Chapter 9

A nurse is reviewing medical records to look for violations of client rights. What finding would signal a violation of client rights?

no documentation of benefits of treatment or treatment options

The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which of the following is the appropriate response by the nurse to the caller?

"I cannot confirm or deny the existence of any client here."

Which of the following clients would most likely be mandated outpatient treatment?

A client who is addicted to alcohol who has two DUI offenses

An adult client is put in restraints after all other attempts to reduce aggression have failed. Which of the following is required now that restraints have been instituted?

A face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint.

Which of the following client situations most urgently requires the nurse to break confidentiality and warn a third party?

A jealous man states, "I am getting my gun and going to shoot my wife's lover!"

The physician has prescribed Haldol 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response?

Accept the client's decision

A nurse is performing safety assessments on a client in mechanical restraints as required by policy. Which action by the nurse demonstrates the ethical principle of nonmaleficence?

Assuring that the restraints are not causing injury to the client

The term "standards of care" refers to expectations of nursing performance given to all clients. Standards of care are developed from which of the following? Select all that apply.

Code of Ethics for Nurses with Interpretive Statements State Nurse Practice Acts Agency job descriptions Professional nursing organizations

A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff?

Contacting the psychiatrist for initiation of commitment proceedings

Under which conditions would it be in the client's best interest for the court to appoint a conservator, or legal guardian? Select all that apply.

Gravely disabled Mentally incompetent Unable to provide basic needs when resources exist

Which one of the following is the most common reason for ethical dilemmas being a challenge to nurses?

Ethical dilemmas are often charged with emotion.

A client was brought to the emergency department by police after neighbors complained that he was loud and disruptive. The client is paranoid and upset and states, "No one can be trusted." Which of the criteria for involuntary admission does this client meet?

He does not meet any of the necessary criteria

Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is an error?

If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights.

When is a nurse legally obligated to breach confidentiality?

If threats are made to an identifiable third party

The nurse is attending an in-service training on safe take-down techniques for aggressive clients. Practicing these techniques help to reinforce the proper handling of this situation. Preparation for safe physical handling prepares the nurse to practice which ethical principle?

Nonmaleficence

A client who is depressed and suicidal is scheduled for electroconvulsive therapy (ECT), which requires consent. After the physician has explained the procedure, the nurse knows that legally, who should sign the consent for this treatment?

The client

Which nursing intervention constitutes false imprisonment?

The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion.

Which of the following are criteria for instituting the short-term use of restraint or seclusion? Select all that apply.

The client is aggressive. The client is imminently dangerous to himself or herself or to others. All other means of calming the client have been unsuccessful.

Which of the following would be an example of circumstances in which a client could be subjected to involuntary hospitalization? Select all that apply.

When a client states that he or she intends to commit suicide and is making plans to do so. When a client states that he or she intends to harm others by a deliberate act. When a client is unable to control his or her rage and is assaulting everyone around him or her.

Which of the following dilemmas involves the ethical principle of fidelity? Select all that apply.

When the nurse is unable to agree with the policies or common practices of an agency When the nurse is faced with a decision to violate a policy that is harmful to the client

A student nurse is assigned to administer oral medications to a client. Which of these actions should a student nurse take if a client refuses to take prescribed oral medications?

ask the client's reason for refusing and report it to the primary care nurse

A nurse is questioning whether it is ethical to seclude a client because of loud and intrusive behavior on the unit. What is the ethical principle that will best guide the decision on appropriate use of seclusion?

autonomy

Ensuring that the client has provided informed consent for a treatment regimen displays which of the following ethical principles?

autonomy

Disclosure of client information beyond the interdisciplinary team without consent of the client is a breach o

confidentiality

A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although she is not dangerous to herself or others, she has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but the client consistently refuses "any drugs." The staff realizes that legally this client can

continue to refuse treatment

A client who had agreed to be hospitalized for depression has decided that now she wants to leave the hospital. The mental health staff caring for her realizes that at present she can legally

leave without discussing the situation with anyone

During rounds, the depressed client is discovered to have completed a suicide attempt in the bathroom. The staff on the inpatient psychiatric unit have been very busy and fell behind on periodic assessment for this client. Which type of lawsuit could the client's family file?

malpractice

An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is

inappropriate; room restriction is not treatment in the least restrictive environment.

A nurse in the emergency department is planning for a client with mental illness to be placed in an inpatient hospitalization. Which is a condition of this type of admission?

present a clear danger to self or others

The client feels his rights have been violated. Placing a client in restraints before using other methods of intervention violates which of the client's rights?

receive treatment in the least restrictive environment

A client made threats to harm his parents if they come too close to him. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for which of the following?

right to freedom

A nurse is discharging a client who is seriously mentally ill into a group home. What is a practical outcome for the client being treated in a community setting?

the ability to maintain stability in the community

A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful?

the nurse did not breach duty

A client being served in a busy inpatient psychiatric unit becomes very noisy and combative. The other clients are complaining about the noise and are afraid that they will be hurt by the client. The nurse determines that the best course of action for all involved is to seclude the client until the client is able to regain control of his behavior. On which ethical principle did the nurse base this decision?

utilitarianism