Mental Health Chapter 6_Legal and Ethical Considerations

Which ethical principle refers to the individual's right to make his or her own decisions? a. Beneficence b. Autonomy c. Veracity d. Fidelity

b. Autonomy Autonomy refers to self-determination, or the right to make one's own decisions. None of the other options are directly related to the client's right to makes decisions.REF: 92

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents a. assault b. battery. c. defamation. d. invasion of privacy.

b. battery. Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.REF: 101; Table 6-3

The nurse reads the medical record and learns that a client has asked for treatment, agreed to receive treatment, and to abide by hospital rules. The nurse may correctly assume that the client has met the criteria for which type of admission? a. Outpatient b. Emergency c. Voluntarily d. Involuntarily

C. Voluntarily Voluntary admission occurs when the client seeks treatment and is willing to be admitted and agrees to comply with hospital and unit rules. None of the other options meet all these criteria.REF: Page 93-94

When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members? a. "That judge is going to really regret putting me in here." b. "All politicians need to be shot." c. "When I'm elected president, I'll make them all pay for doubting me." d. "The man out there who is laughing at me is going to die."

a. "That judge is going to really regret putting me in here." The duty to protect is an ethical and legal obligation of health care workers to protect patients from physically harming themselves or others. This duty arises when the patient presents a serious danger to another. While all that statements infer the client's intention to harm, only the correct option is credible since it actually identifies the possible victim.DIF: Cognitive Level: Apply (Application)REF: pages 22, 23TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

Which hospitalized patient should the nurse identify as being a candidate for the appropriate use of a release from hospitalization known as against medical advice (AMA)?a a. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately b. A 75-year-old patient with dementia who demands to be allowed to go back to his own home c. A 21-year-old actively suicidal patient who wants to be discharged to home and do outpatient counseling d. A 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

a. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately AMS discharges are sometimes used when the patient does not agree with the 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 be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge.DIF: Cognitive Level: Analyze (Analysis)REF: page 11TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between which ethical principles? a. Autonomy and beneficence b. Advocacy and confidentiality c. Veracity and fidelity d. Justice and humanism

a. Autonomy and beneficence Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client's autonomy.REF: 92

When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true? a. They are assured the same as those for any other citizen. b. Their rights are altered to prevent use of poor judgment. c. Their rights are always ensured by appointment of a guardian. d. Their rights are limited to provision of humane treatment.

a. They are assured the same as those for any other citizen. Civil rights are not lost because of hospitalization for mental illness. None of the other statements are accurate when describing the rights of a hospitalized mentally ill client.REF: 95

The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu? a. Alert security to come to the unit for a show of strength b. Request that the client accompany the nurse to the client's room c. Inform the client that restraints will be used if the behavior continues d. Prepare to administer a prn chemical restraint to the client

b. Request that the client accompany the nurse to the client's room Least restrictive alternative doctrine requires using the least drastic means of achieving a specific goal. By first attempting to remove the client to a safer location, the nurse is respecting the client's right to treatment that is less restrictive than the other options.DIF: Cognitive Level: Apply (Application)REF: page 9TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

When considering client rights, which client can be legally medicated against his or her wishes? a. The client has accepted the medication in the past. b. The client may cause imminent harm to himself or others. c. The client's primary provider orders the medication. d. The client's mental illness may relate to cognitive impairment.

b. The client may cause imminent harm to himself 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 himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will.DIF: Cognitive Level: Apply (Application)REF: page 13TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

What nursing action supports a client's right to autonomy? a. Spending time with an extremely anxious client b. Witnessing the informed consent for electroconvulsive therapy from a client c. Spending equal amount of one-on-one time with each client on the unit d. Attending an inservice on a newly approved medication

b. Witnessing the informed consent for electroconvulsive therapy from a client Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one's care. Witnessing the client's informed consent demonstrates attention to the client's right to autonomy. None of the other options are associated with autonomy.REF: 92

Which scenarios describe a HIPAA violation associated with a nurse's behavior? a. An ED (Emergency Department) nurse gives the intensive care unit nurse a client report from a telephone at the nurse's station b. A nurse on the medical-surgical floor calls a patient's primary care provider to obtain a list of current medications. c. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. d. A nurse on the psychiatric unit gives discharge information to the counseling office regarding a client's outpatient treatment.

c. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. Discussing a patient's information in public places where it may be overheard is a violation of a patient's confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team.DIF: Cognitive Level: Apply (Application)REF: pages 21, 22, 105TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced which illegal act? a. Battery b. Defamation of character c. False imprisonment d. Assault

c. False imprisonment False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons. None of the other options relate directly to such seclusion.REF: 101; Table 6-3

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated which ethical principle? a. Autonomy b. Veracity c. Fidelity d. Justice

c. Fidelity Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity. None of the other options addressed abandonment.REF: 92

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual? a. Confidentiality is now reserved to the immediate family. b. Only HIV status continues to be protected and privileged.c c. Nothing may be disclosed that would have been kept confidential before death. d. The nurse must confer with the next of kin before divulging confidential, sensitive information.

c. 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 client that they would have kept confidential while the client was alive. None of the other statements are accurate.REF: 98

Which right of the client has been violated if he is medicated without being asked for his permission? a. Right to dignity and respect b. Right to treatment c. Right to informed consent d. Right to refuse treatment

c. Right to informed consent Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated.REF: 96

What assumption can be made about the client who has been admitted on an involuntary basis? a. The client can be discharged from the unit on demand of next of kin. b. For the first 48 hours, the client can be given medication over objection. c. The client has failed to agree to fully participate in treatment and care planning. d. The client is a danger to self or others or unable to meet basic needs. e. The commitment was court ordered

c. The client has failed to agree to fully participate in treatment and care planning. d. The client is a danger to self or others or unable to meet basic needs. e. The commitment was court ordered Involuntary admission which is court ordered implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently. Neither of the remaining options is accurate assumption regarding an involuntary admission.REF: 93-94

A client reports to the nurse that once he is released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? a. None, because no explicit threat has been made. b. Ask the client if he is threatening his wife. c. Call the client's wife and report the threat. d. Report the incident to the client's therapist.

d. Report the incident to the client's therapist. The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made.REF: 98-99