Chapter 4 NCLEX questions
A psychiatric-mental health nurse is conducting a class for a community group about the rights of individuals w/mental health problems. As part of the program, the nurse is describing the concept of self-determinism. The nurse determines that the program was successful when the group identifies which idea as exemplifying self-determination?
Right to choose other forms of treatment Right to refuse treatment Right to obtain other opinions The right to self-determination entitles all clients to refuse treatment (except during an emergency situation), to obtain other opinions, and to choose other forms of treatment A client has a right not to participate in experimentation in the absence of the client's informed, voluntary, written consent
Which mental health client meets criteria to be involuntarily committed?
A client diagnosed w/borderline personality disorder who is threatening to self-harm Involuntary commitment is confined hospitalization of a person w/o the person's consent but w/a court order Three common elements are found in most statutes for involuntary commitment The individual must be 1) mentally disordered, 2) dangerous to him/herself or others, or 3) unable to provide for his/her basic needs The client diagnosed w/borderline personality disorder is a danger to the self The other clients are not in immediate danger to themselves or others
A psychiatric-mental health nurse is conducting a seminar for a group of colleagues about clients' rights and mental health care treatment. The nurse determines that the seminar was successful when the group describes competency as being valid for:
A specified time It is generally agreed that competence, or the degree to which the client can understand and appreciate the information given during the consent process, refers to a client's cognitive ability to process information at a specific time A pt may be competent to make a treatment decision at one time and not be competent at another time
What can help prevent negative outcomes of malpractice litigations in psychiatric mental health care?
Adhere to the agency's policy and procedure Seek consultation and record input Involve the family in important decisions Evaluate risks to the client Evaluating the risk to the client, involving the family in important decisions, adhering to the agency's policy and procedure, seeking consultation, and recording the input are all activities that help decrease the likelihood of litigation All client care and treatment decisions should and must be documented to ensure protection of client rights
A psychiatric-mental health nurse is reviewing information about the Pt Self-Determination Act. The nurse understands that this law addresses which element?
Advance care The Pt Self-Determination Act addresses the issue of advance care and advance care planning The Americans w/Disabilities Act ensures that individuals w/disabilities, including severe mental health disorders, have legal protection against discrimination in the workplace The Mental Health Systems Act requires that each state to review and revise its laws to ensure that mental health pt receive human rights protections and services that they require This protection is beyond that afforded to pts in other health care areas The Protection and Advocacy for Mentally Ill Individuals Act of 1986 requires each state mental health provider to establish and operate a system that protects and advocates for the rights of individuals w/mental illnesses and investigates any incidents of abuse and neglect
When describing an external advocacy system, which agency would the nurse most likely include?
American Public Health Association American Hospital Association American Healthcare Association Health organizations such as the American Hospital Association, American Healthcare Association, and American Public Health Association serve as advocates for the rights and treatment of mental health clients and are a part of an external advocacy system The Joint Commission and the Centers for Medicare and Medicaid Services are accrediting agencies
A psychiatric-mental health nurse is providing care to a male client who came to the substance abuse rehabilitation facility on his own asking for assistance w/cocaine dependence. The nurse anticipates that the client would be legally required to stay at the facility for which duration?
As long as needed or desired The client's behavior reflects a voluntary admission The person enters the treatment facility, participates in the treatment planning process, and follows through w/the treatment The individual maintains all civil rights and is free to leave at any time, even if it is against medical advice There is no time requirement for the stay
A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which ethical principle?
Autonomy Self-determinism can be defined as being empowered or having the free will to make moral judgments Autonomy is the right to make one's own decisions Personal autonomy and avoidance of dependence on others are key values of self-determinism Veracity is truthfulness Justice encompasses equal treatment for all Beneficence is doing no harm
A psychiatric-mental health nurse is providing outpt care to a pt w/a history of anxiety. Which behavior would the nurse interpret as reflecting self-determinism?
