Client and Mental Health Team Member Safety: Legal & Ethical Considerations

A nurse encourages each client in a group session to speak & be heard. The nurse should identify that this is an example of which of the following ethical principles?

A) Beneficence B) Autonomy C) Nonmaleficence D) Justice Answer: D. Justice involves caring for all clients equally & with the same level of fairness

A nurse tells a client that they will return in 30 min with their medication. The nurse returns in 30 min later with the client's medication. Which of the following ethical principles is the nurse demonstrating?

A) Beneficence B) Autonomy C) Veracity D) Justice Answer: C. Veracity involves being truthful & honoring the verbal commitment made to a client

A nurse on a mental health unit is discussing laws that guide the care of clients on the unit with a newly hired staff member. Which of the following statements by the staff member indicated an understanding?

A) "A claim of assault can only be substantiated if there is evidence of physical harm" B) "False imprisonment only refers to seclusion of clients" C) "Battery is the most common unintentional tort" D) "A physical injury does not need to occur for a client to make a claim of battery" Answer: D. Battery is making contact with another person without their consent. The person does not need to be injured for battery to occur; the contact must simply be unwanted or offensive to the person

A nurse is discussing milieu therapy with a group of newly licensed nurses. Which of the following statements should the nurse make?

A) "Create an environment where structure is promoted over autonomy" B) "Create an environment that is safe and beneficial for recovery" C) "The mental health provider is responsible for the structure and maintenance of therapeutic milieu" D) "Ensure spontaneous changes in activities throughout the client's daily schedule" Answer: B

A nurse is discussing the purpose of ethics with a newly licensed nurse. Which of the following statements should the nurse make?

A) "Ethics describes conflict between two or more actions where each action has a favorable and unfavorable consequence" B) "Ethics involves reasoning about what one should do as a guide for what one actually does" C) "Ethics provides a system of moral principles or standards for governing conduct" D) "Ethics explains the moral inquiry into issues raised by advances in the medicine & life sciences" Answer: C. Ethics provides the nurse w/ a set of mora; principles & standards, & is a basis for determining intentions, motives, & actions. A nurses ethics is the basis from which conduct, including practices & decisions, is made

A nurse is discussing scope of practices related to mental health with a peer. Which of the following statements by the nurse explains practice focus for a mental health nurse?

A) "It is important to consider mental health needs related to population health are based on the social determinants of health" B) "Nursing remains unchanged and the majority of a nurse's responsibility is for the hospitalized client" C) "Nursing in New Life care does not focus on mental health care, but on labor and delivery" D) "School nursing is focused on immunizations and medical needs of children, rather than mental health" Answer: A. Nurses should focus their practice & expand their responsibilities to include care of clients in all populations related to mental health needs as outlined by the social determinants of health

A nurse on a mental health unit is discussing types of admissions with a newly licensed nurse. Which of the following statements should the nurse make?

A) "Most states require two providers to assess a client to confirm the need for an involuntary admission" B) "When a voluntarily admitted client requests discharge, the provider must legally do so within 8 hours of the request" C) "Clients who are involuntarily admitted are not able to testify on their own behalf in a commitment hearing" D) "When a client is admitted involuntarily, they do not have to have a diagnosis of a mental illness" Answer: A.

A nurse on a pediatric mental health unit is discussing the importance of setting boundaries with another nurse. Which of the following statements by the nurse explains why setting boundaries is important?

A) "Setting boundaries will cause the children to try and leave the unit" B) "Children will automatically rebel against all boundaries set on the unit, so you must let them know the consequences" C) "Setting boundaries increases a child's sense of security through knowing the consequences of behaviors" D) "Children are not able to understand boundaries or consequences of their behavior" Answer: C. Setting Boundaries reduces any misunderstanding, establishes behaviors, and provides and understanding of consequences

A charge nurse on a mental health unit is discussing the concept of client competency with a group of newly licensed nurses. Which of the following information should the charge nurse include?

A) A client can be deemed legally competent via confirmation by two mental health providers B) A client is automatically deemed to be incompetent upon admission to the facility if they are experiencing psychosis C) A client who is deemed incompetent will be unable to make decisions for themselves D) A client is considered mentally competent until deemed incompetent by a judge in a legal hearing Answer: D

A nurse is discussing false imprisonment with a group of newly hired staff members. Which of the following information should the nurse include?

