Ch 9 Ethical Legal

Which elements are necessary to prove liability in a malpractice lawsuit? A. Client is injured B. Failure to conform to standards of care C. Injury caused by breach of duty D. Injuries must be visible and verified E. Nurse intended to cause harm F. Recognized relationship between client and nurse

A, B, C, F.

The nurse manager is reviewing ethical principles at a staff meeting. The manager asks, "What examples can you provide where the nurse must consider the principle of nonmaleficence?" Which response(s) by the staff nurse are most appropriate? Select all that apply. "Teaching the client about medications" "Assisting with the client's bone marrow transplant" "Giving the client an injection for a sexually transmitted infection (STIs)" "Performing chest compressions for a client with no pulse" "Encouraging the client to quit smoking"

"Giving the client an injection for a sexually transmitted infection (STIs)" "Assisting with the client's bone marrow transplant" "Performing chest compressions for a client with no pulse" Explanation: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Sometimes an action would do both good and harm; in these cases, the utilitarian theory of doing the greatest good for the greatest number may guide the nurse in deciding which course of action follows the principle of nonmaleficence. Examples include "Performing chest compressions for a client with no pulse" even though doing chest compressions may facilitate broken ribs; "Assisting with the client's bone marrow transplant" even though doing this may cause pain; and "Giving an injection for sexually transmitted infections" even though the injection may cause pain. Teaching the client about medications and encouraging the client to quit smoking are not examples of actions where the nurse must consider nonmaleficence.

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'll have to get the client's signed consent before we can send that information to you." "I am unable to acknowledge whether or not this client is a client on this unit." "Sure, give me your address, and I will see that the information is sent to you." "I'm sorry; we're not allowed to give out that information about our client."

"I am unable to acknowledge whether or not this client is a client on this unit." Explanation: A breach of confidentiality is the release of client information without the client's consent in the absence of legal compulsion or authorization to release information. Acknowledging that this client is a client on the unit would be such a breach. Even if the nurse explains that he or she cannot give the information without the client's consent, the explanation lets the employer know that the client is receiving care in a psychiatric hospital.

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 unintentional harm" "It could be construed as assault" "It could be construed as battery" "It could be construed as negligence"

"It could be construed as assault" Explanation: Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Battery, negligence, and intentional harm do not involve actions that make a person to fear being touched or physically injured without consent. Battery is the intentional act of causing physical harm to someone. Negligence is when a nurse who is fully capable of caring does not care in the way a reasonably prudent nurse would, and as a result the patient suffers unnecessarily. Unintentional harm is used to refer to injuries that were unplanned.

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 uphold the ANA's Code of Ethics." "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." "Nurses should do no harm during the course of care." "Nurses should encourage clients to stop smoking."

"Nurses should be fair when they distribute care among the clients that they are assigned." "Nurses should make sure that all clients have a meal if they are permitted to eat." Explanation: Justice is the duty to treat all fairly, distributing the risks and benefits equally. Basic goods should be distributed, so that the least advantaged members of society are benefited. The other phrases, "Nurses should do no harm during the course of care," "Nurses should uphold the ANA's Code of Ethics" and "Nurses should encourage clients to stop smoking" are not examples of justice.

The nurse is providing information to the caregivers of the client who has been secluded. Which statements about the implementation of the seclusion are correct? Select all that apply. "The client will be assessed by the nurse every 1 to 2 hours." "The client will be removed from seclusion in 1 day." "The client will be assessed by a specialized independent practitioner within the hour." "The client can also be monitored by audio and video equipment." "The health care provider will review the seclusion order every 4 hours."

"The client will be assessed by the nurse every 1 to 2 hours." "The client can also be monitored by audio and video equipment." "The health care provider will review the seclusion order every 4 hours." "The client will be assessed by a specialized independent practitioner within the hour." Explanation: After the client is secluded, the nurse documents assessment of the client every 1 to 2 hours. The health care provider is required to review the client's seclusion order every 4 hours. A specialized practitioner is required to assess the client within 1 hour after the seclusion. After the client has been monitored 1:1 for 1 hour, the staff can use video and audio equipment to continue the monitoring. The client cannot be released from seclusion until specific behavioral criteria are met. Thus, the nurse cannot tell the caregivers that the client will be removed from seclusion in 1 day.

The nurse is admitting a client to the hospital. The nurse gives the client information about client rights while in the hospital. Which statement by the client indicates that more teaching is needed? "You can not give any information to anyone unless I agree." "I can get a copy of my medical record if I want to read it." "The doctor can copy my information and send it to my son." "You can not tell a caller that I am in the hospital."

"The doctor can copy my information and send it to my son." Explanation: Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Protecting an individual from intrusion is a responsibility of health care providers. The client is permitted to read the personal medical record. Doctors and nurses cannot give any information out to anyone unless the client agrees, and cannot tell a caller that the client is in the hospital.

A nursing manager is holding a staff meeting and talking about ethical principles. The nurse manager asks, "Which example of an ethical principle is accurately paired with nursing practice?" Which statement by the staff nurse would be correct? "The nurse is always truthful and honest." "The nurse treats all clients fairly." "The nurse takes action to promote clients' health." "The nurse encourages clients to make choices about health care."

"The nurse treats all clients fairly." Explanation: Justice is the duty to treat all fairly, distributing the risks and benefits equally. Nursing examples include doing equally for all clients and not giving more attention or supplies to one person over another. "The nurse is always truthful and honest" is an example of non-maleficence, "The nurse takes action to promote clients' health" is an example of autonomy and "The nurse encourages clients to make choices about health care" is an example of fidelity. These statements not paired with the correct nursing practice.

