Chapter 9: Legal and Ethical Issues

A client diagnosed with major depression is prescribed electroconvulsive therapy (ECT) for the treatment. Which statement made by the client would indicate a need for the nurse to follow up with the health care provider? "It is not really my decision; I have to get these treatments to feel better." "I understand why I need the treatments; I've been depressed for a long time." "I know that there are alternatives that I can try before agreeing to the treatments." "I understand that there may be risks with the treatments."

"It is not really my decision; I have to get these treatments to feel better."

A nurse is providing care to a client who is hospitalized with a diagnosis of schizophrenia. Which statement would be appropriate for the nurse to include in the client's medical record? "Client stated that they had a good night with no concerns." "Reported an inability to sleep because 'I heard voices throughout the night'." "Acted crazily throughout the night; kept hearing voices and noises." "Had a typical night without incidence of insomnia or nightmares."

"Reported an inability to sleep because 'I heard voices throughout the night'."

A nurse is caring for a voluntary client in the health care facility. The client doesn't show signs of suicidal ideation or pose harm to others. The client states, "I would really like to leave tonight and sleep in my own bed." Although the client wants discharge tonight, the health care provider recommends against it at this time. What is the most appropriate response of the nurse? "You are free to leave at your will." "I will inform your landlord that you will be going home." "I need to check with your family members to see if they think it would be okay." "You will need to sign a written request for discharge."

"You will need to sign a written request for discharge."

Which client most likely has the legal right to refuse treatment? A 20-year-old who has been admitted to the hospital for the treatment of depression after a suicide attempt A homeless person with schizophrenia who was admitted to the hospital with dehydration after refusing to eat for several days A client who voluntarily entered a substance abuse treatment facility to address an addiction to alcohol A client who committed an assault while experiencing delusions

A client who voluntarily entered a substance abuse treatment facility to address an addiction to alcohol

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

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

Acquiring informed consent

What action by a nurse best promotes the ethical principle of justice? Clearly describing the potential adverse effects of a client's new pharmacologic treatment Informing a client who is competent that the client has the right to discontinue treatment Obtaining written, informed consent from a client who has agreed to be in a research study Advocating for enhanced mental health services in an underserved neighborhood

Advocating for enhanced mental health services in an underserved neighborhood

A psychiatric-mental health nurse interested in joining a professional organization asks the psychiatric-mental health clinical nurse specialist about these organizations. Which organization would the clinical nurse specialist describe as the largest professional nursing organization focusing on mental health care? American Psychiatric Nurses Association American Nurses Association International Society of Psychiatric Nursing International Nurses Society on Addictions

American Psychiatric Nurses Association

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 Beneficence Veracity

Autonomy

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 Beneficence Fidelity

Battery

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? Educating clients and families about the potential benefits of the new system Ensuring clients know that they have the right to opt out of the proposed system Being vigilant to identify any potential threats to client confidentiality 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

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? Justice Veracity Beneficence Autonomy

Beneficence

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

Beneficence

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

Beneficence and autonomy

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

Code of Ethics for Nurses

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

Danger to others.

A client is admitted to the behavioral health facility involuntarily. The client is scheduled to undergo electroconvulsive therapy. Which action does the nurse take before the procedure? Ask the client to accept voluntary admission before the client gives informed consent. Sign the document showing informed consent is not necessary. Ask the client's next of kin to provide informed consent. Ensure the client has given informed consent.

Ensure the client has given informed consent.

An agitated client has been put in restraints against the client's will because of inadequate staffing. The nurse determines this as which form of malpractice? False imprisonment Defamation Battery Assault

False imprisonment

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

False imprisonment

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? Beneficence Veracity Fidelity Nonmaleficence

Fidelity

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 Fidelity Nonmaleficence Beneficence

Fidelity

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

Justice

A client in a psychiatric facility has ideations about killing the client's spouse. This client requests to be discharged from the facility. Which represents the most appropriate action? The health care provider should: File for a civil commitment to detain. Allow the client to go home. Ask the caregivers of the client for consent. Not accept the client's request.

File for a civil commitment to detain.