A) A client cannot claim a false imprisonment if they were restrained by use of an injectable antipsychotic medication B) Claims of false imprisonment can be made if a nurse verbally threatens to place a client in seclusion C) Claims of false imprisonment are most often made in reference to the use of seclusion or restraints D) A client cannot claim false imprisonment if they are involuntarily admitted without being assessed by a provider Answer: C. False imprisonment is the confinement of a client when there is no legal reason to do so. Most claims of false imprisonment results from the use of seclusion or restraints

A nurse is planning an in-service about client confidentiality for a group of newly hired nurses. Which of the following examples should the nurse include when discussing exceptions for maintaining client confidentiality. (Select all that apply)

A) A client tells a nurse that they intend to kill a coworker B) A nurse is subpoenaed to testify in court about a client they cared for C) An older adult client reports their caregiver allows them to eat one meal per day D) A client tells a nurse that they stole a watch from a friend's house E) A client tells a nurse that they plan to hang themselves when they are discharged Answer: A, B, C, E

A nurse is discussing the effects of workplace violence by clients and their family members on health care professionals with a peer. The nurse should identify that which of the following organizations provides oversight for nurses regarding workplace violence?

A) American Hospital Association B) Department of health and human services C) Occupational safety and health administration D) The joint commission Answer: C. OSHA is the organization that is tasked with ensuring worker safety, including providing oversight for workplace violence

A nurse is caring for a client who is agitated & requires chemical restraints. Which of the following types of medication should the nurse expect the provider to prescribe?

A) Antidepressant B) Sedative C) Steroid D) N-methyl-D-aspartate receptor (NMDA) inhibitor Answer: B

A nurse is caring for several children who experienced trauma. One of the children goes to group therapy wearing a cape and pretending to be a superhero. The nurse should identify that which of the following interprofessional team members should lead the group session?

A) Drama therapist B) Art therapist C) Occupational Therapist D) Social worker Answer: A. A drama therapist encourages clients to act out feelings that may be difficult for them to express in words.

A nurse is discussing responsibilities in milieu therapy with a group of newly hired nurses. Which of the following should the nurse include? (select all that apply)

A) Explain unit rules, including expectations & client rights B) Provide orientation, including a tour of the unit, rules, & expectations C) Select activities based on preferences of available staff D) Ensure that culturally-sensitive care is provided E) Use a trauma-informed approach to client care Answer: A, B, D, E

A nurse should identify that which of the following US congressional act that mandates mental health parity?

A) Health Insurance Portability and Accountability Act B) Affordable Care act of 2010 C) No surprise act D) Nurse practice act Answer: B. Parity is equal coverage for physical and mental health care, which is guaranteed under the affordable care act of 2010

A nurse is caring for a newly admitted client who expresses concern that their insurance will not cover their care. The nurse should identify that which of the following is a U.S. congressional act that requires providers to inform their clients of the cost for the treatment & whether their insurance will cover it?

A) Health Insurance Portability and Accountability Act B) Affordable Care Act of 2010 C) No Surprise Act D) Nurse practice act Answer: C. No surprise act requires providers to inform clients of the cost of treatment & whether providers are covered by their insurance

A nurse overhears unit staff workers making jokes about a nursing student. This is an example of which of the following?

A) Incivility B) Anger C) Sexual Harassment D) Bullying Answer: A. Incivility is an act or behavior that shows disrespect & lack of courtesy. Such acts, whether intended or unintended, are considered acts of aggression and can affect the well-being of the individual & negatively impact the work environment

A nurse is sitting with a client who is extremely anxious until they fall asleep. The nurse should identify that this is an example of which of the following ethical principles?

A) Justice B) Autonomy C) Nonmaleficence D) Beneficence Answer:: Beneficence. Beneficence involves acting in a manner that is "for the good" or in a way that benefits others

A nurse is preparing a client who has schizophrenia for a magnetic resonance imaging (MRI) of their head to determine if they have a brain injury or a new onset of dementia. The nurse should identify that which of the following members of the interprofessional team likely prescribed the MRI?