The nurse is working with a client who is manic and is in the partial hospitalization program, stabilized, and then given referrals for therapy and support groups. The significant other asks the nurse why the client was not admitted to the hospital? What is the best response from the nurse? Select all that apply. "The partial hospitalization program is for clients who refuse treatment." "The partial hospitalization program is for clients who refuse medication." "The partial hospitalization program is for clients who refuse treatment without prior notification." "The partial hospitalization program is the least restrictive environment appropriate to meet the client's needs." "The partial hospitalization program is for clients who don't want to be judged by the staff."

"The partial hospitalization program is the least restrictive environment appropriate to meet the client's needs." Explanation: Clients have the right to treatment in the least restrictive environment appropriate to meet their needs. An individual does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. An individual cannot be restrained or locked in a room unless all other "less restrictive" interventions are tried first. The partial hospitalization program is the least restrictive environment appropriate to meet the client's needs. Incorrect responses include: "The partial hospitalization program is for client's who refuse treatment," "The partial hospitalization program is for client's who refuse medication," "The partial hospitalization program is for client's who refuse treatment without prior notification," and "The partial hospitalization program is for clients who don't want to be judged by the staff."

The nurse answers the unit phone at lunchtime and gives information about the client to the adult brother of the client, without the client's permission. How would the nurse explain what this action is called? "This action is called breach of confidentiality." "This action is called negligence." "This action is called medical battery." "This action is called informed consent."

"This action is called breach of confidentiality." Explanation: A breech of confidentiality occurs when private information is disclosed to a third party without his or her consent in the absence of legal compulsion or authorization to release information. Medical battery, negligence, and informed consent do not breech private information to a third party without consent.

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? "You know that I can't keep secrets from your health care team." "Don't you trust me to respect your right to confidentiality?" "Without your permission I can't give any information to anyone." "Will this conversation involve your desire to harm yourself?"

"Will this conversation involve your desire to harm yourself?" Explanation: Asking whether the conversation will involove the client's desire to hurt oneself establishes whether the nurse can keep it confidential. Nurses may find it necessary to reassure a client that confidentiality will be maintained except when the information may be harmful to the client or others and except when the client threatens self-harm. The other options are not necessarily true; if the conversation does not affect the client's health or well-being, there is no reason to share the information with anyone. Further, if the conversation affects the client's health or well-being, it will be shared with the client's health care team. The option regarding the client's trust for the nurse is nursing-centered, not client-centered, and does not address the client's question.

The nurse is explaining the responsibilities to a client's legal guardian. Which statements by the nurse are correct? Select all that apply. "You are supposed to write checks for the client." "You have to make the client stay with you." "You are supposed to monitor the client all the time." "You, not the client, should sign legal documents." "You have to make health care decisions for the client."

"You are supposed to write checks for the client." "You have to make health care decisions for the client." "You, not the client, should sign legal documents." Explanation: Clients with severe mental illness are usually appointed a legal guardian or a conservator. The functions of the legal guardian include writing checks for the client, giving informed consent (making health care decisions for the client), and entering contracts. The legal guardian need not make the client stay with himself or herself. The legal guardians are not expected to monitor the client all the time.

The nurse is speaking to a client with severe mania who has been physically restrained. The nurse is explaining the instructions for removing the restraints. What instructions given by the nurse are appropriate? Select all that apply. "You should be willing to do the task I have given you." "You should be able to communicate in a calm manner." "You should not verbally threaten anybody." "You should take medications prescribed by your doctor." "You should be able to demonstrate appropriate behavior."

"You should be able to demonstrate appropriate behavior." "You should not verbally threaten anybody." "You should be able to communicate in a calm manner." Explanation: The purpose of using the restraints is to control the client's extreme behavior. The criteria for removing the restraints are to control oneself, to make no verbal threats, and to verbalize feelings in a rational manner. Telling the client to perform the task assigned by the nurse is not an appropriate instruction as the client may feel threatened. The nurse cannot force the client to take medications as a condition to remove the restraints.

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 health care provider recommends against it at this time. What is the most appropriate response of the nurse? "I need to check with your family members to see if they think it would be okay." "I will inform your landlord that you will be going home." "You are free to leave at your will." "You will need to sign a written request for discharge."

"You will need to sign a written request for discharge." Explanation: Clients admitted to a health care facility have the right to leave, provided they do not pose a danger to themselves or others. A client who wishes to leave the health care facility can sign a written request for discharge. This provides evidence that the client wanted to leave and was not at risk to the self or others. It would be a breach of the client's confidentiality to inform the family members or the client's landlord of the discharge. Although the client is voluntary, the nurse cannot simply tell clients they are free to leave at their own will.

Which client of a forensic nurse has most likely been found not guilty but mentally ill (not guilty by reason of insanity) following the commission of a serious crime? A client who is receiving care involuntarily on a community hospital's psychiatric unit A client who has been released into the community with strict limits on activity A client who is being held involuntarily in a secure psychiatric setting A client with a history of mental illness who is serving a lengthy term in a federal prison

A client who is being held involuntarily in a secure psychiatric setting Explanation: Individuals found not guilty of a crime but mentally ill are normally held in a secure psychiatric setting, not a community hospital, prison, or in the community.

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 The client's primary nurse The client's psychiatrist A hospital-appointed interdisciplinary committee

A guardian appointed by the court Explanation: If individuals admitted to a psychiatric facility are judged to be incompetent to make decisions, the court will appoint a guardian to make decisions for them.

What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)? Pathways to follow for each of the ethical principles A description of case studies featuring ethical dilemmas Information about what to do when confronted with an ethical dilemma A guideline for nurses regarding ethical conduct

A guideline for nurses regarding ethical conduct Explanation: The ANA's Code of Ethics for Nurses guides ethical decision-making.

Which elements are essential in a clinician's duty to warn? A. Client makes threatening statements B. History of violence C. Potential victim(s) are identifiable D. Potential victim is easy to locate E. Threat is not a delusion F. Threat of harm is serious

A, C, F.

A client has a prescription for haloperidol, 5 mg orally two times a day, as ordered by the physician. The client is suspicious and refuses to take the medication. The nurse says, "If you don't take this pill, I'll get an order to give you an injection." The nurse's statement is an example of: a. assault. b. battery. c. malpractice. d. unintentional tort.

