CP Ch. 9: Legal and Ethical Issues

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

What action by a nurse best promotes the ethical principle of justice?

Advocating for enhanced mental health services in an underserved neighborhood

A nurse working on a psychiatric unit receives a telephone call from a client's employer. The employer asks for a copy of the client's latest laboratory work and psychological testing results so that client's medical records in employee health can be updated. Based on the nurse's knowledge of breach of confidentiality, which response would be appropriate?

"I am unable to acknowledge whether or not your employee is a client on this unit."

Which mental health client meets criteria to be involuntarily committed?

A client diagnosed with borderline personality disorder who is threatening to self-harm

The nurse is complaining about a client that has dementia. The client is mobile and slaps the nurse on the gluteus maximus each time he passes by. The nurse tells the client, "If you don't behave yourself, I am going to throw you out and you won't have anywhere to go." The charge nurse overhears the nurse, and states "Do you realize what your statement could be construed as?" What is the best statement for the nurse to respond?

"It could be construed as assault"

The nurse is admitting a client to the hospital. The nurse gives the client information about patient rights while in the hospital. Which statement by the client indicates that more teaching is needed?

"The doctor can copy my information and send it to my son."

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 will need to sign a written request for discharge."

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 client who is being held involuntarily in a secure psychiatric setting

As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?

A guardian appointed by the court

What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)?

A guideline for nurses regarding ethical conduct

A client with depression who is undergoing a colonoscopy tomorrow is receiving preoperative education regarding the procedure. Which nursing task best describes the explanation of the procedure and the associated risks and benefits?

Acquiring informed consent

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.

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

Autism Traumatic brain injury Orthopedic impairment

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

Autonomy

The depressed client is deciding which type of treatment would be beneficial. The nurse would document that the client is utilizing which ethical principle in this situation?

Autonomy

A 22-year-old client diagnosed with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it." The nurse explains to the client, "Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better." This conversation reflects a conflict between which two types of ethical principles?

Autonomy and beneficence

A psychiatric mental health facility is undergoing a change from paper-based health records to electronic records. What action should the nurse prioritize in order to ensure client rights are protected?

Being vigilant to identify any potential threats to client confidentiality

A client is being seen in the mental health clinic because of relapse. The client has been nonadherent with the medication regimen. The nurse reinforces the advantages of taking medications. The nurse is using which ethical principle?

Beneficence

A new nursing student is studying ethics in nursing and informs a client who wants to stop medication about its benefits and how the client will continue to feel better only if use of the drug continues. Which concept is the nursing student using?

Beneficence

Providing milieu therapy is an example of the use of which ethical principle?

Beneficence

The nurse is teaching a client about the importance of adhering to a medication regimen. The client does not believe that it is important. The nurse is communicating which ethical principle?

Beneficence

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?

Beneficence and autonomy

A new nursing student correctly identifies which as most essential for guiding psychiatric-mental health nursing actions?

Code of Ethics for Nurses

The nurse prepares to document care for the client in physical restraints. Which item(s) must the nurse include to ensure legal documentation? Select all that apply.

Detailed assessment Reason the client is at risk for harming self or others Previous unsuccessful de-escalation efforts

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?

Durable power of attorney

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?

Ensure the client has given informed consent.

What term is used to identify the situation when ethical principles conflict or when there is not one clear course of action in a given situation?

Ethical dilemma

The inappropriate use of restraints or seclusion is considered which form of intentional tort?

False imprisonment

A nursing student is initiating a relationship with an assigned client. After meeting and spending approximately 20 minutes talking with the client, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of clients to play volleyball. The student starts to go with them but then remembers the promise to meet with the client. The student decides to forgo volleyball and talk with the client. The student's decision reflects which ethical principle?

Fidelity

The mental health nurse is talking to nursing students in an ethics class and says, "Correctly pair an ethical principle with a nursing practice." Which statement by a student would be correct?

Fidelity: "Telling the client that you will return in 15 minutes, then returning in 15 minutes."

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

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

Human

A client 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?

Justice

A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

Justice

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?

Justice

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

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:

Living will

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

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?

Medical battery

When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what?

Nonmaleficence

Which ethical principle requires a nurse to prevent clients from harming themselves or others?

Nonmaleficence

A nursing student identifies which as the most important tool of psychiatric nursing?

Self

Which court decision or act states that psychotherapists have a duty to exercise reasonable care in protecting the foreseeable victims of their clients' violent actions?

Tarasoff v. Regents of the University of California

A psychiatric treatment team is planning care for a client who was involuntarily admitted for treatment of depression and suicide ideation. When planning care, of what legal parameters of care must the nurse be aware?

The client can refuse medication

A 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

When it is discovered that a nurse did not act reasonably when providing care in accordance with the standards of professional practice, which factor would confirm the nurse has been negligent?

The nurse was responsible for client injury

The nurse is assessing whether a room is fit for seclusion of clients. What are the requirements of a seclusion room? Select all that apply.

The room should not have any sharp objects The room should have a bed that is bolted to the floor The room should have facility for direct visual monitoring

Professional regulations and laws that govern nursing practice are in place for what reason?

To protect the safety of the public

The nursing instructor is talking to a class of nursing students about the American's with Disabilities Act, and persons having various disabilities that have the right to education in the least restrictive environment. The nursing instructor asks the students, "what is the reason for the least restrictive environment?" Which example should the student nurse choose?

Unique needs

A client with bipolar disorder has been following the prescribed medication regimen. The client indicates to the nurse a desire to stop the medication now that the client is feeling better. The nurse tells the client that most likely the client will have to remain on the medication for life to keep the condition under control. The nurse is practicing which principle?

Veracity

The client asks about a new medication, it's side effects, cost and if the drug is compatable with the other medication the client takes. The nurse answers all questions the client asks without withholding information. The nurse is guided by which ethical principle?

Veracity

A nurse sitting with a client in a therapy session with the psychotherapist hears the client state, "I have had it with this marriage. I'm telling you, and not that I ever would do it, but I feel like hiring a hit man to kill my spouse!" Which action is the nurse obligated to take?

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

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

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

justice