Chapter 4: Ethics, Standards, and Nursing Frameworks
Mandatory use of seat belts is an example of which ethical principle? A.) Justice B.) Paternalism C.) Veracity D.) Fidelity
ANswer: B.) Paternalism
Providing milieu therapy is an example of the use of which ethical principle? A.) beneficence B.) veracity C.) fidelity D.) autonomy
Answer: A.) beneficence
A nurse working in a psychiatric facility needs to be competent to practice safe care. The nurse obtains this competency through which of the following avenues? Select all that apply. - Education - Word of mouth - Experience - Personal beliefs - Deception
Answer: - Education - Experience
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? A.) The American Nurses Association Standards of Practice B.) The policies and procedures manual of the institution C.) The recognized norms in the jurisdiction where the team is working D.) The World Health Organization Guidelines for Nursing Practice
ANswer: A.) The American Nurses Association Standards of Practice
A nurse is reviewing standards of practice. Which component would the nurse identify as correct? A.) Quality of practice B.) Outcome identification C.) Collaboration D.) Resource utilization
ANswer: B.) Outcome identification
An experienced nurse working in mental health uses the holisitc and well-supported biopsychosocial model. The nurse correctly identifies which of the following as domains of this model? Select all that apply. - Biologic - Psychological - Religious - Social - Family
Answer: - Biologic - Psychological - Social
A new graduate practicing in a psychiatric center has learned that there are two levels of practice: basic and advanced. The graduate correctly identifies which of the following as used to help differentiate these levels? Select all that apply. - Educational preparation - Personal preferences - Complexity of practice - Performance of nursing function - Personal desires of the patient
Answer: - Educational preparation - Complexity of practice - Performance of nursing function
Which of these activities are beyond the standards of practice of the psychiatric mental health (PMH) registered nurse and are reserved for the PMH advanced practice registered nurse? Select all that apply. - Ordering a reduced dosage of a client's sustained serotonin reuptake inhibitor - Structuring milieu therapy - Planning and providing a health promotion activity - Providing individual psychotherapy - Providing group psychotherapy
Answer: - Ordering a reduced dosage of a client's sustained serotonin reuptake inhibitor - Structuring milieu therapy - Providing individual psychotherapy - Providing group psychotherapy Rationale: Prescriptive authority, group and individual psychotherapy and milieu therapy are limited to the PMH advanced practice registered nurse. Health promotion can be carried out by PMH registered nurses.
The psychological domain contains which theoretical bases? Select all that apply. - Thoughts - Relationships - Feelings - Culture - Behavior
Answer: - Thoughts - Feelings - Behavior
The nurse is providing care for a client with a diagnosis of depression. How can the nurse best address the client's needs in the biologic domain? A.) Administering the client's scheduled dose of citalopram B.) Evaluating the client's response to milieu therapy C.) Teaching the client communication techniques D.) Encouraging the client to join a support group
Answer: A.) Administering the client's scheduled dose of citalopram
What action by a nurse best promotes the ethical principle of justice? A.) Advocating for enhanced mental health services in an underserved neighborhood B.) Informing a client who is competent that the client has the right to discontinue treatment C.) Clearly describing the potential adverse effects of a client's new pharmacologic treatment D.) Obtaining written, informed consent from a client who has agreed to be in a research study
Answer: A.) Advocating for enhanced mental health services in an underserved neighborhood
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? A.) Being vigilant to identify any potential threats to client confidentiality B.) Ensuring clients know that they have the right to opt out of the proposed system C.) Educating clients and families about the potential benefits of the new system D.) Teaching clients that they may lose the right to view their health records under the new system
Answer: A.) Being vigilant to identify any potential threats to client confidentiality
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? A.) Beneficence B.) Autonomy C.) Veracity D.) Justice
Answer: A.) Beneficence
A psychiatric mental health nurse is providing care for several clients and is aware of the need to adhere to the Standards of Practice. How can the nurse best demonstrate the standard of evaluation? A.) Determining whether a client's status has improved during milieu therapy B.) Assessing a recently-admitted client's judgment C.) Asking an advanced-practice colleague to interpret a client's computed tomography report D.) Administering a PRN dose of an antipsychotic after performing an assessment
