client who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The client continues to need routine psychiatric services. The nurse should explain to the client that she or he will most likely be referred to which of the following services? A. intensive outpatient program. B. partial hospitalization program. C. crisis center in the community. D. in-home mental health care.

A. intensive outpatient program.

A physician would like to include a client with schizophrenia in a research study testing a new medication. The nurse's obligation is to do what?

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

In which type of involuntary commitment does the judicial system often remit the client to a state psychiatric setting until further notice? A. Emergency B. Extended C. Observational D. Outpatient

B. Extended

A client is being discharged but still needs close supervision. Which type of involuntary commitment would be appropriate for this client? A. Emergency B. Outpatient C. Observational D. Extended

B. Outpatient

The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which is the appropriate response by the nurse to the caller? A. "The person you are asking for is not a client here." B. "You will need to be placed on the client's contact list before I can discuss any information with you." C. "I cannot confirm or deny the existence of any client here." D. "Hold one minute while I get the client for you."

C. "I cannot confirm or deny the existence of any client here."

The charge nurse is discussing a process in healthcare that reflect's dedication and comittment to meeting standards, and demonstrate a higher level of performance and patient care. The charge nurse asks the staff nurses, "What process am I speaking of ?" Which process should the staff nurse choose? A. "The process of registration depicts the process of dedication and commitment to meeting standards and demonstrating high patient care performance." B. "The process of incorporation depicts the process of dedication and commitment to meeting standards and demonstrating high patient care performance." C. "The process of accreditation depicts the process of dedication and commitment to meeting standards and demonstrating high patient care performance." D. "The process of standardization depicts the process of dedication and commitment to meeting standards and demonstrating high patient care performance."

C. "The process of accreditation depicts the process of dedication and commitment to meeting standards and demonstrating high patient care performance."

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. The client's psychiatrist B. A hospital-appointed interdisciplinary committee C. A guardian appointed by the court D. The client's primary nurse

C. A guardian appointed by the court *

Which element of malpractice occurs when the nurse does not act as a reasonable, prudent person would have acted in a similar circumstance? A. Causation B. Injury or damage C. Breach of duty D. Duty

C. Breach of duty

Which is indicative of a voluntary admission? A. Client is a danger to self or others B. Client can be committed against his or her will C. Client makes an autonomous decision to seek inpatient treatment D. Client cannot care for self

C. Client makes an autonomous decision to seek inpatient treatment

The client is visibly angry and has been placed into seclusion for safety issues. Which is the most common reason for ethical dilemmas being a challenge to nurses? A. A multitude of laws must be understood to make a clear decision. B. There are no clear ethical codes established for guidance. C. Ethical dilemmas are often charged with emotion. D. Clients are not familiar with the ethical code that nurses must follow.

C. Ethical dilemmas are often charged with emotion.

Which nursing intervention constitutes false imprisonment? A. A client is hospitalized as an involuntary admission and attempts to leave the unit. The nurse calls the security team per hospital protocol. They prevent the client from leaving. B. A psychotic client is admitted as an involuntary client and runs out of the psychiatric unit. The nurse runs after the client and succeeds in talking the client into returning to the unit. C. The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion. D. The client is confused, combative, and insists that no one can stop him from leaving. The nurse restrains the client without a physician's order, then seeks the order.

C. The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion.

The nurse is caring for a client after having various diagnostic tests. The client discusses a proxy being in attendance for the health care provider's diagnosis. The nurse requests a copy for the file, and allows the proxy to be in attendance with what type of document? A. living will B. informed consent C. durable power of attorney D. patient rights

C. durable power of attorney

The client is diagnosed with fibroid tumors and the surgeon states the uterus must come out. The nurse understands that the clients signature may be obtained on a consent, but obtaining informed consent for the surgery is the responsibility of whom? A> OR technician B. supervisor C. surgeon D. manager

C. surgeon

A client has just been explained the reason that he must undergo an MRI. When the nurse asks the client if he understands the explanation, he correctly describes what has been said to him. The client is said to be what?

Competent

A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which would be the most appropriate action by the nursing staff?