Client seeks a second opinion about condition and proposed treatment A self-determined individual is internally motivated to make choices based on personal goals, not to please others or to be rewarded Personal autonomy and avoidance of dependence on others are key values of self-determinism In mental health care, self-determinism is the right to choose one'sown health-related behaviors, which at times differ from those recommended by health professionals A client's right to refuse treatment, to choose the second or third best health care recommendation rather than the first, and to seek a second opinion are all self-deterministic acts
What is accurate regarding documenting in the client record?
Courts consider acts not recorded as acts not done A client record is the primary documentation of the client's problem, verifies the behavior of the client at the point of care, and describes the care provided For handwritten documentation, the entries should always be written in pen w/o erasures The record should not include staff biases General, stereotypical statements, such as "had a good night" or "no complaints" are meaningless and should be avoided
A nurse is teaching a client newly diagnosed w/a mental disorder and their family. Which is an important aspect of a psychiatric advance directive (PAD)?
During periods of competency, PADs can be revoked PADs are relatively new legal instruments that allow clients, while they are competent, to document their choice of treatment and care This declaration must be made in advance and signed by two witnesses Although a physician can override this declaration during times when the client's decision making is clearly distorted because of mental illness, the client must be informed first and the order made by the court During periods of competency, PADs can be revoked
A psychiatric-mental health nurse is conducting a review class about legal liability and psychiatric-mental nursing. Which element would the nurse most likely include as being required to prove negligence on the part of a health care professional?
Duty Damages Cause in fact Cause in proximity Five elements are required to prove negligence: duty (accepting assignment to care for a pt), 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 w/in 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
Although competency is a legal determination, it is not clearly defined across states. What is a true statement regarding competence?
It is decision specific Competence is decision specific, so a client may be competent to decide on a simple treatment w/a relatively clear consequence but may not be competent to decide about a treatment w/a complex set of outcomes A competent client can refuse any aspect of the treatment plan Competency is different from rationality, which is a characteristic of a client's decision, not of the client's ability to make a decision A person who is competent may make what seems to be an irrational decision, and it cannot be overruled by health care providers
Which is an accurate statement regarding an advance care directive?
It must be witnessed by two people and notarized An advance care directive does not need to be written, reviewed, or signed by an attorney It must be witnessed by two people and notarized, and applies only if the individual is unable to make his/her own decisions as a result of being incapacitated or if, in the opinion of two physicians, the person is otherwise unable to make decisions for him/herself
A physician who fails to obtain informed consent before performing a procedure is subject to liability for:
Medical battery Intentional and unauthorized harmful or offensive contact, occurs when a client is treated w/o informed consent Assault is the threat of unlawful force to inflict bodily injury upon another False imprisonment is detention or imprisonment contrary to provision of the law Battery is intentional and unpermitted contact w/another
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?
Ranting and waving a loaded gun in a crowded mall Involuntary commitment is the mandated treatment w/o the person's consent but w/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
A client diagnosed w/depression tells the psychiatric-mental health nurse that the client wants to use an herbal supplement to treat the symptoms rather than an antidepressant. The nurse interprets this information as demonstrating which concept?
Self-determinism Is the right to choose one's own health-related behaviors, which at times differ from those recommended by health professionals A client's right to refuse treatment, to choose the second or third best health care recommendation rather than the first, and to seek a second opinion are all self-deterministic acts Competency refers to the degree to which the client can understand and appreciate the information given during the consent process and the client's cognitive ability to process information at a specific time Confidentiality is an ethical duty of nondisclosure Informed consent is a legal procedure to ensure that the client knows the benefits and costs of treatment
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 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
A client w/schizophrenia has a psychiatric advance directive (PAD) which rules out the use of antipsychotics. The care team would be justified in disregarding the provisions of the PAD in which circumstance?
The PAD is verbal, not written A PAD must be a signed and witnessed document A PAD may not necessarily align w/the client's best interests and it applies in inpt settings The fact that the client is 20 years old does not nullify a properly created PAD
