(Mental Health Exam 1) Legal Parts

Involuntary hold 5250

14 days beyond the 72 hours Must have cert or writ hearing as it is a human rights violation

What is a gravely disabled client

An individual who is in danger of serious physical harm resulting from an inability to provide for basic needs, such as food, clothing, shelter, medical care and personal safety.

3. Which is an example of an intentional tort? 1. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome. 2. A nurse physically places an irritating client in four-point restraints. 3. A nurse makes a medication error and does not report the incident. 4. A nurse gives patient information to an unauthorized person.

2 Rationale: A tort, intentional or unintentional, is a violation of civil law in which an individual has been wronged. A nurse who intentionally physically places an irritating client in restraints has touched the client without consent and has committed an intentional tort.

Competence

Able to carry out personal affairs A special court hearing is needed to determine if competent Three elements: Must have mental disorder Must have impairment in judgement Incapable of carrying out personal affairs If deemed incompetent--- Cannot vote, marry, drive, or make contracts Need court hearing to regain competency

Involuntary hold 5270

Another 30 days beyond the 14 days Another cert or writ hearing is needed

A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? 1. Allow the client to decline the medication and document the decision. 2. Tell the client that if the medication is refused, hospitalization will occur. 3. Arrange with a relative to add the medication to the client's morning orange juice. 4. Call for help to hold the client down while the injection is administered.

Answer: 1 It is ethically appropriate for the nurse to allow the client to decline the medication and provide accurate documentation. The client's right to refuse treatment should be upheld, unless the refusal puts the client or others in harm's way.

Without authorization, a nurse administers an extra dose of an antipsychotic medication to an agitated client. The nurse's coworker observes this action but does nothing for fear of retaliation. What is the ethical interpretation of the coworker's lack of involvement? 1. Taking no action is still considered an unethical action by the coworker. 2. Taking no action releases the coworker from ethical responsibility. 3. Taking no action is advised when potential adverse consequences are foreseen. 4. Taking no action is acceptable, because the coworker is only a bystander.

Answer: 1 Rationale: The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. This coworker has a responsibility to report any observed unethical actions.

A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? 1. The nurse refuses to give any information to the caller, citing rules of confidentiality. 2. The nurse hangs up on the caller. 3. The nurse confirms that the person has been at the facility but adds no additional information. 4. The nurse suggests that the caller speak to the client's therapist.

Answer: 1 Rationale: The most appropriate action by the nurse is to refuse to give any information to the caller. Admission to the facility would be considered protected health information (PHI) and should not be disclosed by the nurse without prior client consent.

A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

Answer: 1 Rationale: The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian/representative can do so.

Which situation exemplifies both assault and battery? 1. The nurse becomes angry, calls the client offensive names, and withholds treatment. 2. The nurse threatens to "tie down" the client and then does so, against the client's wishes. 3. The nurse hides the client's clothes and medicates the client to prevent elopement. 4. The nurse restrains the client without just cause and communicates this to family

Answer: 2 Rationale: In this situation, the nurse has committed both acts of assault and battery. Assault refers to an action resulting in fear and apprehension that the person will be touched without consent. Battery is actually touching another person without consent.

Which potential client should a nurse identify as a candidate for involuntary commitment? 1. The client living under a bridge in a cardboard box. 2. The client threatening to commit suicide. 3. The client who never bathes and wears a wool hat in the summer. 4. The client who eats waste from garbage cans.

Answer: 2 Rationale: The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatment is in danger of harming self and requires emergency treatment.

Group therapy is strongly encouraged, but not mandatory, on an inpatient psychiatric unit. The nurse manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the nurse manager's policy preserve? 1. Justice 2. Autonomy 3. Veracity 4. Beneficence

Answer: 2 Rationale: The unit manager's policy regarding voluntary client participation in group therapy preserves the ethical principle of autonomy. The principle of autonomy presumes that individuals are capable of making independent decisions for themselves and that healthcare employees must respect these decisions.

A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? 1. A client makes inappropriate sexual innuendos to a staff member. 2. A client constantly demands attention from the nurse by begging, "Help me get better." 3. A client physically attacks another client after being confronted in group therapy. 4. A client refuses to bathe or perform hygienic activities.

Answer: 3 Rationale: The nurse has the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making informed choices. The client's refusal to accept treatment can be challenged, since the client is endangering the safety of others.

A brother calls to speak to his sister, who has been admitted to a psychiatric unit. The nurse connects him to the community phone, and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law has the nurse broken? 1. The National Alliance for the Mentally Ill Act 2. The Tarasoff Ruling 3. The Health Insurance Portability and Accountability Act 4. The Good Samaritan Law

Answer: 3 Rationale: The nurse has violated HIPAA by revealing that the client has been admitted to the psychiatric unit. The nurse should not have provided any information without proper consent from the client.