A. Assault

The client who is involuntarily committed to an inpatient psychiatric unit loses which right? a. Right to freedom b. Right to refuse treatment c. Right to sign legal documents d. The client loses no rights

A. right to freedom

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? Encouraging the client to be self-determined Ascertaining the client's privacy Acquiring informed consent Acting in a beneficent manner

Acquiring informed consent Explanation: In accordance with the ethical principle of veracity, the client can only provide informed consent if the nurse applies the principle of veracity—the duty to be honest and truthful. Informing the client of the risks and benefits of a procedure is best described as obtaining informed consent. Informed consent involves the client's right of self-decision. Client privacy is defined as the right to be left alone and free from intrusion or control by the health care providers. Self-determination allows the client to indicate what treatments the client would accept or refuse. Acting in a beneficent manner encompasses doing good acts by the nurse.

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? Crisis intervention In-home detoxification Residential services Acute inpatient care

Acute inpatient care Explanation: Of the settings listed, acute inpatient hospitalization and care involves the most intensive treatment and is considered the most restrictive setting in the continuum.

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports him or her in whatever decision he or she makes? Parent surrogate Caregiver Advocate Teacher

Advocate Explanation: In the advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. The primary caregiving role in mental health settings is the implementation of the therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the client about the medication regimen. In the role of the parent surrogate, the nurse may be tempted to assume a parental role.

What action by a nurse best promotes the ethical principle of justice? Advocating for enhanced mental health services in an underserved neighborhood Obtaining written, informed consent from a client who has agreed to be in a research study Informing a client who is competent that the client has the right to discontinue treatment Clearly describing the potential adverse effects of a client's new pharmacologic treatment

Advocating for enhanced mental health services in an underserved neighborhood Explanation: Justice focuses on the fair and equitable distribution of risks and benefits, such as advocating for necessary care among a population or community. The right to discontinue treatment and the principle of informed consent are related to autonomy. Clearly describing adverse effects is an example of veracity.

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? International Nurses Society on Addictions American Nurses Association American Psychiatric Nurses Association International Society of Psychiatric Nursing

American Psychiatric Nurses Association Explanation: The American Psychiatric Nurses Association (APNA) and the International Society of Psychiatric Nursing (ISPN) are two organizations for psychiatric nurses that focus on mental health care. 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. 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. Although a large professional nursing organization, the American Nurses Association (ANA) focuses on addressing the emergent needs of nursing in general. The ANA supports psychiatric-mental health nursing practice through liaison activities and working closely with psychiatric-mental health nursing organizations.

A nurse is attempting to determine a client's right to independence and the extent to which the nurse would offer beneficial treatment to the client. Which ethical principle would the nurse identify as being involved? Select all that apply. Veracity Justice Autonomy Beneficence Fidelity

Autonomy Beneficence Explanation: Autonomy refers to a person's right to self-determination and independence. Beneficence refers to one's duty to benefit or promote the good of others.Fidelity is faithfulness to obligations and duties. It is keeping promises. Veracity is the duty to tell the truth. Justice is the duty to treat all fairly, distributing the risks and benefits equally.

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? Beneficence Justice Veracity Autonomy

Autonomy Explanation: The American Nurses Association identified four primary principles to guide ethical decisions. These principles include the client's right to autonomy, the right to beneficence (doing good) by the nurse, the right to justice or fair treatment, and the right to veracity (the truth) regarding the client's condition and treatment.

A client with schizophrenia will not take medication because the client is gaining weight. This client is exercising which ethical principle? Autonomy Nonmaleficence Paternalism Justice

Autonomy Explanation: This client is executing the right to self-determination in making personal decisions. Nonmaleficence is the duty to cause no harm, both for the individual and for all. Justice is faithfulness to obligations and duties. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

A hospitalized client is delusional, yelling, "The world is coming to an end. We must all run to safety!" When other clients complain that this client is loud and annoying, the nurse decides to put the client in seclusion. The client has made no threatening gestures or statements to anyone. The nurse's action is an example of: a. assault. b. false imprisonment. c. malpractice. D. Negligence.

B. False imprisonment

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? Justice Veracity Beneficence Autonomy

Beneficence Explanation: Beneficence is the principle of using the knowledge of science and incorporating the art of caring to develop an environment in which individuals achieve their maximal health care potential. It is "doing good."

A client who was deemed to be at high risk for suicide was ordered visual checks every 15 minutes. The nurse had been performing these checks since the beginning of a shift but neglected to pass off this responsibility to a colleague before leaving the unit for a scheduled break. As a result, the client made a suicide attempt while the nurse was off the unit. Which ethical principle has the nurse most clearly violated? Beneficence Fidelity Veracity Autonomy

Beneficence Explanation: The ethical principle of beneficence refers to the duty to benefit or to promote the good of others. In this case, the nurse neglected to ensure the client safety by signing off to the nurse relieving her break. One could also assume the nurse also failed to apply the ethical principle of nonmaleficence or the requirement to do no harm to others either intentionally or unintentionally. Autonomy is related to independence in decision making, while beneficence is doing good and veracity is telling the truth. Fidelity refers to the obligation to honor commitments or contracts. Veracity refers to the duty to be honest and truthful.

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 Fidelity and paternalism Beneficence and fidelity Justice and autonomy

Beneficence and autonomy Explanation: Beneficence and autonomy are in conflict. Beneficence is practicing with the intent to do good; however, professionals define how to do good, which may override the wishes and self-determination of the client. Autonomy is the client's right to make decisions for himself or herself. Justice refers to fairness; that is, treating all people fairly and equally without regard for social and economic status, race, sex, marital status, religion, ethnicity and cultural beliefs. Fidelity is the nurse's faithfulness to duties, obligations, and promises.

