Psych - Unit 1 - Chapter 9: Legal and Ethical Issues

A nurse working on a psychiatric unit receives a telephone call from a client's employer. The employer asks for a copy of the client's latest laboratory work and psychological testing results so that client's medical records in employee health can be updated. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate? "I'm sorry; we're not allowed to give out that information about our client." "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 your the client is a client on this unit." "Sure, give me your address, and I will see that the information is sent to you."

"I am unable to acknowledge whether or not your the client is a client on this unit." 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 the client is a client on the unit would be such a breach. Even if the nurse explains that they 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 caring for a group of clients in a treatment and recovery facility. Which client statement(s) does the nurse determine best shows motivation for recovery? Select all that apply. "I like to make my own decisions." "I make choices based on my personal goals." "I like having my own space and independence in my relationships." "I need others around me to help keep me on track." "I need to please others and to have them like me as a person."

"I like to make my own decisions." "I make choices based on my personal goals." "I like having my own space and independence in my relationships." A self-determined person is internally motivated and likes to make their own decisions. They are not dependent on others for success. A self-determined person does not need to please others for success or approval. Additionally, a self-determined person likes to have space and independence, making their own choices based on personal goals.

A nurse has received an in-service education about ethical dilemmas. Which statement made by the nurse would indicate that teaching was effective? "If an ethical dilemma occurs, staff will have to discuss it and vote on the outcome." "If an ethical dilemma occurs, each principle will be evaluated and treated as the same level of importance." "If an ethical dilemma occurs, the client's personal values will be considered as most important." "If an ethical dilemma occurs, we have a meeting with the client to determine what they want to do."

"If an ethical dilemma occurs, each principle will be evaluated and treated as the same level of importance." Ethical dilemmas occur due to conflicting ethical values in a situation. In an ethical dilemma, all the principles are important and relevant. In a situation of ethical conflict, the psychiatric-mental health nurse weighs the values protected in each principle and helps others see the different sides of an ethical question. Therefore, the nurse's statement, "If an ethical dilemma occurs, each principle will be evaluated and treated at the same level of importance" would demonstrate effective teaching. The other statements would indicate a need for further teaching.

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

"It could be construed as assault" 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.

A client diagnosed with major depression is prescribed electroconvulsive therapy (ECT) for the treatment. Which statement made by the client would indicate a need for the nurse to follow up with the health care provider? "It is not really my decision; I have to get these treatments to feel better." "I understand why I need the treatments; I've been depressed for a long time." "I understand that there may be risks with the treatments." "I know that there are alternatives that I can try before agreeing to the treatments."

"It is not really my decision; I have to get these treatments to feel better." Clients have a right to autonomy, which respects that each client has the fundamental right to make voluntary decisions about their health care and life decisions. The process of informed consent respects the right to autonomy. To give consent to a treatment or procedure, the client must have all the needed relevant information, be rationally deliberate, and not forced into a decision. The client's statement, "It is not really my decision; I have to get these treatments to feel better", may indicate the client does not know the alternative options present and feels pressured to get the electroconvulsive therapy (ECT) sessions. This statement would require the nurse to follow up with the health care provider to ensure the client is adequately informed before deciding on the treatment. The client's statements, "I understand why I need the treatments; I've been depressed for a long time", "I understand that there may be risks with the treatments", and "I know that there are alternatives that I can try before agreeing to the treatments", indicate adequate teaching was performed with the client and the client is making a voluntary decision to proceed with the treatments.

The nurse is providing information to the caregivers of a client who has been secluded due to aggressive behavior against staff and other clients. Which statement(s) about the implementation of the seclusion will the nurse make to the caregivers? Select all that apply. "The client will be removed from seclusion in 1 day." "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."

"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." 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 patient rights while in the hospital. Which statement by the client indicates that more teaching is needed? "I can get a copy of my medical record if I want to read it." "You can not give any information to anyone unless I agree." "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." 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 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? "I can get a copy of my medical record if I want to read it." "You can not give any information to anyone unless I agree." "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." 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.

The interdisciplinary team caring for a client diagnosed with depression is having daily meetings about the client's plan of care. What could the nurse say to protect the client from unwarranted use of paternalism in their care? "The client has a right to their privacy." "We need to treat the client with dignity and respect regardless of their values." "We should involve the client in the decision-making process." "We need to truthfully tell the client their plan of care."

