Chapter 6 review question

Which situations *demonstrates liable behavior* on the part of the staff? Select all a. forgetting to obtain consent for electroconvulsive therapy for a cognitively impaired patient b. leaving a patient with suicidal thoughts alone in the bathroom to shower c. promising to restrain a patient who stole from another patient on the unit d. reassuring a patient with paranoia that his antipsychotic medication was not tampered with e. placing a patient who has repeatedly threatened to assault staff in seclusion

ANS: A, B, C

Lucas has completed his inpatient psychiatric treatment which was ordered by the court system. Which statement reveals that Lucas *does not understand* the concept of *conditional release*? a."I will continue treatment in an outpatient treatment center." b. "My nurse practitioner has recommended group therapy." c. "I am finally free, no more therapy." d. "Attending therapy and taking my meds are a part of the cognitional release."

c. "I am finally free, no more therapy."

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

Implied consent occurs when no verbal or written agreement takes place prior to a caregiver delivering treatment. Which of the following examples represents implied consent? a. the mother of an unconscious patient saying okay to surgery b. care given to a heroin overdose victim c. immobilizing a patient who has refused to take medication d. signing general intake paperwork with specific parameters

b. care given to a heroin overdose victim

How can a newly hired nurse best attain information concerning the states mental health laws and statutes? a. discuss the issue with the facility's compliance officer b. conduct an internet search using the keywords "mental + health + statutes + (your state)" c. consult the American Nurses Association's (ANA) code of ethics for nurses d. review the facility's latest edition of the policies manual

b. conduct an internet search using the keywords "mental + health + statutes + (your state)"

Based on *Maslow's hierarchy* of needs, physiological needs for a restrained patient include: (Select all) a. private toiling, oral hydration b. checking the tightness of the restraints c. therapeutic communication d. maintaining a patent airway

ANS: A, B, D

What assumption can be made about the client who has been admitted on an involuntary basis? Select all that apply. 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.

ANS: C, D, E, 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

Which statement made by the nurse concerning *ethics* demonstrates the *best* understanding of the concept? a. "It isn't right to deny someone healthcare because they can't pay for it." b. "I never discuss my patient's refusal of treatment." c. "The hospital needs to buy more respirators so we always have one available." d. "Not all ICU patients have the right to unbiased attention from the staff."

a. "It isn't right to deny someone healthcare because they can't pay for it."

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

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 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

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.

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

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

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

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.

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. 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

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 facility admission for mental healthcare, what characteristic is *unique* to a *voluntary* admission? a. the patient poses no substantial threat to themselves or others b. the patient has the right to seek legal counsel c. a request in writing is required before admission d. a mental illness has been previously diagnosed

c. a request in writing is required before admission

A nurse makes a post on a social media page about his peer taking care of a patient with a crime-related gunshot wound in the emergency department. He does not use the name of the patient. The nurse: a. has not violated confidentiality laws because he did not use the patient's name b. cannot be held liable for violating confidentiality laws because he was not the primary nurse for the patient c. has violated confidentiality laws and can be held liable. d. cannot be held liable because postings on social media site are excluded from confidentiality laws.

c. has violated confidentiality laws and can be held liable.

Which nursing intervention *demonstrates* the ethical principle of *beneficence*? a. refusing to administer a placebo to a patient b. attending an in-service on the operation of the new IV infusion pumps c. providing frequent updates to the family of a patient currently in surgery d. respecting the right of the patient to make decisions about whether or not to have electroconvulsive therapy

c. providing frequent updates to the family of a patient currently in surgery

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

In providing care for patients of a mental health unit, Li recognizes the importance of standards of care. when Li notices that some policies fall short of the state licensing laws, which of the following statements represents the most appropriate standard of care pathway? a. professional association, customary care, facility policy b. state board of nursing, facility policy, customary care c. facility policy, professional associations, state board of nursing d. state board of nursing, professional; association, facility policy

d. state board of nursing, professional; association, facility policy