A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent? 1. The client is paranoid. 2. The client is 87 years old. 3. The client incorrectly reports his or her spouse's name, date, and time of day. 4. The client relies on his or her spouse to interpret the information.

Answer: 3 Rationale: The nurse should question the validity of informed consent when the client incorrectly reports the spouse's name, date, and time of day. This indicates that the client is disoriented and may not be competent to make informed choices.

Which situation reflects violation of the ethical principle of veracity? 1. A nurse discusses with a client another client's impending discharge. 2. A nurse refuses to give information to a physician who is not responsible for the client's care. 3. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. 4. A nurse does not treat all of the clients equally, regardless of illness severity.

Answer: 3 Rationale: The nurse who tricks a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients.

Which statement should a nurse identify as correct regarding a client's right to refuse treatment? 1. Clients can refuse pharmacological but not psychological treatment. 2. Clients can refuse any treatment at any time. 3. Clients can refuse only electroconvulsive therapy (ECT). 4. Professionals can override treatment refusal by an actively suicidal or homicidal client.

Answer: 4 Rationale: Healthcare professionals can override treatment refusal when a client is actively suicidal or homicidal, and may be a danger to self or others. This situation is treated as an emergency, and treatment may be provided without informed consent.

A geriatric client is confused and wandering in and out of every room. Which scenario reflects the least restrictive alternative for this client? 1. The client is placed in seclusion. 2. The client is placed in a geriatric chair with tray. 3. The client is placed in soft Posey restraints. 4. The client is monitored by an ankle bracelet.

Answer: 4 Rationale: The least restrictive alternative for this client would be monitoring movement by the use of an ankle bracelet. The client does not pose a direct dangerous threat to self or others,rendering physical restraints or seclusion as unjustified. Lack of adequate staffing is not an acceptable reason to seclude or restrain a client.

An involuntarily committed client is verbally abusive to the staff, repeatedly threatening to sue. The client records the full names of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit? 1. Verbally redirect the client, and then refuse one-on-one interaction. 2. Involve the hospital's security division as soon as possible. 3. Notify the client that documenting personal staff information is against hospital policy. 4. Continue professional attempts to establish a positive working relationship with the client.

Answer: 4 Rationale: The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client. The involuntarily committed client should be respected and has the right to assert grievances if rights are infringed upon.

An inpatient psychiatrist refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which ethical principle should a nurse determine has been violated based on these actions? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

Answer: 4 Rationale: The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally, regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious beliefs.

After disturbing the peace, an aggressive, disoriented, unkempt, and homeless individual is escorted to an emergency department. The client threatens suicide. Which of the following criteria would enable a physician to consider involuntary commitment? (Select all that apply.) 1. Being dangerous to others 2. Being homeless 3. Being disruptive to the community 4. Being gravely disabled and unable to meet basic needs 5. Being suicidal

Answers: 1, 4, and 5 Rationale: The physician can consider involuntary commitment when a client is dangerous to others, gravely disabled, or is suicidal.

Forced treatment

Client has a right to refuse treatment and medications In order to force medications the client must have a Riese hearing. Physician must petition the court to have client deemed unable to consent to treatment but must also show that efforts were made to obtain consent.

5150

First involuntary hold for 72 hours Criteria: Danger to self? Danger to others? Gravely disabled? Applies to adolescents 16 and older

Seclusion

Involuntary confinement in a room or area where the client cannot leave Physician, PhD, LCSW, NP must evaluate need within one hour of initiation and q8h → written order required. Maximum time of 4h for ages 18+. 2h for ages 9-17. 1 hr for less than 9 years old. Orders renewed according to these time limits for a maximum of 24 consecutive hours; new orders at least q4 hrs. Discontinued as early as possible. Monitored continuously by trained staff in person, or through video monitor Monitor physical status/well-being of the client including respiratory status, skin integrity and vital signs

18. A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit or a service is defined as a ______________________.

Right

Patients rights

The right to treatment services which promote the potential of the person to function independently. Treatment should be provided in ways that are least restrictive of the personal liberty of the individual. The right to dignity, privacy, and humane care The right to be free from harm, including unnecessary or excessive physicl restraint, isolation, abuse or neglect. Medication may not be used as punishment for the convenience of staff, as a substitute for, or in quantities that interfere with the treatment program.

Assault

Threatened to touch or fear of being touched

Restraints

a device that stops or slows something's motion Must release at least every 2 hours Check circulation and vitals every 15 mins One to one monitoring

A branch of philosophy that addresses methods for determining the rightness or wrongness of one's actions is defined as ___________________.

ethics

Battery

the intentional touching of a person without his or her consent