Ch. 9 PrepU questions

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? 1. Tarasoff v. Regents of the University of California 2.The Patient Self-Determination Act 3.The Mental Health Systems Act of 1980 4.Public Law 99-319, The Protection and Advocacy for Mentally Ill Individuals Act of 1986

1. Tarasoff v. Regents of the University of California

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? 1. Warn the client's spouse, based on the Tarasoff rule. 2. Hold all psychotherapeutic content under strict confidence. 3. Have the client sign a safety contract. 4. Offer the client medication to help with anxiety and impulsive feelings.

1. Warn the client's spouse, based on the Tarasoff rule.

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 physician at this time. What is the most appropriate response of the nurse? 1."You will need to sign a written request for discharge." 2."I need to check with your family members if they think it would be okay." 3."You are free to leave at your will." 4."I will contact your landlord and let the landlord know you will be home."

1."You will need to sign a written request for discharge."

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? 1.A client who is being held involuntarily in a secure psychiatric setting 2.A client with a history of mental illness who is serving a lengthy term in a federal prison 3.A client who is receiving care involuntarily on a community hospital's psychiatric unit 4.A client who has been released into the community with strict limits on activity

1.A client who is being held involuntarily in a secure psychiatric setting

The Tarasoff decision has resulted in the mental health clinician having a responsibility to do what? 1.A duty to warn 2.Mandated outpatient treatment 3.Placement of the client in the least restrictive environment 4.Appointment of a legal guardian

1.A duty to warn

What action by a nurse best promotes the ethical principle of justice? 1.Advocating for enhanced mental health services in an underserved neighborhood 2.Informing a client who is competent that the client has the right to discontinue treatment 3.Clearly describing the potential adverse effects of a client's new pharmacologic treatment 4.Obtaining written, informed consent from a client who has agreed to be in a research study

1.Advocating for enhanced mental health services in an underserved neighborhood

The nurse recognizes that the difference between a voluntary and an involuntary commitment is what? 1.An involuntarily committed client may not initiate his or her own discharge 2.The voluntarily committed client is usually less aggressive 3.An involuntarily committed client may refuse all treatment 4.The voluntarily committed client usually has good insight into his or her mental health problem

1.An involuntarily committed client may not initiate his or her own discharge

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? 1.Assess the client's legal capacity when that client is asked to give consent. 2.Talk the client out of revoking consent once the study has started. 3.Obtain informed consent when the primary provider cannot be present. 4.Persuade the client to consent, because the new drug has shown promising results.

1.Assess the client's legal capacity when that client is asked to give consent.

A client has been estranged from the client's parents for several years, and they have expressed a desire to reconcile with the client. The client initially agreed to a meeting but has told the nurse that the client plans to cancel it at the last minute. The nurse has encouraged the client to attend the meeting, knowing that the family's support would be valuable. What ethical principles are in conflict in this situation? Select all that apply. 1.Autonomy 2.Beneficence 3.Non-maleficence 4.Veracity 5.Fidelity

1.Autonomy 2.Beneficence

A psychiatric mental health facility is undergoing a change from paper-based health records to electronic records. What action should the nurse prioritize in order to ensure client rights are protected? 1.Being vigilant to identify any potential threats to client confidentiality 2.Ensuring clients know that they have the right to opt out of the proposed system 3.Educating clients and families about the potential benefits of the new system 4.Teaching clients that they may lose the right to view their health records under the new system

1.Being vigilant to identify any potential threats to client confidentiality

A new nursing student is studying ethics in nursing and informs a client who wants to stop medication about its benefits and how the client will continue to feel better only if use of the drug continues. Which concept is the nursing student using? 1.Beneficence 2.Autonomy 3.Veracity 4.Justice

1.Beneficence

A client admitted to the mental health unit has exhibited physical behaviors that put the client and others at risk. The nurse applies four-point restraints on the client without obtaining a physician's order or the client's consent. The nurse is at risk of being accused of what? 1.False imprisonment 2.Negligence 3.Battery 4.Slander