Answer: A.) Determining whether a client's status has improved during milieu therapy
Which standard of practice deals with the analysis of assessment data and assessment of level of risk? A.) Diagnosis B.) Outcomes Identification C.) Planning D.) Implementation
Answer: A.) Diagnosis
A psychiatric-mental health nurse has joined the Society for Education and Research in Psychiatric-Mental Health Nursing. The nurse is an active member of which nursing organization? A.) International Society of Psychiatric-Mental Health Nurses (ISPN) B.) International Council of Nurses (ICN) C.) Alliance for Psychosocial Nursing (APN) D.) American Psychiatric Nurses Association (APNA)
Answer: A.) International Society of Psychiatric-Mental Health Nurses (ISPN) Rationale: This nurse has joined a division of the ISPN, not the ICN, APN or APNA. The ISPN consists of four specialist divisions: the Association of Child and Adolescent Psychiatric Nurses, International Society of Psychiatric Consultation Liaison Nurses, Society for Education and Research in Psychiatric-Mental Health Nursing, and Adult and Geropsychiatric-Mental Health Nurses. The purpose of ISPN is to unite and strengthen the presence and the voice of psychiatric-mental health nurses and to promote quality care for individuals and families with mental health problems. The APNA is the largest psychiatric-mental health nursing organization, with the primary mission of advancing psychiatric-mental health nursing practice; improving mental health care for culturally diverse individuals, families, groups, and communities; and shaping health policy for the delivery of mental health services.
When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what? A.) Nonmaleficence B.) Informed consent C.) Self-determination D.) Pro-choice
Answer: A.) Nonmaleficence
A psychiatric-mental health registered nurse recommended a change in a client's medication dosing schedule, and in doing so violated standards of practice. To whom is the nurse ultimately accountable for this violation of nursing standards. A.) Society B.) The nurse's peers C.) The nurse's manager D.) Herself or himself
Answer: A.) Society Rationale: Nurses are ultimately held accountable by society for practicing according to their standards. Standards define and inform society about the professional role of psychiatric-mental health nurses.
The nurse is working with a client who has expressed a desire to discontinue treatment. The care team knows that this decision would have negative consequences for the client and is discussing the ethics of the situation. In order to best address the situation, the nurse should first: A.) ask reflective questions in order to fully understand the situation. B.) enlist the assistance of the institution's legal team. C.) ask the client to describe his wishes in writing. D.) inform the client that agreeing with his decision would violate the principle of nonmaleficence.
Answer: A.) ask reflective questions in order to fully understand the situation.
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? A.) beneficence B.) justice C.) veracity D.) paternalism
Answer: A.) beneficence
Which domain of the biopsychosocial model encompasses functional health patterns such as exercise and sleep? A.) biologic B.) psychological C.) social D.) physical
Answer: A.) biologic
Which ethical principles become an issue in mental health when a segment of a population does not have access to health care? A.) justice B.) nonmaleficence C.) fidelity D.) veracity
Answer: A.) justice
Mandatory use of helmets when driving a motorcycle is an example of which ethical principle? A.) paternalism B.) justice C.) veracity D.) fidelity
Answer: A.) paternalism Rationale: Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of a client. Mandatory use of seat belts and motorcycle helmets is an example of paternalism. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligation and duties.
Which is an activity of an advanced practice registered nurse and beyond the scope of practice of a registered nurse? A.) psychotherapy B.) case management C.) milieu therapy D.) complementary interventions
Answer: A.) psychotherapy
Student nurses are learning about the ethical treatment of clients. The nursing educator asks the students about the meaning of non-maleficence. Which response by the student nurse is best? A.) "The nurse must follow all orders." B.) "The nurse must pay attention to the client's advanced directives." C.) "The client can do no harm to themselves." D.) "The nurse encourages the client to stop smoking."
Answer: B.) "The nurse must pay attention to the client's advanced directives." Rationale: Non-maleficence is the duty to cause no harm, both individual and for all. The nurse must pay attention to the client's wishes and doing no harm. "The nurse encourages the client to stop smoking," "The client can do no harm to themselves" and "The nurse must follow all orders" are not examples of non-maleficence.