A) Licensed clinical social worker B) Psychologist C) Psychiatrist D) Occupational therapist Answer: C. Psychiatrists are medical doctors who can diagnose & prescribe medical procedures, tests, & medications

A nurse is discussing privacy & confidentiality with a client. Which of the following US congressional act that sets the standards for client privacy & confidentiality?

A) No surprise act B) Health Insurance Portability and Accountability Act C) Affordable Care Act of 2010 D) Nurse practice act Answer: B. HIPAA protects the privacy & confidentiality of a client's health information

A nurse in the emergency department is caring for a client who experienced abuse by an intimate partner and is scared to return home. To which of the following interprofessional team members should the nurse refer the client?

A) Occupational Therapist B) Social worker C) Substance use counselor D) Pharmacist Answer: B. Social workers provide client support & advocacy related to living situations

A nurse is caring for a client who is in physical restraints. The nurse should identify which of the following complications can results from inadequate monitoring of the client? (select all that apply)

A) Positional Asphyxia B) Food aspiration C) Cardiac Arrest D) Infection E) Somnolence Answer: A, B, C

A nurse is caring for a group of children who have experienced trauma. During group therapy, the children create drawings representing their family & community. Which of the following interprofessional team members is likely leading this group?

A) Psychologist B) Art therapist C) Social worker D) Registered nurse Answer: B. An art therapist uses different media, including painting, drawing, & pottery, to help clients explore their experience & express their feelings

A nurse on a mental health unit is caring for a client who becomes agitated. The nurse encourages the client to return to their room to calm down. Which of the following de-escalation techniques is the nurse using?

A) Seclusion B) Time out C) Restraints D) Distraction Answer: B. Time out involves getting the client time to regain control of their emotions, calm down, & end the behavior

A nurse is discussing burnout among nurses with a colleague. Which of the following is a strategy to reduce burnout?

A) Self-scheduling work shifts B) Keeping to oneself at work C) Working extra shifts during staff shortages D) Skipping shared governance meetings Answer: A. Self-scheduling work shifts allows nurses to have more control over work-life balance & helps reduce burnout. Strategies for reducing burnout include engagement in shared governance, effective communication, supportive teams, supportive leadership, & consistent self care

A nurse is discussing what to do about feelings of burnout with a group of nurses. Which of the following is the best strategy the nurse should implement?

A) Suggest that nurses who are experiencing burnout get treatment or quit their position B) Reduce meetings for shared governance C) Request an increase in pay D) Meet with other nurses to create a plan to support each other Answer: D

A nurse is leading a group session when a client begins cursing and running around the room shouting. Which of the following actions should the nurse take?

A) Suggest the client go someplace quiet and compose themselves B) Administer an anxiolytic to the client C) Insist the client go to the seclusion room where monitoring can be done D) Notify the entire treatment team to secure the area Answer: A. Suggest the client go someplace quiet and compose themselves indicates that the nurse will not tolerate their behavior. This is an example of less restrictive alternative to restraints and will give the client a chance to change their behavior prior to returning to the group

A newly hired nurse confides in another nurse despite trying to be hopeful, they feel very depressed. Which of the following actions should the nurse take?

A) Suggest the newly hired nurse contact a mental health professional B) Notify the employee assistance program about the newly hired nurse C) Notify risk management D) Suggest the newly hired nurse try yoga Answer: A

A nurse is beginning a debrief with staff about a behavioral emergency that resulted in physically restraining a client. The nurse should identify that which of the following is the purpose of debriefing?

A) To determine what to say to the client about the incident B) To determine which team members did not perform well C) To carefully document the entire incident D) To improve the quality of future responses Answer: D. Debriefing provides staff & clients with the opportunity to discuss how the situation evolved, their feelings, & to promote recovery for the client

A nurse is caring for a client who has schizophrenia & has recently been diagnosed with a terminal illness. The client's interprofessional team should recommend which of the following for the client?

A) Urgent Care B) Dementia Care C) Experimental Therapy D) Hospice Care Answer: D. Hospice care focuses on the care, comfort, & quality of life for a person who has a terminal illness & is approaching the end of life