A psychiatric nurse is assigned to perform observation of a client in restraints. The nurse knows that this client must be checked on how often? Every 4 hours Constantly for the first hour Every hour Every shift

Constantly for the first hour Explanation: A client in restraints must be observed 1:1 constantly for the first hour at which time the client must be assessed by a licensed independent practitioner.

Which would indicate a duty to warn a third party? a. A client with delusions states, "I'm going to get them before they get me." b. A hostile client says, "I hate all police." c. A client says he plans to blow up the federal government. d. A client states, "If I can't have my girlfriend back, then no one can have her."

D. A client states, "If I can't have my girlfriend back, then no one can have her."

Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members? Suicidal ideation. Unwilling to take medications. Extremely aggressive. Danger to others.

Danger to others. Explanation: Duty to warn refers to the responsibility of the nurse or the health care provider to warn identifiable third parties of threats made by clients. If the client is dangerous to any other member, the nurse is supposed to notify the person in danger immediately about the client's ideation. This law is not applicable to the client who has suicidal ideation, is extremely aggressive, or is unwilling to take medications. Client confidentiality is a very strict policy that should be abided by the nurses in any other circumstances.

Principles that serve as codes of conduct about right and wrong behaviors to guide actions are known as what? Fidelity Veracity Beneficence Ethics

Ethics Explanation: Ethics are principles that serve as codes of conduct about right and wrong behaviors to guide actions. Beneficence is the principle of doing good, not harm. Veracity is a systematic behavior of honesty and truthfulness in speech. Fidelity is faithfulness to duties, obligations, and promises.

A client with a diagnosis of depression has been referred to a support group led by an advanced practice psychiatric-mental health nurse. What action by the nurse best demonstrates the ethical principle of nonmaleficence? Assisting the client with investigating treatment options that will be covered by the client's health insurance plan Informing the client that many, but not all, clients benefit from participation in a support group Discontinuing the client's participation in the group because it causes the client intense anxiety Informing the client that participation in the group is fully voluntary and that the client can withdraw at any time

Discontinuing the client's participation in the group because it causes the client intense anxiety Explanation: Nonmaleficence focuses on avoiding harm, including intense anxiety. Voluntary participation involves autonomy and a clear explanation of risks and benefits involves veracity. Advocacy regarding financial matters does not involve the avoidance of harm.

Which intervention does not meet the standard of care for the client in seclusion? A health care provider's order given every 6 hours Documented assessment by the nurse every 1 to 2 hours Face-to-face evaluation by a licensed independent practitioner within 3 hours of seclusion Close supervision of the client

Documented assessment by the nurse every 1 to 2 hours Explanation: Documented assessment should take place by the nurse every 1 to 2 hours with close supervision of the client. ????

Which intervention does not meet the standard of care for the client in seclusion? Close supervision of the client Documented assessment by the nurse every 3 to 4 hours A health care provider's order given every 6 hours Face-to-face evaluation by a licensed independent practitioner within 1 hour of seclusion

Documented assessment by the nurse every 3 to 4 hours Explanation: Documented assessment should take place by the nurse every 1 to 2 hours with close supervision of the client.

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. Cause in fact Damages Duty Cause in proximity Occurrence of a simple mistake Financial obligation

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.

Malpractice is proven when certain criteria have been met. Which list includes the correct criteria? Duty of care, professional performance, injury related to the nurse's action, failure to document injury, and proven injury Duty of care, professional performance, injury related to the nurse's action, and action foreseeably could have caused the injury Duty of care, professional performance, injury related to the nurse's action, action foreseeably could have caused the injury, and proven injury Professional performance, injury related to the nurse's action, action foreseeably could have caused the injury, and proven injury

Duty of care, professional performance, injury related to the nurse's action, action foreseeably could have caused the injury, and proven injury Explanation: Malpractice includes the following elements of nursing negligence: The nurse professional had a duty of due care toward the plaintiff; the nurse professional's performance fell below the standard of care and was, therefore, a breach of that duty; as a result of the failure to meet the standard of care, the plaintiff consumer was injured, and the nurse's action was the proximate cause of the injury; and the plaintiff consumer must prove his or her injuries.

The inappropriate use of restraints or seclusion is considered which form of intentional tort? False imprisonment Assault Causation Battery

False imprisonment Explanation: False imprisonment is defined as the unjustified detention of a client, such as the inappropriate use of restraint or seclusion. Battery involves harmful or unwarranted contact with the client. Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Causation occurs when a breach of duty was the direct cause of loss, damage, or injury.

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? Defamation Assault Battery False imprisonment

False imprisonment Explanation: False imprisonment is the intentional and unjustifiable detention of a person against his or her will. Detention can occur with the use of physical restraint, barriers, or threats of harm. Battery is unlawful touching of another without consent. Defamation involves injury to a person's reputation or character through oral (slander) or written (libel) communications to a third party. Assault is an act that puts another person in apprehension of being touched or of bodily harm without consent.

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? Autonomy Beneficence Veracity Fidelity

Fidelity Explanation: Fidelity is the nurse's faithfulness to duties, obligations, and promises. Autonomy is the client's right to make decisions for himself or herself. Veracity is a systematic behavior of honesty and truthfulness in speech. Beneficence is the principle of doing good, not harm.

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: Ask the caregivers of the client for consent. Allow the client to go home. File for a civil commitment to detain. Not accept the client's request.

File for a civil commitment to detain. Explanation: Every client in a health care facility has a right to request to be discharged. If a client has suicidal ideations or is a danger to others, then the client should be under close supervision at all times. The health care provider should file a civil commitment to detain the client against the client's will until a hearing takes place to decide the matter. The caregivers may not understand the situation of the client and the danger that the client poses for the family. Thus, it would be inappropriate for the health care provider to ask the caregivers for consent.