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? A.) Ascertaining the client's privacy B.) Acquiring informed consent C.) Encouraging the client to be self-determined D.) Acting in a beneficent manner
Answer: B.) Acquiring informed consent
A nurse is implementing interventions that address a client's psychological domain. Which intervention would be most appropriate? A.) Teaching the client about sleep hygiene B.) Assisting with behavior therapy C.) Encouraging support from the family D.) Linking the client with community resources
Answer: B.) Assisting with behavior therapy
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? A.) Associate's degree B.) Bachelor's degree C.) Master's degree D.) Doctoral degree
Answer: B.) Bachelor's degree
A new nursing student correctly identifies which as most essential for guiding psychiatric-mental health nursing actions? A.) Personal beliefs B.) Code of Ethics for Nurses C.) State laws D.) Federal laws
Answer: B.) Code of Ethics for Nurses
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? A.) Veracity B.) Justice C.) Autonomy D.) None of the above
Answer: B.) Justice
While caring for a client with insomnia, the nurse teaches the client to use guided imagery. This intervention is an example of which domain? A.) Biologic B.) Psychological C.) Social D.) All of the above
Answer: B.) Psychological
The nursing student is learning about ethical principles paired with nursing practice. The nursing educator asks, "Which example of an ethical principle is correctly paired with nursing practice?" Which statement by the student would be correct? A.) "Equally dividing time and other resources among a group of clients." B.) "Doing no harm during the course of nursing care." C.) "Fully answering the client's questions without withholding information." D.) "Upholding the ANA's Code of Ethics."
Answer: C.) "Fully answering the client's questions without withholding information." Rationale: Veracity is the duty to be honest or truthful; nursing practice example includes fully answering all the client's questions without withholding information. Fidelity, upholding the ANA's Code of Ethics, beneficence, doing no harm during the course of nursing care and justice and equally dividing time and other resources among a group of clients, are not paired correctly with nursing practice.
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? A.) Justice B.) Beneficence C.) Autonomy D.) Veracity
Answer: C.) Autonomy
A client with insomnia has been prescribed a sleep medication that does not contain REM sleep suppressors. This is an example of an intervention related to which domain in the biopsychological model? A.) Psychological B.) Social C.) Biologic D.) All of the above
Answer: C.) Biologic
A nurse is assessing a psychiatric client using the biopsychosocial model. Which area would the nurse address with the biologic domain? A.) Family structure B.) Behavior C.) Nutritional patterns D.) Cognitive level
Answer: C.) Nutritional patterns
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? A.) Health promotion B.) Counseling C.) Psychotherapy D.) Intake screening
Answer: C.) Psychotherapy
A nurse working in a remote area needs a psychiatrist to assist in diagnosing a client. The nurse schedules an interview between a psychiatrist and the client. The psychiatrist will observe and interview the client using videoconferencing software. This is a specific example of which of the following? A.) Clinical reasoning B.) Remote care C.) Telemedicine D.) Continuity of care
Answer: C.) Telemedicine
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? A.) justice B.) beneficence C.) veracity D.) fidelity
Answer: C.) veracity
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? A.) Beneficence and fidelity B.) Fidelity and paternalism C.) Justice and autonomy D.) Beneficence and autonomy
Answer: D.) Beneficence and autonomy
A client's plan of care includes revoking privileges for inappropriate behavior, based on a contract between the client and the nurse who wrote the plan. Another nurse decides to ignore this because the client promises that the client will adhere to the contract in the future. The second nurse's behavior may have violated which ethical principle? A.) Veracity B.) Beneficence C.) Autonomy D.) Fidelity
Answer: D.) Fidelity
Which of the following provides a foundation for clinical decision-making? A.) Justice B.) Paternalism C.) Legal precedence D.) Nursing process
Answer: D.) Nursing process
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? A.) Ascertaining the client's privacy B.) Acquiring informed consent C.) Encouraging the client to be self-determined D.) Acting in a beneficent manner
B.) Acquiring informed consent
