PREPU CHAPTER 3
The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which is the appropriate response by the nurse to the caller? "I cannot confirm or deny the existence of any client here." "You will need to be placed on the client's contact list before I can discuss any information with you." "The person you are asking for is not a client here." "Hold one minute while I get the client for you."
Correct response: "I cannot confirm or deny the existence of any client here." Explanation: The protection and privacy of personal health information is regulated by the federal government through the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Protected health information is any individually identifiable health information in oral, written, or electronic form. Mental health and substance abuse records have additional special protection under the privacy rules. Requesting placement on the contact list or getting the client verifies the client's presence to the caller. Denying the client's presence affirms the client's existence whether present or not, which violates client privacy and confidentiality.
The nurse has a physician's order for haloperidol (Haldol) 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response? Accept the client's decision. Obtain a discharge order for noncompliance. Tell the client that he is too sick to refuse. Restrain the client and give the medication IM.
Correct response: Accept the client's decision. Explanation: Clients have the right to refuse medication even when they are psychotic. The client cannot be discharged just because he refuses to take his medications. Answer C is not an appropriate response by the nurse to the situation. Restraints are not an appropriate means of getting the client to take the medication.
A psychiatric-mental health nurse is admitting a client to the facility. How should the nurse best apply the principles of the Patient Self-Determination Act (PSDA) during this process? Ask the client about any advance care directives that that the client has established Assure the client that evidence-based care will be provided at all times during the admission Assure the client that Medicare and Medicaid reimbursement will be pursued at all times Inform the client that no information will be provided to his or her insurer without explicit permission
Correct response: Ask the client about any advance care directives that that the client has established Explanation: The PSDA specifies the need to recognize the presence of any advance care directives that the client may have established. Evidence-based care, confidentiality and advocacy are all aspects of high-quality care, but none is an explicit provision of the PSDA.
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. Talk the client out of revoking consent once the study has started. Obtain informed consent when the primary provider cannot be present. Persuade the client to consent, because the new drug has shown promising results.
Correct response: Assess the client's legal capacity when that client is asked to give consent. Explanation: The nurse serves as the client's advocate, the team's colleague, and the facility's excellent employee by continually evaluating the client's ability to give informed consent and his or her willingness to participate and continue with a treatment modality. Unless serving as the primary provider, the nurse is not responsible for obtaining informed consent. That is the role of the primary provider.
A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what? Assault Battery Beneficence Fidelity
Correct response: Battery Explanation: All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client's informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove they did not consent to the procedure, providers did not give adequate information for a decision, or the treatment exceeded the scope of the consent.
A psychiatric-mental health nurse is providing outpatient care to a patient with a history of anxiety. Which behavior would the nurse interpret as reflecting self-determinism? Client asks the nurse to decide which treatment option to follow. Client seeks a second opinion about condition and proposed treatment. Client chooses a treatment to please the nursing staff. Client relies on clinic staff for direction and guidance.
Correct response: Client seeks a second opinion about condition and proposed treatment. Explanation: A self-determined individual is internally motivated to make choices based on personal goals, not to please others or to be rewarded. Personal autonomy and avoidance of dependence on others are key values of self-determinism. In mental health care, self-determinism is the right to choose one's own health-related behaviors, which at times differ from those recommended by health professionals. A client's right to refuse treatment, to choose the second or third best health care recommendation rather than the first, and to seek a second opinion are all self-deterministic acts.
A client has just been explained the reason that he must undergo an MRI. When the nurse asks the client if he understands the explanation, he correctly describes what has been said to him. The client is said to be what? Logical Congruent Competent Autonomous
Correct response: Competent Explanation: Competence involves the ability of the client to understand and make decisions based on information given.
A psychiatric-mental health nurse is conducting a review class about legal liability and psychiatric-mental health nursing. Which element would the nurse most likely include as being required to prove negligence on the part of a health care professional? Select all that apply. Duty Cause in fact Damages Cause in proximity Financial obligation Occurrence of a simple mistake
Correct response: Duty Cause in fact Damages Cause in proximity Explanation: Five elements are required to prove negligence: duty (accepting assignment to care for a patient), breach of duty (failure to practice according to acceptable standards of care), cause in fact (the injury would not have happened if the standards had been followed), cause in proximity (harm actually occurred within the scope of foreseeable consequence), and damages (physical or emotional injury caused by breach of the standard of care). Simple mistakes are not negligent acts. Financial obligation is not a required element of negligence.
A client was brought to the emergency department by police after neighbors complained that the client was loud and disruptive. The client is paranoid and upset and states, "No one can be trusted." Which of the criteria for involuntary admission does this client meet? Dangerous to self Dangerous to others Gravely disabled He does not meet any of the necessary criteria
Correct response: He does not meet any of the necessary criteria Explanation: Having a mental illness alone is not sufficient for an involuntary commitment. In this situation, the client is not a clear danger to himself or others and there is no evidence that he is gravely disabled.
Placing a client in restraints before using other methods of intervention violates the client's right to ... Receive confidential and respectful care Provide informed consent Refuse treatment Receive treatment in the least restrictive environment
Correct response: Receive treatment in the least restrictive environment Explanation: Less restrictive treatments must be tried and found to be ineffective before more restrictive measures can be used.
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. The client can obtain release against medical advice. The client is in need of a public guardian. The client is considered incompetent.
Correct response: The client can refuse medication. Explanation: Competent clients have the right to refuse medication. Even thought the client is an involuntary admission, the client is competent and able to be involved in treatment planning. Because the client was admitted involuntarily, the client is not able to obtain release. The client who is legally declared incompetent is given a court appointed guardian or representative who is responsible for giving consent. A client is considered competent unless the court has declared that the client is incompetent. The client who is incompetent is not able to give or refuse consent for treatment.