Contacting the psychiatrist for initiation of commitment proceedings

Which client of a forensic nurse has most likely been found not guilty but mentally ill (not guilty by reason of insanity) following the commission of a serious crime? A. A client who is receiving care involuntarily on a community hospital's psychiatric unit B. A client who has been released into the community with strict limits on activity C. A client with a history of mental illness who is serving a lengthy term in a federal prison D. A client who is being held involuntarily in a secure psychiatric setting

D. A client who is being held involuntarily in a secure psychiatric setting

A psychiatric-mental health nurse is admitting a client to the facility. How should the nurse best apply the principles of the Patient Self-Determination Act (PSDA) during this process? A. Assure the client that Medicare and Medicaid reimbursement will be pursued at all times B. Inform the client that no information will be provided to his or her insurer without explicit permission C. Assure the client that evidence-based care will be provided at all times during the admission D. Ask the client about any advance care directives that that the client has established

D. Ask the client about any advance care directives that that the client has established

A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which would be the most appropriate action by the nursing staff? A. Calling security and asking them to detain the client B. Contacting the client's family to request they convince the client to stay C. Allowing the client to leave with community resources for follow-up care D. Contacting the psychiatrist for initiation of commitment proceedings

D. Contacting the psychiatrist for initiation of commitment proceedings

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? A. Assault B. Defamation C. Battery D. False imprisonment

D. False imprisonment

Which of the following types of involuntary admission allows time for an appropriate diagnosis to be received? A. Outpatient B. Emergency C. Extended D. Observational

D. Observational

All of the following are civil rights afforded to all people receiving mental health care except which of the following? A. Right to send and receive sealed mail B. Right to have or refuse visitors C. Right to refuse treatment D. Right to leave the hospital when involuntarily committed

D. Right to leave the hospital when involuntarily committed

A client has been voluntarily admitted to the hospital. The nurse knows that which of the following statements is inconsistent with this type of hospitalization? A. The client has a right to leave if not a danger to self or others. B. The client retains all of his or her rights. C. The client can sign a written request for discharge. D. The client cannot be released without medical advice.

D. The client cannot be released without medical advice.

A nurse is reviewing a journal article about mental health care and voluntary and involuntary treatment. After reading the article, the nurse demonstrates a need for additional review when the nurse identifies which element as being most commonly included as part of the statute? A. The client must be a danger to self or others. B. The client is unable to provide for basic needs. C. The client must be mentally disordered. D. The client must be refusing medication.

D. The client must be refusing medication.

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? A. The facility is in an inaccessible location. B. The client's diagnosis is not psychiatric in etiology. C. The client's diagnosis is not terminal. D. The client voluntarily admitted for treatment.

D. The client voluntarily admitted for treatment.

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? A. Offer the client medication to help with anxiety and impulsive feelings. B. Hold all psychotherapeutic content under strict confidence. C. Have the client sign a safety contract. D. Warn the client's spouse, based on the Tarasoff rule.

D. Warn the client's spouse, based on the Tarasoff rule.*

An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is: A. appropriate; room restriction is an effective behavior modification technique. B. appropriate; the adolescent should not have conflicts with others. C. inappropriate; the adolescent should be offered a sedative before room restriction. D. inappropriate; room restriction is not treatment in the least restrictive environment.

D. inappropriate; room restriction is not treatment in the least restrictive environment.

The client just received a diagnosis of end-stage renal disease. After hearing options, the client visited a lawyer and documented what treatment is to be held in the event that the client is unable to make decisions. The nurse asks for a copy of this document for the chart. The name of this document is: A. informed consent B. durable power of attorney C. patient rights D. living will

D. living will

When a 23-year-old client, after attempting suicide, asks to speak with the nurse but wants assurance that the conversation will remain confidential, the nurse responds how? A. "You know that I can't keep secrets from your health care team." B> "Without your permission I can't give any information to anyone." C. "Don't you trust me to respect your right to confidentiality?" D> "Will this conversation involve your desire to harm yourself?"

D> "Will this conversation involve your desire to harm yourself?"

The nurse is detaining the client from leaving the hospital by refusing to allow him to take his personal items. This is an example of which of the following?

False imprisonment

When is a nurse legally obligated to breach confidentiality? A. At any time a client is threatening B. If threats are made to an outside party C. Whenever the client becomes aggressive D. When the client violates the nurse's boundaries

If threats are made to an outside party

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

Malpractice

Which of the following are criteria for instituting the short-term use of restraint or seclusion? Select all that apply.

The client is aggressive. The client is imminently dangerous to the self or to others. All other means of calming the client have been unsuccessful.

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

advance directive

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

autism traumatic brain injury orthopedic impairment

A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful? a) There was no evidence that a breach of duty was a direct cause of the loss, damage, or injury. b) The nurse did not have a duty. c) The client did not suffer some type of loss, damage, or injury. d) The nurse did not breach duty.

b) The nurse did not have a duty.

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? a) The Mental Health Systems Act of 1980 b) The Patient Self-Determination Act c) Public Law 99-319, The Protection and Advocacy for Mentally Ill Individuals Act of 1986 d) Tarasoff v. Regents of the University of California

d) Tarasoff v. Regents of the University of California *

Which of the following medication classifications are used to assist clients to calm down? Select all that apply.

medications Antipsychotics Mood stabilizers

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

negligence