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? Occupational Safety and Health Administration (OSHA) American Nurses Association (ANA) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Health Insurance Portability and Accountability Act (HIPAA)

Health Insurance Portability and Accountability Act (HIPAA) Explanation: The HIPAA Privacy Provisions Rule states that client records are secure and not readily available to those who do not need them to carry out treatment, payment, or health care operations activities. This situation would not include a violation of OSHA, ANA, or JCAHO.

A client was admitted to a psychiatric facility because the client was found walking around naked and talking incoherently. The client has no known next of kin and has been adjudicated incompetent. The client refuses any antipsychotic medications but has not been harmful to the self or others. What action should the facility take? Continue custodial care. Contact social services to find outpatient housing. Give the client medications by depot injection. Initiate court proceedings to have a guardian named.

Initiate court proceedings to have a guardian named. Explanation: When a client cannot give informed consent due to mental illness, health care providers must obtain substituted consent for necessary treatments or procedures. Substituted consent is authorization that another person gives on behalf of a client who needs a procedure or treatment but who cannot provide such consent independently. Substituted consent can come from a court-appointed guardian or, in some instances, from the client's next of kin. If the client has not previously been adjudicated incompetent and no next of kin are available to give substituted consent, if the law so permits, the health care agency may initiate a court proceeding to appoint a guardian so that treatment professionals can carry out the procedure or treatment.

When determining the existence of malpractice, which factor is not considered? Causation Duty Injury Intent

Intent Explanation: Malpractice must be proven by duty, breach of duty, injury or damage, and causation. Intention is not a factor that is considered.

A client was brought to the emergency department by police after neighbors reported him being loud and disruptive. The client is agitated and is extremely upset. The client states, "No one can be trusted." Which decision about about whether to involuntarily admit the client would be most appropriate? Involuntary admission is the correct decision because the client is cannot provide for basic needs. Involuntary admission is possibly a correct decision because the client may be a danger to others Involuntary admission is appropriate because the client is a danger to self Involuntary admission is inappropriate because the client does not meet the necessary criteria.

Involuntary admission is inappropriate because the client does not meet the necessary criteria. Explanation: Having a mental illness alone is not sufficient for an involuntary commitment. In this situation, the client is not a danger to himself or others and is not gravely disabled (unable to provide for basic needs).

A client receives a court order for commitment. Which best exemplifies the concept of "least restrictive environment"? Admission of client to a locked inpatient psychiatric unit Medication administration for sedation so the client cannot get out of bed Involuntary commitment to an outpatient community mental health center Placement of client in a secured padded room in response to threats of self-harm

Involuntary commitment to an outpatient community mental health center Explanation: An example of the concept of "least restrictive environment" is the involuntary commitment of a client to an outpatient mental health center. Medications cannot be given unnecessarily, such as to keep a client in bed. An individual cannot be restrained or locked in a room unless all other "less restrictive" interventions are attempted first. Placing a client in a locked inpatient unit would also not be considered the "least restrictive."

Which state allows for an insanity defense? Iowa Idaho Montana Utah

Iowa Explanation: Iowa has not abolished the insanity defense. Idaho, Montana, and Utah have abolished this defense.

Which statement accurately describes the insanity defense? It is commonly used It is accepted by the public It is rarely successful It is viewed positively by the courts

It is rarely successful Explanation: In actuality, this defense can be used only when the person meets the criteria for an insanity defense. So it is used infrequently and is not usually successful.

Which ethical principle is in jeopardy when segments of the mentally ill population do not have access to care? Paternalism Autonomy Fidelity Justice

Justice Explanation: Justice becomes an issue in mental health when a segment of a population does not have access to health care. Fidelity is faithfulness to obligations and duties. Autonomy is the fundamental right of self-determination. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

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 None of the above Autonomy Veracity

Justice Explanation: Justice is the duty to treat all clients fairly. It can become an ethical issue in mental health when a segment of the population does not have access to care, as in this case, in which access to inpatient care is warranted but denied.

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 nonmaleficence veracity paternalism

Justice Explanation: Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue in mental health when a segment of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individual and for all. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties, that is, keeping promises.

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? Fidelity Veracity Nonmaleficence Justice

Justice Explanation: Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue in mental health when a segment of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individual and for all. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties, that is, keeping promises.

A client has lived independently prior to being admitted to an inpatient unit. The client will be unable to return home following discharge. Which environment would be most appropriate for the client? Nursing home Least restrictive Most restrictive Transitional care unit

Least restrictive Explanation: In such cases, the goal is to stabilize and discharge the client to the least restrictive environment possible. Although a nursing home or transitional care unit may be appropriate, the health care team must look at the least restrictive environment for the client.

Which ethical principle focuses on the duty to do no harm? Beneficence Nonmaleficence Autonomy Justice

Nonmaleficence Explanation: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness. Beneficence refers to one's duty to benefit or promote good for others.

When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what? Informed consent Self-determination Nonmaleficence Pro-choice

Nonmaleficence Explanation: Nonmaleficence is the principle of creating no harm. It refers to preventing or minimizing harm to an individual. The other options do not represent the situation presented in the question.

Which ethical principle requires a nurse to prevent clients from harming themselves or others? Nonmaleficence Justice Autonomy Beneficence

Nonmaleficence Explanation: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Beneficence refers to one's duty to benefit or promote good for others. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness.

A client asks if the medication has any possible negative side effects. The nurse considers the client highly suggestible, believes the medication will benefit the client, and, since the client has no history of cardiovascular disease, does not tell the client of the potential for cardiac dysrhythmias. The nurse's actions involve a conflict between veracity and which other ethical principle? Nonmaleficence Fidelity Beneficence Justice

Nonmaleficence Explanation: The conflict is between veracity and nonmaleficence. Veracity is a systematic behavior of honesty and truthfulness in speech. Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Justice in health care is seen as the equitableness of benefits, including the right to access care. Beneficence is the principle of doing good, not harm. Fidelity is the nurse's faithfulness to duties, obligations, and promises.