1.False imprisonment

The inappropriate use of restraints or seclusion is considered which form of intentional tort? 1.False imprisonment 2.Battery 3.Assault 4.Causation

1.False imprisonment

Earlier in the shift, the nurse promised to help a client acquire some paper and a pen and draft a letter to a family member later in the day. The nurse became increasingly busy during the shift but has now taken some time to assist the client in this way. What ethical principle has the nurse best exemplified? 1.Fidelity 2.Veracity 3.Non-maleficence 4.Beneficence

1.Fidelity

What is the therapeutic goal of seclusion? 1.Give the client the opportunity to gain self-control 2.Promote thoughtful reflection regarding behavior 3.Punish the client for bad behavior 4.Allow the nurse to monitor for side effects of medications

1.Give the client the opportunity to gain self-control

When staff members physically control the client and move him or her to a seclusion room, what form of restraint is being implemented? 1.Human 2.Mechanical 3.Short term 4.Long term

1.Human

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? 1.Initiate court proceedings to have a guardian named. 2.Give the client medications by depot injection. 3.Continue custodial care. 4.Contact social services to find outpatient housing.

1.Initiate court proceedings to have a guardian named.

A client receives a court order for commitment. Which best exemplifies the concept of "least restrictive environment"? 1.Involuntary commitment to an outpatient community mental health center 2.Medication administration for sedation so the client cannot get out of bed 3.Placement of client in a secured padded room in response to threats of self-harm 4.Admission of client to a locked inpatient psychiatric unit

1.Involuntary commitment to an outpatient community mental health center

One way that nurses can protect themselves against liability from malpractice is to do what? 1.Know the statutory and professional standards. 2.Avoid documenting incriminating information. 3.Carry individual malpractice insurance. 4.Request legal consultation from the employer.

1.Know the statutory and professional standards.

When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what? 1.Non-maleficence 2.Informed consent 3.Self-determination 4.Pro-choice

1.Non-maleficence

Client charts are legal documents that can be used in court; therefore, all nursing notes and progress records should above all include which information? 1.Reflect descriptive, nonjudgmental, and objective statements. 2.Provide interpretive, subjective statements by the nurse about the client's behavior. 3.Include difficulties expressed between professional members of the health care team that may have affected the client's progress. 4.Reflect the meaning that the client's behavior had for other clients on the unit.

1.Reflect descriptive, nonjudgmental, and objective statements.

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? 1.The American Nurses Association Standards of Practice 2.The policies and procedures manual of the institution 3.The recognized norms in the jurisdiction where the team is working 4.The World Health Organization Guidelines for Nursing Practice

1.The American Nurses Association Standards of 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? 1.The client can refuse medication. 2.The client can obtain release against medical advice. 3.The client is in need of a public guardian. 4.The client is considered incompetent.

1.The client can refuse medication.

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. 1.The room should have pens or pencils. 2.The room should not have any sharp objects. 3.The room should not have locked doors. 4.The room should have a bed that is bolted to the floor. 5. The room should have facility for direct visual monitoring.

2.The room should not have any sharp objects. 4.The room should have a bed that is bolted to the floor. 5. The room should have facility for direct visual monitoring.

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. 1.The client must attend the follow-ups as per the schedule. 2.The client must attend specific group therapy programs. 3.The client must take prescribed medications as per the dosing schedule. 4.The client must attend community health care lectures on the disorder. 5.The client can decide whether to join the assisted outpatient treatment program.

1.The client must attend the follow-ups as per the schedule. 2.The client must attend specific group therapy programs. 3.The client must take prescribed medications as per the dosing schedule.