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 Short term Mechanical Human

Human

A client receives a court order for commitment. Which best exemplifies the concept of "least restrictive environment"? Involuntary commitment to an outpatient community mental health center Restraining the client with the fewest number of restraint points possible Placing the client in a locked padded room in response to threats of self-harm Medication administration for sedation so the client cannot get out of bed

Involuntary commitment to an outpatient community mental health center

A client comes to the emergency department with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which principle is being ignored by discharging this client? Veracity Justice None of the above Autonomy

Justice

One way that nurses can protect themselves against liability from malpractice is to do what? Request legal consultation from the employer. Know the statutory and professional standards. Carry individual malpractice insurance. Avoid documenting incriminating information.

Know the statutory and professional standards.

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

Malpractice

An advanced care directive is listed on a psychiatric-mental health client's medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for which legal tort? False imprisonment Medical battery Assault Battery

Medical battery

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

Nonmaleficence

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 recognized norms in the jurisdiction where the team is working The American Nurses Association Standards of Practice The World Health Organization Guidelines for Nursing Practice The policies and procedures manual of the institution

The American Nurses Association Standards of Practice

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

The client can refuse medication.

A client's estranged spouse has phoned the hospital unit several times seeking information about the client's admission and status. A nurse hears a colleague tell the client, "No, your spouse has not called as far as I know." When confronted by the nurse, the colleague states, "I'm just trying to look out for the client by protecting the client from stress." How should the colleague's actions be interpreted? The colleague had good motives but violated the principle of veracity The colleague was not justified in deceiving the client and contradicted the principle of fidelity The colleague was unjustified in allowing autonomy to override beneficence The colleague's actions are a justifiable example of paternalism aimed at protecting the client's best interests

The colleague had good motives but violated the principle of veracity

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

autonomy

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

autonomy and beneficence

Providing milieu therapy is an example of the use of which ethical principle? autonomy veracity beneficence fidelity

beneficence

Providing milieu therapy is an example of the use of which ethical principle? veracity autonomy fidelity beneficence

beneficence

A psychiatric-mental health (PMH) nurse manager is creating an educational in-service about the challenges for PMH nurses. Which topic(s) would be covered during the in-service? Select all that apply. decreasing mental illness stigma expanding knowledge increasing therapeutic communication integrating holistic care advancing technology

expanding knowledge integrating holistic care decreasing mental illness stigma advancing technology

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

Justice

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

Justice

As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client? A guardian appointed by the court The client's primary nurse The client's psychiatrist A hospital-appointed interdisciplinary committee

A guardian appointed by the court

What action by a nurse best promotes the ethical principle of justice? Informing a client who is competent that the client has the right to discontinue treatment Obtaining written, informed consent from a client who has agreed to be in a research study Advocating for enhanced mental health services in an underserved neighborhood Clearly describing the potential adverse effects of a client's new pharmacologic treatment

Advocating for enhanced mental health services in an underserved neighborhood

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

Beneficence

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? Justice Beneficence Autonomy Veracity

Beneficence

A client who is involuntarily admitted to the psychiatric facility refuses to take a psychotropic medication. The nurse holds the client down to give the medication. Which statement is true regarding this situation? The nurse may be held legally liable. The nurse is protected under the Nurse Practice Act. The client cannot refuse the medication. The client is unable to make competent decisions.

The nurse may be held legally liable.

When it is discovered that a nurse did not act reasonably when providing care in accordance with the standards of professional practice, which factor would confirm the nurse has been negligent? The nurse was responsible for a client injury that resulted in permanent disability The nurse was responsible for client injury The client's actions played a part in the nurse's reaction The nurse was responsible for a client's injury and it was serious

The nurse was responsible for client injury

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

justice

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

justice

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: informed consent patient rights living will durable power of attorney

living will

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: patient rights informed consent living will durable power of attorney

living will

A psychiatric-mental health registered nurse (PMH-RN) is considering attending graduate school to become a psychiatric-mental health advanced practice registered nurse (PMH-APRN). What aspect of client care would be within the scope of the PMH-APRN? psychotherapy milieu therapy complimentary interventions health promotion and maintenance

psychotherapy