A client is being discharged but still needs close supervision. Which type of involuntary commitment would be appropriate for this client? Extended Outpatient Observational Emergency

Outpatient Explanation: An outpatient involuntary commitment would be appropriate for this client. The client is stable enough for discharge but still needs to be closely monitored. An emergency, observational, or extended involuntary commitment would not be appropriate for this client.

To care for clients in the least restrictive environment, treatment is usually delivered in which care setting? Institution Inpatient Hospital Outpatient

Outpatient Explanation: Treatment is usually delivered in the community (as opposed to a hospital or institution) and, ideally, in an outpatient setting.

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? Health promotion Intake screening Psychotherapy Counseling

Psychotherapy Explanation: Although the advanced level psychiatric-mental health nurse would be able to perform the functions of health promotion, counseling, and intake screening, because of the nurse's advanced level of preparation, the nurse would be able to perform psychotherapy. Health promotion, counseling, and intake screening are basic-level functions in the practice area of psychiatric-mental health nursing.

After educating a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which as a right? Freedom from restraints or seclusion Access to one's own mental health records upon request Refusal of treatment during an emergency situation An individualized written treatment plan

Refusal of treatment during an emergency situation Explanation: The Bill of Rights for persons receiving mental health services includes the right to be free from restraints or seclusion, to access one's own mental health care records upon request, to have an individualized written treatment plan, and to refuse treatment except during an emergency situation.

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? State Board of Nursing Standards of Practice Code of Ethics for Nurses Standards of Professional Performance

Standards of Practice Explanation: The ANA and the psychiatric nursing organizations collaborate in defining the boundaries of psychiatric-mental health nursing and informing society about the parameters of practice. The standards are authoritative statements that describe the responsibilities for which the practitioners are accountable. The six standards of practice include competencies for which Psychiatric-Mental Health Registered Nurse (PMH-RN) and Advanced Practice Psychiatric-Mental Health Registered Nurses (PMH-APRN) are accountable and define the parameters of psychiatric-mental health nursing practice. Ten standards of professional performance for psychiatric-mental health nurses define and inform society about the professional role of psychiatric-mental health nurses. The Code of Ethics for Nurses presents ethical values, obligations, duties and professional ideals, establishes an ethical standard, and confirms nursing's commitment to society. The State Board of Nursing is considered the legal agency for the practice of nursing.

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 Mental Health Systems Act of 1980 The Patient Self-Determination Act Public Law 99-319, The Protection and Advocacy for Mentally Ill Individuals Act of 1986

Tarasoff v. Regents of the University of California Explanation: In Tarasoff v. Regents of the University of California, the high court said that psychotherapists have a duty to warn the foreseeable victims of their clients' violent actions. The acts listed do not specify a duty to warn.

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 The World Health Organization Guidelines for Nursing Practice The recognized norms in the jurisdiction where the team is working The policies and procedures manual of the institution

The American Nurses Association Standards of Practice Explanation: The American Nurses Association standards outline the scope of practice for PMH-RNs and PMH-APRNs. These standards override institutional policies and local norms. There is no World Health Organization Guidelines for Nursing 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 obtain release against medical advice. The client can refuse medication. The client is in need of a public guardian. The client is considered incompetent.

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.

A client who was admitted to the facility voluntarily has requested to be discharged and allowed to return home. The health care provider files for a civil commitment to hold the client in the hospital. What is the most likely reason to file this action? The client needs medications to be administered on time. The client has suicidal ideation. The client needs to be monitored regularly for vital signs. The client requires psychotherapy.

The client has suicidal ideation. Explanation: Clients who have voluntarily admitted themselves to the hospital may leave unless they pose a threat to others or themselves. If the client has expressed serious thoughts about committing suicide, the health care provider may file for civil commitment to detain. Psychotherapy sessions can be completed on an outpatient basis so that the client could come for the session and go back home after the sessions. Additionally, the client's vital signs can be monitored on an outpatient basis. The regimen for drug administration can be explained to the caregivers of the client.

What findings would lead the nurse to conclude that the client needs a conservator? Select all that apply. The client is not taking medications on time. The client is unable to act in the client's best interest. The client has schizophrenia. The client is extremely aggressive. The client cannot provide food, clothing and shelter for self.

The client is unable to act in the client's best interest. The client cannot provide food, clothing and shelter for self. Explanation: A conservator or a legal guardian is required for clients with psychiatric illness if they are not able to act in their own best interests or if they cannot provide food, clothing, and shelter for themselves (in spite of having resources). A diagnosis of schizophrenia alone does not mean the client requires a legal guardian. If the client is aggressive, then the client needs to be monitored closely. Appointing a legal guardian will not be of use for this client. If the client does not take the medications on time it does not indicate that the client requires a conservator.

A nurse is explaining assisted outpatient treatment to a client who is being discharged from the hospital. Which instructions should the nurse give the client regarding the assisted outpatient treatment? Select all that apply. The client must attend community health care lectures on the disorder. The client must attend specific group therapy programs. The client must attend the follow-ups as per the schedule. The client must take prescribed medications as per the dosing schedule. The client can decide whether to join the assisted outpatient treatment program.

The client must attend the follow-ups as per the schedule. The client must attend specific group therapy programs. The client must take prescribed medications as per the dosing schedule. Explanation: The assisted or mandated outpatient treatment program requires that the client attend all the follow-up sessions and join specific group therapy sessions that could help the client to function better in the community. The client must also take prescribed medications as per the dosing schedule. The assisted outpatient treatment does not require that the client has to attend all community health care lectures on the disorder. The assisted outpatient treatment is a mandatory program; the client has to attend the program irrespective of his or her willingness.

A nurse is reviewing a journal article about malpractice and the elements required to prove negligence. The nurse demonstrates a need for additional review when the nurse identifies which element as being necessary? The client must be injured physically as a result of the nurse's action. The nurse's performance fell below the standard of care. The nurse professional had a duty of due care toward the plaintiff. The client must prove the existence of injury.