Following an assault, a client with mental illness has been declared unfit to stand trial. The nurse should draw what conclusion from this fact? The client cannot comprehend the legal proceedings The client committed an act that a person without mental illness would not have committed The client poses a significant risk to reoffend The client is openly hostile to investigators and/or the legal team
Correct response: The client cannot comprehend the legal proceedings Explanation: A person is found unfit to stand trial on the basis of an inability to understand or participate in proceedings. It is unrelated to a comparison with the actions of a hypothetical person without mental illness or the client's risk of reoffense. Hostility does not constitute the basis for being unfit to stand trial.
A psychiatric-mental health client has been admitted to the emergency department following an episode of psychotic behavior. The client has presented a written psychiatric advance directive (PAD) that exhaustively details many aspects of her desired care. What factor should prompt the care team to disregard the provisions of the PAD? The client had been deemed legally incompetent when she created the document The provisions of the PAD are contrary to the long-term health of the client The PAD rules out treatments that are evidence-based and likely beneficial The client has a history of involuntary inpatient treatment
Correct response: The client had been deemed legally incompetent when she created the document Explanation: A PAD is invalid if the individual was incompetent when it was created. It cannot be ignored solely on the basis of the risks and benefits of its provisions. A person with a history of involuntary admissions can create a valid PAD, provided he or she was competent at the time it was created.
A nurse is reviewing a journal article about mental health care and voluntary and involuntary treatment. After reading the article, the nurse demonstrates a need for additional review when the nurse identifies which element as being most commonly included as part of the statute? The client must be mentally disordered. The client must be a danger to self or others. The client must be refusing medication. The client is unable to provide for basic needs.
Correct response: The client must be refusing medication. Explanation: Because involuntary commitment is a prerogative of the state agency, each state and the District of Columbia have separate commitment statutes; however, three common elements are found in most of these statutes. The individual must be (1) mentally disordered, (2) dangerous to self or others, or (3) unable to provide for basic needs (i.e., "gravely disabled"). Refusing to take medication is not a common element.
A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful? The nurse did not have a duty. The nurse did not breach duty. The client did not suffer some type of loss, damage, or injury. There was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.
Correct response: The nurse did not breach duty. Explanation: For a malpractice suit to be successful, the client or family needs to prove the following four elements: (1) Duty: a legally recognized relationship (i.e., physician to client, nurse to client) existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. (2) Breach of duty: the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. (3) Injury or damage: the client suffered some type of loss, damage, or injury. (4) Causation: the breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner. The nurse did have a duty to the client.The nurse did not breach this duty by the nursing actions and in fact maintained the client's safety, which is the nurse's highest duty. The client did experience loss of autonomy from being restrained but this is legally justifiable if the client's safety was jeopardized if not restrained. Since there was no breach of duty, there was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.
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: patient rights durable power of attorney advance directive informed consent
Correct response: advance directive Explanation: Advance care directives are written instructions for health care when individuals are incapacitated. Informed consent, durable power of attorney, and patient rights are not instructions for health care when individuals are incapacitated. A durable power of attorney means that the advance care directives stays in effect if you become incapacitated and unable to handle matters on your own. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them.
A student nurse is assigned to administer oral medications to a client. Which of these actions should a student nurse take if a client refuses to take prescribed oral medications? tell the client that the nurse will receive a poor grade if he or she does not administer the medication tell the client that refusal is not permitted and staff will require the client to take the medication document the client's refusal on the medication administration record without comment ask the client's reason for refusing and report it to the primary care nurse
Correct response: ask the client's reason for refusing and report it to the primary care nurse Explanation: The client has the right to refuse medication unless a court order to medicate has been obtained. The client's reason for refusing should be ascertained, and the refusal should be reported to a unit nurse. Sometimes refusals are based on unpleasant side effects. Threats and manipulation are inappropriate such as referring to grades, other staff requiring the client to take medications, or that refusal is not permitted.
A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although she is not dangerous to herself or others, she has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but she consistently refuses "any drugs." The staff realizes that legally this client can ... be coerced to accept treatment be committed by her family to receive needed treatment have her family sign permission for treatment continue to refuse treatment
Correct response: continue to refuse treatment Explanation: The client maintains the right to refuse treatment even if it is needed when she is not dangerous to herself or others. If a client is able to give consent, she cannot be coerced into doing so, have her family sign permission for her, or be committed by the family to receive treatment unless she is a danger to herself or others.
An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is: inappropriate; room restriction is not treatment in the least restrictive environment. inappropriate; the adolescent should be offered a sedative before room restriction. appropriate; room restriction is an effective behavior modification technique. appropriate; the adolescent should not have conflicts with others.
Correct response: inappropriate; room restriction is not treatment in the least restrictive environment. Explanation: Clients have the right to treatment in the least restrictive environment appropriate to meet their needs. It means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. It also means that the client must be free of restraint or seclusion unless it is necessary. Verbal and behavioral techniques should be instituted before physical measures such as sedation, restraint, or seclusion.
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? non-maleficence negligence beneficence assault
Correct response: negligence Explanation: Negligence is an unintentional tort that is a breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries. Assault, beneficence, and non-maleficence do not demonstrate the law that has been broken. Assault is a threat of imminent harmful or offensive contact with a person. Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. Non-maleficence, beneficence, and assault have not been breached.
A nurse in the emergency department is planning for a client with mental illness to be placed in an inpatient hospitalization. Which is a condition of this type of admission? is noncompliant with medication at home present a clear danger to self or others develops new symptoms of the illness has no support systems in the community
Correct response: present a clear danger to self or others Explanation: Hospitalization is justified when the client is a danger to self or others. Medication noncompliance, new symptoms, or no community support would require in hospital treatment.