Mental Health - Chapter 6 - Legal and Ethical Considerations

An adult patient with anxiety and a history of alcohol abuse is an inpatient on the psychiatric unit. The patient becomes angry and aggressive, strikes another patient, and then attacks a staff member. The patient is taken to seclusion and medicated with haloperidol and lorazepam. In this case, the haloperidol and lorazepam may be considered what type of intervention? 1 A restraint 2 Malpractice 3 False imprisonment 4 A medication time-out

1 A restraint Chemical restraints are defined by those medications or dose of medication that is not being used for the patient's condition. Medication time-out is incorrect; false imprisonment and malpractice refer to specific legal terms that do not have any bearing on this medication scenario.

An adult patient has a diagnosis of paranoid schizophrenia. The patient has stopped taking medications and believes that he or she is to be taken by the aliens to live with them on another planet. The patient was observed walking through traffic on a busy road, and then was found climbing the railing on a bridge, to "be ready for them to take me in their ship." The patient is hospitalized. During the nurse's shift the patient begins running up and down the halls, banging his or her head on the walls, and yelling, "Get them out of my head!" On what basis can the patient be medicated against his or her will? 1 If the patient may cause imminent harm to him- or herself or others 2 If the patient has taken the medication in the past and has had no adverse effects 3 If the patient still has the capacity to make an informed decision regarding medication 4 If the patient is provided education regarding the medication before administration of the medication

1 If the patient may cause imminent harm to him- or herself or others A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to him- or herself or to others. The patient having taken the medication in the past with no adverse effects, if the patient still has the capacity to make an informed decision regarding medication, and if the patient is provided education regarding the medication before administration of the medication are not legally valid reasons to give medication against a patient's will.

A third-party insurer only pays for a set number of visits for psychiatric care. What does this illustrate? 1 Non-parity 2 Malfeasance 3 Discrimination 4 Preexisting conditions

1 Non-parity Parity is the term used to describe equal payment for mental and physical health; only allowing a certain number of visits regardless of circumstances illustrates non-parity. Preexisting conditions occur before insurance has begun. Discrimination involves unjust treatment based on characteristics like race, age, or sex. Malfeasance is legal wrongdoing.

For conducting clinical trials of a new drug, the nurse has been assigned to perform the initial screening to select Alzheimer's patients with severe impairment of thoughts and memory. As the patients' advocate, the nurse ensures that patients are well informed before signing the informed consent. Which information should be provided to the patients before obtaining informed consent? 1 Risks and benefits of the treatment 2 The 100% safety of the treatment for use 3 The unavailability of alternative treatment options 4 The inability to withdraw from the study after enrolling his or her name

1 Risks and benefits of the treatment The nurse ensures that the patients sign the informed consent form after being explained about the trial in detail. If the patient has impaired thoughts and memory, the nurse informs the patient's guardians about the risks and benefits of the treatment. The nurse informs the patients or their guardians about the alternative treatment options. The patient has the right to choose the appropriate treatment. The nurse does not give false assurance about the new drug being 100% safe, because no medication is 100% safe. The nurse indicates the probability of side effects and the success rate of the treatment. The patient has the right to refuse the treatment and can withdraw from the study at any time.

The civil rights of persons with mental illness who are hospitalized for treatment are 1 The same as those for any other citizen 2 Altered to prevent use of poor judgment 3 Limited to provision of humane treatment 4 Always ensured by appointment of a guardian

1 The same as those for any other citizen Civil rights are not lost because of hospitalization for mental illness.

A patient refuses to take oral medications, so the nurse administers the drug by injection. What does this illustrate? 1 Assault 2 Battery 3 Negligence 4 False imprisonment

2 Battery Battery is the actual, harmful touching of another person, in this case, administering an injection against the patient's will. Assault can be a verbal threat. Negligence would occur if the nurse failed to provide correct and adequate treatment. False imprisonment would occur if the patient was restrained without cause.

If a patient with psychiatric illness is determined to be too incompetent to make decisions affecting his or her care 1 No treatment other than custodial care can be provided. 2 The doctrine of least restrictive alternative is null and void 3 Staff members are required to use their best judgment when defining care 4 The court appoints a guardian to make decisions on the patient's behalf

4 The court appoints a guardian to make decisions on the patient's behalf An incompetent patient is unable to make legal decisions that would affect his or her care, such as consenting to surgery. A court-appointed guardian functions on behalf of the patient.

An in-patient psychiatry facility provides unique passwords to each nurse to allow access to the selected patient records. A nurse administrator forgets the password and wants to access the records using a coworker nurse's password. What is the most appropriate action by the nurse? 1 Get permission from the nursing supervisor to share the password. 2 Help the nurse administrator retrieve the password using appropriate sources. 3 Allow the nurse administrator to use the password to access the records. 4 Access the patient records and provide required information to the nurse administrator.