"We should involve the client in the decision-making process." Paternalism is an approach that assumes that because professionals have specialized knowledge and education, they are best equipped to make decisions for others. Nurses protect against unwarranted use of paternalism by encouraging client, family, and community involvement in decisions. Therefore, the nurse's statement "We should involve the client in the decision-making process" demonstrates the nurse's advocacy to ward against unwarranted paternalism in the care of the client. The statement "The client has a right to their privacy" is advocating for the client's right to autonomy. The statement "We need to treat the client with dignity and respect regardless of their values" is advocating for the client's right to justice. The statement "We need to truthfully tell the client their plan of care" is advocating for the client's right to veracity.

A client diagnosed with anxiety is being assessed by the nurse utilizing the biopsychosocial model. Which question made by the nurse would indicate the social domain is being assessed? "When you feel anxious, what thoughts come to your mind?" "How many hours of sleep do you get each night?" "Who is in your support network?" "How do your emotions affect your behavior?"

"Who is in your support network?" The biopsychosocial model utilizes three domains including the biologic, psychological, and social domains. The social domain includes theories that describe the influences of social forces on the client, family, and community within cultural settings. Therefore, the nurse's question, "Who is in your support network?" assesses the social domain. The biologic domain consists of the physiological aspects of all health conditions, including exercise, elimination, sleep, and nutrition. The nurse's question o "How many hours of sleep do you get each night?" is assessing the client's biologic domain. The psychological domain involves the thoughts, feelings, and behavior that influence one's emotions, cognition, and behavior. The nurse's questions of "When you feel anxious, what thoughts come to your mind?" and "How do your emotions affect your behavior?" are assessing the psychological domain.

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

"Will this conversation involve your desire to harm yourself?" 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.

A client calls the behavioral health unit to inquire about volunarily admission for themselves. Which is the best response by the nurse? "Do you feel you are a danger to yourself or others?" "Are you able to take care of yourself?" "You are able to make an autonomous decision to seek inpatient treatment." "You may be committed involuntarily when you come in."

"You are able to make an autonomous decision to seek inpatient treatment." With voluntary admission, clients make an autonomous decision to seek inpatient treatment by submitting a formal, written request. Involuntary commitment encompasses those who are a danger to themselves or others, cannot care for themselves, or are committed against their will.

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

"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." 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 able to demonstrate appropriate behavior." "You should not verbally threaten anybody." "You should be able to communicate in a calm manner." "You should be willing to do the task I have given you." "You should take medications prescribed by your doctor."

"You should be able to demonstrate appropriate behavior." "You should not verbally threaten anybody." "You should be able to communicate in a calm manner." 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? "You will need to sign a written request for discharge." "I need to check with your family members to see if they think it would be okay." "You are free to leave at your will." "I will inform your landlord that you will be going home."

"You will need to sign a written request for discharge." 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 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 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 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? The client's primary nurse The client's psychiatrist A hospital-appointed interdisciplinary committee A guardian appointed by the court

A guardian appointed by the court 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.

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

Acute inpatient care 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? Advocate Caregiver Teacher Parent surrogate

Advocate 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 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 Obtaining written, informed consent from a client who has agreed to be in a research study

Advocating for enhanced mental health services in an underserved neighborhood 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 newly hired nurse is researching the scope and standards of practice for psychiatric-mental health nurses. Which nursing organization would the new nurse identify that developed the scope and standards of practice? International Society of Psychiatric Consultation Liaison Nurses International Society of Psychiatric Nursing (ISPN) American Nurses Association (ANA) American Psychiatric Nurses Association (APNA)

American Nurses Association (ANA) The American Nurses Association (ANA) fosters high standards of practice, promotes safe and ethical work environments for nurses, and advocates for needed health care policy and legislation. The ANA clarifies the boundaries of the scope and standards of practice for health care professionals. The American Psychiatric Nurses Association (APNA) is the largest psychiatric-mental health (PMH) nursing organization, and the organization works to advance PMH nursing practice and helps shape mental health policy to improve mental health care for culturally diverse clients and communities. The International Society of Psychiatric Nursing (ISPN) focuses on specific interests of PMH nursing and consists of four divisions including 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.

A psychiatric-mental health nurse is searching for a nursing organization that shapes mental health policy. Which nursing organization helps create mental health policy and improves mental health care for culturally diverse clients and communities? International Society of Psychiatric Consultation Liaison Nurses International Society of Psychiatric Nursing (ISPN) American Nurses Association (ANA) American Psychiatric Nurses Association (APNA)

American Psychiatric Nurses Association (APNA) The American Psychiatric Nurses Association (APNA) is the largest psychiatric-mental health (PMH) nursing organization, and the organization works to advance PMH nursing practice and helps shape mental health policy to improve mental health care for culturally diverse clients and communities. The International Society of Psychiatric Nursing (ISPN) focuses on specific interests of PMH nursing and consists of four divisions including 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. The American Nurses Association (ANA) fosters high standards of practice, promotes safe and ethical work environments for nurses, and advocates for needed health care policy and legislation.