The client must be injured physically as a result of the nurse's action. Explanation: As a result of the failure to meet the standard of care, the plaintiff consumer was injured, and the nurse's action was the proximate cause of the injury. The act must have resulted in some kind of injury to the client. However, the injury does not have to be physical; it can be emotional injury as well.

A client's estranged spouse has phoned the hospital unit several times seeking information about the client's admission and status. A nurse hears a colleague tell the client, "No, your spouse has not called as far as I know." When confronted by the nurse, the colleague states, "I'm just trying to look out for the client by protecting the client from stress." How should the colleague's actions be interpreted? The colleague was not justified in deceiving the client and contradicted the principle of fidelity The colleague's actions are a justifiable example of paternalism aimed at protecting the client's best interests The colleague had good motives but violated the principle of veracity The colleague was unjustified in allowing autonomy to override beneficence

The colleague had good motives but violated the principle of veracity Explanation: Deception violates veracity, even if it is motivated by the client's interests. This deception would not be considered to be a justifiable example of paternalism. Fidelity focuses on obligations and duties. The colleague neglected the client's autonomy rather than promoting it.

A new graduate nurse demonstrates understanding that developing and maintaining competency is crucial to giving adequate and safe care to all psychiatric clients. To whom would the new graduate assign this responsibility for maintaining this standard of professional performance? The graduate nurse The American Nurses Association The facility where the graduate now works The nursing school from which the student graduated

The graduate nurse Explanation: Developing and maintaining competency is the responsibility of the professional psychiatric-mental health nurse.

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 asks the client to calm down. The nurse sedates the client with morphine. The nurse ties the client's wrist using wrist restraints. The nurse and a group of paramedics hold the client.

The nurse and a group of paramedics hold the client. Explanation: Restraint is the direct application of physical force to restrict the client's freedom of movement. The nurse and a group of paramedics holding the client is an example of human restraint. The nurse does not apply force while telling the client to calm down. Sedating the client is an example of chemical restraint. Applying a wrist cuff to control the aggression of the client indicates the use of mechanical restraints.

Which situations depict a nurse employing the principles of fidelity while providing care? Select all that apply. The nurse tells the client that the client will be having a test done shortly, and 15 minutes later the nurse arrives to take the client to have the test administered. The nurse tells the client, "I will return to give you pain medication in 1 hour." The nurse returns in 1 hour. The client asks questions about surgery and the nurse answers the questions completely. The client asks, "If I take this medication, will the cancer go away?" The nurse tells the truth.

The nurse tells the client, "I will return to give you pain medication in 1 hour." The nurse returns in 1 hour. The nurse tells the client that the client will be having a test done shortly, and 15 minutes later the nurse arrives to take the client to have the test administered. Explanation: Fidelity is faithfulness to obligations and duties, such as telling a client you will do something and returning to complete the task. The client asking questions about surgery and the nurse answering the questions completely and the nurse telling the complete truth are not examples of fidelity.

When it is discovered that a nurse did not act reasonably when providing care in accordance with the standards of professional practice, which factor would confirm the nurse has been negligent? The nurse was responsible for client injury The nurse was responsible for a client's injury and it was serious The client's actions played a part in the nurse's reaction The nurse was responsible for a client injury that resulted in permanent disability

The nurse was responsible for client injury Explanation: After it is determined that the nurse did not act responsibly in providing care in accordance with established standards of care, the remaining issue is to confirm that injury occurred as a result of the nurse's actions. That the client's injury was serious, resulted in permanent disability, and is the result of the client's actions are not part of the decision.

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 pens or pencils. The room should not have locked doors. The room should have facility for direct visual monitoring. The room should have a bed that is bolted to the floor. The room should not have any sharp objects.

The room should not have any sharp objects. The room should have a bed that is bolted to the floor. The room should have facility for direct visual monitoring. Explanation: Seclusion requires a psychiatric client to be confined in a room that is specially constructed. The room should not have any sharp objects like knives or pens and pencils, as the client can inflict self-harm or harm to medical personnel. The bed should ideally be bolted to the floor to prevent any kind of danger due to the client's aggression. The nurse should be able to visually monitor the client, using a window or using video cameras. The room should have a locking door to prevent the client from attempting to run away.

Professional regulations and laws that govern nursing practice are in place for what reason? To ensure that practicing nurses have strong interpersonal skills To protect the safety of the public To ensure that enough new nurses are always available To limit the number of nurses in practice

To protect the safety of the public Explanation: Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.

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? Fidelity Veracity Autonomy Justice

Veracity Explanation: Veracity is the duty to tell the truth. In this case, the client wants to hear that the client can stop medication, but the nurse is honest and tells the client that the client will need to continue it to stay healthy.

An adolescent client has refused to wash or change clothes for several days. The client's hair is greasy, the client's clothes are stained, and the client has a strong malodor. Three male staff members approach the client to escort the client to the shower. The client resists and becomes combative with staff members. The client is placed in seclusion and is told the client will be released when the client is calm and willing to shower. Which is an accurate statement of the client's rights in this situation? Not violated, because the client's combative behavior warranted seclusion and restraint to protect others Violated, primarily because of the inappropriate use of restraints Violated, primarily because showering is a personal preference Not violated, because hygiene is an important aspect of treatment

Violated, primarily because of the inappropriate use of restraints Explanation: Clients have the right to treatment in the least restrictive environment. No staff can confine a person with mental illness who is not a threat to self or others. Nurses must assess a client's condition and status constantly so that health care professionals can initiate more or less restrictive treatment alternatives based on the client's evolving needs.

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? Have the client sign a safety contract. Warn the client's spouse, based on the Tarasoff rule. Hold all psychotherapeutic content under strict confidence. Offer the client medication to help with anxiety and impulsive feelings.