2 Help the nurse administrator retrieve the password using appropriate sources. Some facilities provide unique passwords to the staff members to allow access to select patient records. These passwords should not be shared. Staff members are responsible for changes done to records accessed through their password. If a colleague forgets the password, the nurse may help by retrieving the password from appropriate sources. The nurse should never share the password because it can be misused. The nurse should not access the patient's record on the colleagues' behalf, as it is not legal. Getting permission from the nursing supervisor is inappropriate because the passwords are not shared.

The charge nurse shares with the psychiatric technician that negligence of a patient 1 Applies only when the patient is abandoned or mistreated 2 Is an act or failure to act in a way that a responsible employee would act 3 Is an action that puts the patient in fear of being harmed by the employee 4 Means the employee has given malicious false information about the patient

2 Is an act or failure to act in a way that a responsible employee would act Behaving as a wise and prudent person would act under the same circumstances is one way of judging whether the standard of care has been violated. Employers typically hope that staff will prevent patients from striking each other.

After work, a nurse posted on a social media page that a patient in a local psychiatric unit committed suicide by hanging. The post did not contain the name of the patient or the hospital. Which analysis is correct? 1 The nurse has a right to self-expression as long as a patient's identity is protected. 2 The nurse's actions were illegal as well as unethical. The nurse is liable for the behavior. 3 The nurse did not violate confidentiality laws because the name of the patient and hospital were kept private. 4 The nurse is not liable because the posting on the social media site was made outside the work environment.

2 The nurse's actions were illegal as well as unethical. The nurse is liable for the behavior. A legal privilege exists as a result of specific laws and to protect the confidentiality of certain professional communications. The theory behind providing a privilege is to ensure that patients will speak frankly and be willing to disclose personal information about themselves when they know that their confidential conversations will not be repeated or distributed. The Code of Ethics for Nurses asserts that it is a duty of the nurse to protect confidential patient information. Failure to provide this protection may harm the nurse-patient relationship, as well as the patient's well-being. The obligation for confidentiality continues after a patient's death. Fidelity is an ethical principle that relates to loyalty. Loyalty applies to the nurse's relationship with a patient as well as the relationship with an employer.

Which age group of patients can receive funds for treatment from Medicare? 1 2 to 10 years 2 14 to 15 years 3 18 to 65 years 4 1 month to 2 years

3 18 to 65 years Medicare is an agency that provides federal funding to patients from 18 to 65 years old. These patients include those who have physical or mental limitations that restrict their ability to carry out normal activities or to protect themselves. Medicare provides funding to patients who are victims of elder abuse, neglect, and those who have substance abuse. It does not provide funding to patients younger than 18 years old.

The nurse is caring for a patient with a mental disorder. The nurse notes that the patient also has chronic leukemia. Which action by the nurse is an ethical practice to maintain confidentiality of the patient's medical history? 1 Discussion of the patient's condition with other colleagues 2 Discussion of the patient's condition with the patient in a cafeteria 3 Discussion of the patient's condition with a health care professional 4 Discussion of the patient's condition with other patients with the same condition

3 Discussion of the patient's condition with a health care professional The Health Insurance Portability and Accountability Act (HIPAA) states the importance of maintaining confidentiality of patients' medical history and records. Failure of the nurse or other health care professionals to maintain patient confidentiality is malpractice and against HIPAA rules. Discussion of medical information, such as reports, the treatment plan, and efficacy of medication, can be discussed among the staff members, like nurses and health care professionals, and does not violate HIPAA rules. Maintaining patient confidentiality is important for developing a good nurse patient relationship and also influences the well-being of the patient. Discussion of the health condition with the patient should be within the premises of the health care facility. It is not an ethical practice to discuss with the patient in public places like the cafeteria. Discussion with other patients with the same condition or with social workers is also an illegal approach and a violation of HIPAA rules.

When caring for a patient, the nurse considers the concept of autonomy. What action should the nurse perform to follow this concept? 1 Order the patient to take medication. 2 Convince the patient to take medication. 3 Respect the patient's decision about medication. 4 Ask the family to administer medication to the patient.

3 Respect the patient's decision about medication. Autonomy is the duty to respect patients' rights to take their own decisions about medical care. Ordering the patient to take medication is not an appropriate action because the nurse should acknowledge the patient's right to make a decision. Convincing the patient to take medication or asking the family to give medications to the patient does not reflect autonomy.

