Psych - Videbeck Ch 9
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 have a bed that is bolted to the floor. The room should have facility for direct visual monitoring. The room should not have any sharp objects.
The client is brought to the hospital in a coma. The nurse understands that when a person is incapacitated, the document used to dictate the patient's written instructions for health care is called:
advance directive
Which ethical principles become an issue in mental health when a segment of a population does not have access to health 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
A psychiatric-mental health client has an advance care directive on the client's medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for:
medical battery.
The nurse is caring for a client that is confused. The nurse, while giving the client a bed bath leaves the room to get supplies. The nurse returns to find the client on the floor with the bed in high position, and side rails down. What law has been broken?
negligence
A nurse working on a psychiatric unit receives a telephone call from the employer of one of the clients on the unit. The employer asks to be sent a copy of the client's latest laboratory work and psychological testing results so the client's medical records in employee health can be kept up to date. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate?
"I am unable to acknowledge whether or not this client is a client on this unit."
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"
A class of student nurses are discussing trends in mental health care. A student states, "There should be equal access to mental health care and resources for clients who live in rural areas, those without health insurance, and for the poor." Which statement by the nurse would best reflect the correct ethical principle?
"Justice refers to treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs."
The nursing ethics committee is reviewing the ethical principle of justice. One committee member states, "What are some examples of justice?" Which statement(s) by the nurse exemplifies justice? Select all that apply.
"Nurses should make sure that all clients have a meal if they are permitted to eat." "Nurses should be fair when they distribute care among the clients that they are assigned."
A nurse is providing care to a male client who is hospitalized with a diagnosis of schizophrenia. Which would be appropriate for the nurse to include in the client's medical record?
"Reports being unable to sleep because the client heard voices throughout the night."
The mental health nurse is talking to nursing students in an Ethics class and asks, "Which example of an ethical principle is correctly paired with nursing practice?" Which statement by the student would be correct?
"Telling the client that you will come in to help with dressing in 15 minutes, then returning in 15 minutes."
When a 23-year-old client, after attempting suicide, asks to speak with the nurse but wants assurance that the conversation will remain confidential, the nurse responds how?
"Will this conversation involve your desire to harm yourself?"
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 physician at this time. What is the most appropriate response of the nurse?
"You will need to sign a written request for discharge."
Which mental health client meets criteria to be involuntarily committed?
A client diagnosed with borderline personality disorder who is threatening to self-harm
The Tarasoff decision has resulted in the mental health clinician having a responsibility to do what?
A duty to warn
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
After teaching a group of nursing students about the least restrictive environment, the instructor determines that the education was successful when the group identifies which as the most restrictive setting?
Acute inpatient care
What action by a nurse best promotes the ethical principle of justice?
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
The nurse recognizes that the difference between a voluntary and an involuntary commitment is what?
An involuntarily committed client may not initiate his or her own discharge
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 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 nurse recruiter is interveiwing a nurse for a psychiatric-mental health nursing position at the community clinic. When reviewing the applicant's educational background, the recruiter would identify which as the preferred level of preparation?
Bachelor's degree
Which is the most important reason for psychiatric nurses to understand law, legislation, and legal processes that relate to professional nursing practice?
Because doing so gives the nurse the ability to provide quality care that will safeguard the rights and safety of clients.
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
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 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.
Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members?
Danger to others.
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
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
The inappropriate use of restraints or seclusion is considered which form of intentional tort?
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?
Fidelity
When promoting client safety on an inpatient psychiatric unit, which interventions would be used as the measure of last resort?
Four-point restraint
What is the therapeutic goal of seclusion?
Give the client the opportunity to gain self-control
A mental health nurse is caring for a client with an anxiety and substance use disorder. The family is requesting to see the client's records. The nurse understands that this would be a violation of which law?
Health Insurance Portability and Accountability Act (HIPAA)
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 receives a court order for commitment. Which best exemplifies the concept of "least restrictive environment"?
Involuntary commitment to an outpatient community mental health center
Which statement accurately describes the insanity defense?
It is rarely successful
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-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
A nursing student identifies which as the most important tool of psychiatric nursing?
Self
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
Which ethical principle focuses on the duty to do no harm?
Nonmaleficence
Which ethical principle requires a nurse to prevent clients from harming themselves or others?
Nonmaleficence
A client is being discharged but still needs close supervision. Which type of involuntary commitment would be appropriate for this client?
Outpatient
A psychiatric-mental health nurse is practicing at the advanced level. Which function would this nurse be able to perform based on the nurse's advanced level of preparation?
Psychotherapy
Which are functions of assertive community treatment? Select all that apply.
Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses
A psychiatric-mental health nurse is looking for information about the parameters of professional psychiatric-mental health nursing practice, specifically information that provides the framework for nursing practice. The nurse would most likely seek out which source?
Standards of Practice
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
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 American Nurses Association Standards of Practice
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 with a psychiatric illness has become extremely aggressive and the nurse decides that the client needs to be restrained. Which action would be considered human restraint?
The nurse and a group of paramedics hold the client.
A psychiatric-mental health nurse is providing care to several clients. Some of the clients have been voluntarily admitted while others have been involuntarily admitted. Which description about voluntary admissions demonstrates that the nurse understands thedifferences between these two types of admissions?
They have agreed to the hospitalization.
Professional regulations and laws that govern nursing practice are in place for what reason?
To protect the safety of the public
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
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.
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
A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which ethical principle?
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
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 nurse is reviewing the Standards of Professional Performance. Which area would the nurse most likely find being addressed?
communication
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 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
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 client would a nurse determine to be the most likely candidate for involuntary commitment? The client who:
is screaming in the street and disturbing neighbors.
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
The nursing instructor is discussing the Individuals with Disabilities Education Act and various disablities 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.
traumatic brain injury autism orthopedic impairment
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