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

An involuntarily committed client may not initiate his or her own discharge An involuntary commitment prevents a client from initiating his or her own discharge, so this is the correct answer. A voluntarily committed client is not necessarily less aggressive than a client committed involuntarily. Both voluntarily and involuntarily committed clients may refuse treatment. And, while insight may be a factor that leads to a voluntary commitment, the voluntarily committed client may or may not possess this.

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? Justice Beneficence Autonomy Veracity

Autonomy 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 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. Autonomy Beneficence Nonmaleficence Veracity Fidelity

Autonomy Beneficence There is tension between the client's autonomy (the right to attend or carry out the meeting as the client desires) and the nurse's desire to promote good (i.e., beneficence—facilitate the family's support).

A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what? Assault Battery Beneficence Fidelity

Battery All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client's informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove they did not consent to the procedure, providers did not give adequate information for a decision, or the treatment exceeded the scope of the consent.

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

Beneficence 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 people achieve their maximal health care potential. According to the principle of autonomy, each person has the fundamental right of self-determination. Justice is the duty to be treated fairly. Veracity is the duty to tell the truth.

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? Beneficence Autonomy Veracity Justice

Beneficence 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? Autonomy Beneficence Fidelity Veracity

Beneficence 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 fidelity Fidelity and paternalism Justice and autonomy Beneficence and autonomy

Beneficence and autonomy 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 Every shift Constantly for the first hour Every hour

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

Danger to others. 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.

Which intervention does not meet the standard of care for the client in seclusion? 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 A health care provider's order given every 6 hours

Documented assessment by the nurse every 1 to 2 hours 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. Duty Cause in fact Damages Cause in proximity Financial obligation Occurrence of a simple mistake

Duty Cause in fact Damages Cause in proximity 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, action foreseeably could have caused the injury, and proven injury Duty of care, professional performance, injury related to the nurse's action, failure to document 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, 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 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 nurse is preparing to develop a nurse-client relationship with a newly admitted client with depression. Which action(s) by the nurse are appropriate in the orientation phase of the nurse-client relationship? Select all that apply. Have the client make full use of all services available. Engage the client in the treatment plan. Provide information related to the plan of care. Have the client independently work through feelings. Answer any questions the client may have about the plan of care.

Engage the client in the treatment plan. Provide information related to the plan of care. Answer any questions the client may have about the plan of care. The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions. Making use of services available is included in the exploitation phase. During the identification phase, the client works interdependently with the nurse, expresses feelings, and begins to feel stronger.

A client is admitted to the behavioral health facility involuntarily. The client is scheduled to undergo electroconvulsive therapy. Which action does the nurse take before the procedure? Ask the client's next of kin to provide informed consent. Sign the document showing informed consent is not necessary. Ask the client to accept voluntary admission before the client gives informed consent. Ensure the client has given informed consent.

Ensure the client has given informed consent. Clients who are involuntarily committed have the right to treatment, as well as the right to refuse treatment. Additionally, those who are involuntarily committed do not lose the right to informed consent. The client should be provided information on the treatment and the client should provide informed consent. The other answer choices are incorrect and do not allow the client to maintain autonomy.

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

Ethics 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.

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

False imprisonment 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.

A nurse is initiating a relationship with a new client. After meeting, the nurse makes arrangements to visit again around lunchtime. A colleague invites the nurse to go to the gym with them during lunch. The nurse decides to forgo the gym and talk with the client. The nurse's decision reflects which ethical principle? Autonomy Beneficence Fidelity Veracity

Fidelity Fidelity is faithfulness to obligations and duties. It is keeping promises. Fidelity is important in establishing trusting relationships. With autonomy, each person has the fundamental right of self-determination. According to the 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. Veracity is the duty to tell the truth.

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? Veracity Beneficence Autonomy Fidelity

Fidelity 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.

The mental health nurse is talking to nursing students in an ethics class and says, "Correctly pair an ethical principle with a nursing practice." Which statement by a student would be correct? Fidelity: "Telling the client that you will return in 15 minutes, then returning in 15 minutes." Justice: "Acknowledging that the client has the right to refuse treatment." Autonomy: "Treating all clients fairly." Paternalism: "Being knowledgeable and caring."

Fidelity: "Telling the client that you will return in 15 minutes, then returning in 15 minutes." Fidelity is faithfulness to obligations and duties and to keep promises, such as telling a client you will do something or return at a certain time. Fidelity is important in establishing trusting relationships. "Acknowledging that the client has the right to refuse treatment" is an example of the principle of autonomy. "Treating all clients fairly" is an example of the principle of justice. "Being knowledgeable and caring." is an example of the principle of beneficence. These three statements are not correctly paired with the principle they represent.