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? 1.The colleague had good motives but violated the principle of veracity 2.The colleague was not justified in deceiving the client and contradicted the principle of fidelity 3.The colleague's actions are a justifiable example of paternalism aimed at protecting the client's best interests 4.The colleague was unjustified in allowing autonomy to override beneficence

1.The colleague had good motives but violated the principle of veracity

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? 1.The nurse was responsible for client injury 2.The nurse was responsible for a client's injury and it was serious 3.The nurse was responsible for a client injury that resulted in permanent disability 4.The client's actions played a part in the nurse's reaction

1.The nurse was responsible for client injury

Providing milieu therapy is an example of the use of which ethical principle? 1.beneficence 2.veracity 3.fidelity 4.autonomy

1.beneficence

A nurse is providing care to a male client who is hospitalized with a diagnosis of schizophrenia. Which would be appropriate for the nurse to include in the client's medical record? 1."Client states that he had a good night with no issues." 2."Reports being unable to sleep because the client heard voices throughout the night." 3."Had a typical night without incidence of insomnia or nightmares." 4."Acted crazily throughout the night; kept hearing voices and noises."

2."Reports being unable to sleep because the client heard voices throughout the night."

The nurse is explaining the responsibilities to a client's legal guardian. Which statements by the nurse are correct? Select all that apply. 1."You have to make the client stay with you." 2."You are supposed to write checks for the client." 3."You are supposed to monitor the client all the time." 4."You have to make health care decisions for the client." 5."You, not the client, should sign legal documents."

2."You are supposed to write checks for the client." 4."You have to make health care decisions for the client." 5."You, not the client, should sign legal documents."

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? 1.Ascertaining the client's privacy 2.Acquiring informed consent 3.Encouraging the client to be self-determined 4.Acting in a beneficent manner

2.Acquiring informed consent

A client who has bipolar disorder stops taking medication because the client says the client likes how the client feels in a manic state. The client is exercising which principle? 1.Paternalism 2.Autonomy 3.Justice 4.Veracity

2.Autonomy

A nurse recruiter is interviewing a nurse for a psychiatric-mental health nursing position at the community clinic. When reviewing the applicant's educational background, the recruiter would identify which as the preferred level of preparation? 1.Associate's degree 2.Bachelor's degree 3.Master's degree 4.Doctoral degree

2.Bachelor's degree

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? 1.Assault 2.Battery 3.Beneficence 4.Fidelity

2.Battery

Which is the most important reason for psychiatric nurses to understand law, legislation, and legal processes that relate to professional nursing practice? 1.Because only by lobbying can psychiatric nurses have an impact on the delivery of services on a national level. 2.Because doing so gives the nurse the ability to provide quality care that will safeguard the rights and safety of clients. 3.Because these activities are included in the Nursing Code of Ethics. 4.Because doing so gives the nurse guidelines by which to use seclusion and restraint appropriately, when needed.

2.Because doing so gives the nurse the ability to provide quality care that will safeguard the rights and safety of clients.

Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members? 1.Suicidal ideation. 2.Danger to others. 3.Extremely aggressive. 4.Unwilling to take medications.

2.Danger to others.

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? 1.Battery 2.False imprisonment 3.Defamation 4.Assault

2.False imprisonment

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? 1.Most restrictive 2.Least restrictive 3.Nursing home 4.Transitional care unit

2.Least restrictive

Which are functions of assertive community treatment? Select all that apply. 1.Increases the likelihood of relapse 2.Reduces inpatient service use 3.Promotes continuity of outpatient care 4.Increases the stability of people with serious mental illnesses 5.Decreases availability of services

2.Reduces inpatient service use 3.Promotes continuity of outpatient care 4.Increases the stability of people with serious mental illnesses

A psychiatric-mental health nurse is providing care to several clients. Some of the clients have been voluntarily admitted while others have been involuntarily admitted. Which description about voluntary admissions demonstrates that the nurse understands the differences between these two types of admissions? 1.They can leave the hospital whenever they want. 2.They have agreed to the hospitalization. 3.They are not considered a danger to themselves or others. 4.They cannot refuse treatment.