Warn the client's spouse, based on the Tarasoff rule. Explanation: Mental health clinicians have a duty to warn identifiable third parties of threats made by clients even if the threats were discussed during a therapeutic session otherwise protected by client-therapist privilege.

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: informed consent patient rights durable power of attorney advance directive

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.

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 flu orthopedic impairment pneumonia autism

autism traumatic brain injury orthopedic impairment Explanation: The right to be treated in the least restrictive environment means that an individual cannot be restricted to an institution when he or she can be successfully treated in the community. Disabilities include autism, orthopedic impairments, and traumatic brain injuries. Flu, and pneumonia are not among the problems included in the Individuals with Disabilities Education Act.

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? justice beneficence paternalism autonomy

autonomy Explanation: Autonomy reflects the fundamental right of all persons for self-determination, to make independently make choices. Autonomy is reflected by the client's statement to stop taking the medication. The nurse's urging the client to continue to use the medication because of the medication's benefits reflects the principle of beneficence, that is, the nurse is using scientific knowledge and incorporating that knowledge to promote the client's maximum health potential. In this case, the medication would help to control the client's depressive symptoms. Justice reflects the duty to treat all fairly; paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

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? justice and beneficence veracity and fidelity autonomy and beneficence non-maleficence and autonomy

autonomy and beneficence Explanation: According to the principle of autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. The client has the right to decide whether to go to a family meeting or not, and the nurse urges the client to go to the meeting because the nurse knows that the family will be a great support to the client. The ethical principles that are not in conflict in this situation are justice and beneficence, non-maleficence and autonomy, and veracity and fidelity.

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 paternalism veracity justice

beneficence Explanation: According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximum health care potential. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is the duty to tell the truth. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

Providing milieu therapy is an example of the use of which ethical principle? autonomy fidelity veracity beneficence

beneficence Explanation: When using the ethical principle of beneficence, a health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential, as in milieu therapy. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties. According to the principle of autonomy, each person has the fundamental right of self-determination.

A nurse is reviewing the Standards of Professional Performance. Which area would the nurse most likely find being addressed? assessment evaluation communication outcome identification

communication Explanation: Ten standards of professional performance for psychiatric-mental health nurses define and inform society about the professional role of psychiatric-mental health nurses and include ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental health. Assessment, outcome identification and evaluation are standards found in the Standards of Practice.

The nurse gives the client quetiapine (Seroquel) in error when olanzapine (Zyprexa) was ordered. The client has no ill effects from the quetiapine. In addition to making a medication error, the nurse has committed which? a. Malpractice b. Negligence c. Unintentional tort d. None of the above

d. none of the above

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 living will informed consent patient rights

durable power of attorney Explanation: A durable power of attorney for health care appoints a proxy, usually a relative or trusted friend, to make health care decisions on an individual's behalf. The living will, patient rights, and informed consent are not included in the durable power of attorney. A living will is a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them. 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.

Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who: refuses to take the prescribed medication. refuses to participate in the planned therapy. is homeless and has been diagnosed with a mental disorder. is screaming in the street and disturbing neighbors.

is screaming in the street and disturbing neighbors. Explanation: A client who is screaming in the street is more likely to be judged as a danger to the self or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy does not pose an immediate danger to oneself or others.

Which ethical principles become an issue in mental health when a segment of a population does not have access to health care? justice fidelity veracity nonmaleficence

justice Explanation: Justice is the duty to treat all fairly, distributing the risk and benefits equally. Justice becomes an issue in mental health when a segment of a population does not have access to health care. Basic good should be distributed so the least advantaged members of society benefit. Nonmaleficence, fidelity, and veracity are not being used in this situation.

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: patient rights informed consent durable power of attorney living will

living will Explanation: A living will states what treatment should be omitted or refused in the event that a person is unable to make those decisions. 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 rules of conduct between patients and medical caregivers as well as the institutions and people that support them. A durable power of attorney means that the document stays in effect if you become incapacitated and unable to handle matters on your own.

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: false imprisonment. assault. battery. medical battery.

medical battery. Explanation: Failure to respect a client's advance care directive is considered medical battery. Assault is the threat of unlawful force to inflict bodily injury on another. Battery is intentional and unpermitted contact with another. False imprisonment is detention or imprisonment contrary to the provision of law.

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? beneficence assault negligence non-maleficence

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.

Which situations would describe the nurse employing the principles of patient autonomy while providing care? Select all that apply. explain all risks in a way the client can understand provide immunizations as scheduled for the client encourage the client to stop smoking present all options for treatment to the client find solutions for a client that is in pain

present all options for treatment to the client explain all risks in a way the client can understand Explanation: Patient autonomy means allowing the client to make choices for him/herself and recognizing their right to choose his/her own health care decisions. Helping a client that is in pain, providing immunizations as scheduled and encouraging the client to stop smoking are not principles of patient autonomy.

A psychiatric-mental health nurse is reviewing the medical record of a client who was involuntarily committed to the mental health unit of the hospital. The nurse determines that the client was most likely involuntarily committed for which reason? missed an appointment with the mental health counselor ranting and waving a loaded gun in a crowded mall recently lost a sibling and had a crying outburst at work refused to take medication at the clinic this morning

ranting and waving a loaded gun in a crowded mall Explanation: Involuntary commitment is the mandated treatment without the person's consent but with a court order. Although statutes vary, three common elements are found in most 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"). Only the person ranting and waving a loaded gun in a crowded mall would meet these three elements.

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 budget factors placement options availability of space

unique needs Explanation: Least restrictive environment means the individual cannot be restricted to an institution when he or she can be successfully treated according to the client's needs, and stay in the community. Budget factors, placement options, and availability of space are not factors related to The American's with Disabilities Act.

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? fidelity justice veracity beneficence

veracity Explanation: Veracity is the duty to be honest or truthful. The nurse is exercising veracity when fully answering any questions the client is answering without withholding information. Justice, beneficence and fidelity are not the ethical principle described in this question.