What assumption can be made about the patient who has been admitted on an involuntary basis? 1 The patient can be discharged from the unit on demand. 2 For the first 48 hours, the patient can be given medication over objection. 3 The patient has agreed to fully participate in treatment and care planning. 4 The patient is a danger to self or others or is unable to meet basic needs.

4 The patient is a danger to self or others or is unable to meet basic needs. Involuntary admission implies that the patient did not consent to the admission. The usual reasons for admitting a patient over his or her objection is if the patient presents a clear danger to self or others or is unable to meet even basic needs independently.

A patient informs the nurse that he or she has a strong urge to beat up one particular staff member. The nurse, who is very busy, finishes her shift and leaves. The next day, the nurse finds that the patient had beaten up the staff member. Which nursing action could have prevented the incident? 1 Increase in the number of the staff working the facility 2 Adequate treatment of the patient's psychiatric condition 3 Timely and accurate documentation of the patient's intent 4 Recruitment of staff members who are careful of their security

3 Timely and accurate documentation of the patient's intent Timely and accurate documentation is very crucial for providing effective nursing care and preventing mishaps in the health care facility. The incident could have been prevented if the nurse had documented the patient's intent, so that all team members could be informed of it. Preventive actions might have been taken as a result. Adequacy of the treatment is not related to the patient's violent behavior. The increased number of staff members or recruitment of careful staff members could not have prevented the incident because no one knew of the patient's intent.

Family members are worried about a depressed relative whose job recently was terminated. The family requests hospitalization of this person. An assessment reveals the person is moderately depressed but without intent or thoughts about self-harm. Which action demonstrates application of the least restrictive alternative doctrine? 1 Hospitalize the person as a temporary admission. 2 Contact with the person's prior employer for additional information. 3 With the person's agreement, arrange for immediate outpatient counseling. 4 Admit the person involuntarily to an inpatient mental health treatment unit.

3 With the person's agreement, arrange for immediate outpatient counseling. The least restrictive alternative doctrine mandates that the least drastic means be taken to achieve a specific purpose. Outpatient counseling is the least restrictive intervention. With the person's agreement, this intervention will provide services. Temporary admission is used for people who are so confused or demented they cannot make decisions on their own or are so ill they need emergency admission. Contacting the person's prior employer violates confidentiality. Involuntary admission is necessary when a person is in need of psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs. This scenario does not fulfill those criteria.

Which patient may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)? 1 A 75-year-old patient with dementia who demands to be allowed to go back to his or her own home. 2 A 21-year-old actively suicidal patient on the psychiatric unit who wants to be discharged to home and do outpatient counseling. 3 A 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care. 4 A 37-year-old patient hospitalized for 6 days; the health care provider feels 1 more day would benefit the patient, but the patient doesn't agree and wishes to be discharged.

4 A 37-year-old patient hospitalized for 6 days; the health care provider feels 1 more day would benefit the patient, but the patient doesn't agree and wishes to be discharged. Against medical advice discharges are sometimes used when the patient does not agree with the health care provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would not be allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion does not affect an AMA discharge.

Of all healthcare workers, those working in which field are most likely to be assaulted by patients? 1 Pediatrics 2 Obstetrics 3 Psychiatric 4 Emergency

4 Emergency Emergency room nurses are most likely to be physically assaulted. Psychiatric nurses have a high incidence, but it is lower than in the emergency department. Pediatrics and obstetrics do not rank as highly.

The nurse is working on an inpatient psychiatric unit and caring for the patient, who is becoming agitated. The nurse speaks with the patient one to one in a private setting to find out the reason for the agitation and then assists the patient with ways to calm down, possibly including as-needed medication to prevent further escalation of the patient's agitation, which could lead to seclusion or restraints. The nurse is making care decisions based on what concept? 1 Veracity 2 Bioethics 3 Writ of habeas corpus 4 Least restrictive alternative doctrine

4 Least restrictive alternative doctrine The least restrictive alternative doctrine is described as using the least drastic means of achieving a specific goal. By doing the actions described the nurse possibly is preventing the more restrictive setting of seclusion or restraints. Writ of habeas corpus is a legal term meaning a written order "to free the person." Veracity is one of the five ethical principles or guidelines. Bioethics refers to ethics in a health care setting.

After the death of a patient, what rule of confidentiality should be followed by nurses who provided care for the individual? 1 Confidentiality is now reserved to the immediate family. 2 The nurse must confer with the next of kin before divulging confidential, sensitive information. 3 Only human immunodeficiency virus (HIV) status continues to be protected and privileged. 4 Nothing may be disclosed that would have been kept confidential before death.

4 Nothing may be disclosed that would have been kept confidential before death. Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a patient that they would have kept confidential while the patient was alive.