2.They have agreed to the hospitalization.

Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who: 1.refuses to take the prescribed medication. 2.is screaming in the street and disturbing neighbors. 3.refuses to participate in the planned therapy. 4.is homeless and has been diagnosed with a mental disorder.

2.is screaming in the street and disturbing neighbors.

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? 1."I'm sorry; we're not allowed to give out that information about our client." 2."I'll have to get the client's signed consent before we can send that information to you." 3."I am unable to acknowledge whether or not this client is a client on this unit." 4."Sure, give me your address, and I will see that the information is sent to you."

3."I am unable to acknowledge whether or not this client is a client on this unit."

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? 1.Justice 2.Beneficence 3.Autonomy 4.Veracity

3.Autonomy

A client is being seen in the mental health clinic because of relapse. The client has been non-adherent with the medication regimen. The nurse reinforces the advantages of taking medications. The nurse is using which ethical principle? 1.Autonomy 2.Justice 3.Beneficence 4.Veracity

3.Beneficence

Which ethical principle is in jeopardy when segments of the mentally ill population do not have access to care? 1.Fidelity 2.Autonomy 3.Justice 4.Paternalism

3.Justice

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? 1.Health promotion 2.Counseling 3.Psychotherapy 4.Intake screening

3.Psychotherapy

A nursing student identifies which as the most important tool of psychiatric nursing? 1.Clinical reasoning 2.Reflection 3.Self 4.Plan of care

3.Self

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? 1.The nurse professional had a duty of due care toward the plaintiff. 2.The nurse's performance fell below the standard of care. 3.The client must be injured physically as a result of the nurse's action. 4.The client must prove the existence of injury.

3.The client must be injured physically as a result of the nurse's action.

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? 1.Autonomy 2.Justice 3.Veracity 4.Fidelity

3.Veracity

Which client most likely has the legal right to refuse treatment? 1.A client who committed an assault while experiencing delusions 2.A 20-year-old who has been admitted to the hospital for the treatment of depression after a suicide attempt 3.A homeless person with schizophrenia who was admitted to the hospital with dehydration after refusing to eat for several days 4.A client who voluntarily entered a substance abuse treatment facility to address an addiction to alcohol

4.A client who voluntarily entered a substance abuse treatment facility to address an addiction to alcohol

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? 1.The client's primary nurse 2.The client's psychiatrist 3.A hospital-appointed interdisciplinary committee 4.A guardian appointed by the court

4.A guardian appointed by the court

A nurse tells a client that the nurse will bring the client pain medicine in 5 minutes after checking on another client. The nurse returns in 5 minutes and administers the medication as planned. The nurse is practicing which principle by returning as promised? 1.Autonomy 2.Non-maleficence 3.Paternalism 4.Fidelity

4.Fidelity

When promoting client safety on an inpatient psychiatric unit, which interventions would be used as the measure of last resort? 1.Surveillance 2.Seclusion 3.Room restriction 4.Four-point restraint

4.Four-point restraint

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? 1.Freedom from restraints or seclusion 2.Access to one's own mental health records upon request 3.An individualized written treatment plan 4.Refusal of treatment during an emergency situation

4.Refusal of treatment during an emergency situation

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? 1.The nurse asks the client to calm down. 2.The nurse sedates the client with morphine. 3.The nurse ties the client's wrist using wrist restraints. 4.The nurse and a group of paramedics hold the client.

4.The nurse and a group of paramedics hold the client.

A 22-year-old client with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it." The nurse explains to the client, "Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better." This conversation reflects a conflict between which two types of ethical principles? 1.autonomy and justice 2.paternalism and veracity 3.justice and nonmaleficence 4.autonomy and beneficence

4.autonomy and beneficence

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? 1.non-maleficence 2.paternalism 3.veracity 4.justice

4.justice

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? 1.nonmaleficence 2.paternalism 3.veracity 4.justice

4.justice