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

File for a civil commitment to detain. 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.

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

Four-point restraint Four-point restraint is the most restrictive of the interventions mentioned above, with surveillance being the least. When promoting safety, the method of last resort would be the most restrictive measure.

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

Give the client the opportunity to gain self-control The goal of seclusion is to give the client an opportunity to regain physical and emotional self-control. Clients are not to be punished for behaviors. The client who meets the criteria for seclusion is not in the emotional state to engage in self-reflection. Seclusion is used for the purpose of assuring client and staff safety.

A client with a diagnosis of depression has been referred to a support group led by a psychiatric-mental health nurse. Which action by the nurse best demonstrates the ethical principle of nonmaleficence? Inform the client that all questions will be answered completely. Explain that discussion with all members of the group is mandatory. Discuss the right treatment option to take. Inform the client that participation in the group is not necessary because it causes the client anxiety.

Inform the client that participation in the group is not necessary because it causes the client anxiety. Nonmaleficence is the duty to cause no harm, for the individual and all others. Participation is causing harm, so the nurse tells the client that participation is not necessary. Telling the client that each person has the right to decide what course to take, that participation in the group is mandatory, or that you will answer all questions without withholding information does not demonstrate nonmaleficience.

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

Intent 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 appropriate because the client is a danger to self Involuntary admission is possibly a correct decision because the client may be a danger to others Involuntary admission is the correct decision because the client is cannot provide for basic needs. 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. 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).

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

It is rarely successful 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? Fidelity Autonomy Justice Paternalism

Justice 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 group of psychiatric-mental health nurses are discussing current trends in mental health care. One of the nurses 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 nurse's opinion most closely reflects which ethical principle? Nonmaleficence Paternalism Veracity Justice

Justice Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue when some portion of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth.

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? Nonmaleficence Justice Veracity Fidelity

Justice Justice is the duty to treat all fairly, thus 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 individually and for all. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties, that is, keeping promises.

While performing the admission assessment of a new client, the nurse observed that the client brought a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or remove the medication from the room. Subsequently, the client experienced a serious adverse drug reaction as a result of the interaction between this drug and one of the drugs that the client was prescribed in the hospital. This nurse may be guilty of what? Assault Malpractice Failure of duty to warn Incompetence

Malpractice The four elements of nursing malpractice are evident in this scenario. Assault is an act that puts another person in apprehension of being touched (or of bodily harm without consent), and failure of duty to warn surrounds a client's threat to harm another person. Incompetence, in the legal sense, surrounds a client's right to autonomy.

An advanced care directive is listed on a psychiatric-mental health client's medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for which legal tort? Assault Battery Medical battery False imprisonment

Medical battery 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.

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

Nonmaleficence 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? Justice Nonmaleficence Beneficence Fidelity

Nonmaleficence 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 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 Counseling Psychotherapy Intake screening

Psychotherapy 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.

A nurse manager is conducting a review class for a group of nurses working at the local community health center about the rights of persons receiving mental health services. After teaching the class, the nurse manager determines a need for additional discussion when the group identifies which as a right? Freedom from restraints or seclusion Access to one's own mental health records upon request An individualized written treatment plan Refusal of treatment during an emergency situation

Refusal of treatment during an emergency situation 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 hospital client has attributed the long-standing struggle with depression to the fact that the client was sexually abused by the client's father as a child and early adolescent. The client has admitted to the nurse that the client intends to seek out the father and "do some justice." What is the nurse's primary responsibility in response to the client's threat? Document that the client is experiencing delusions. Note the statement mentally but maintain silence to protect the client's confidentiality. Inform the client that threats of violence will not be tolerated in the health care facility. Report the client's threat to the appropriate authorities.

Report the client's threat to the appropriate authorities. Nurses have a duty to report threats of harm so that appropriate action may be taken. This action may vary from state to state, but the duty to report threats of violence supersedes the client's right to privacy.

A nursing student identifies which as the most important tool of psychiatric nursing? Clinical reasoning Reflection Self Plan of care

Self The most important tool of psychiatric nursing is the self. Through relationship building, clients learn to trust the nurse, who then guides, teaches, and advocates for quality care and treatment.

A psychiatric treatment team is planning care for a client who was involuntarily admitted for treatment of depression and suicide ideation. When planning care, of what legal parameters of care must the nurse be aware? The client can refuse medication. The client can obtain release against medical advice. The client is in need of a public guardian. The client is considered incompetent.

The client can refuse medication. 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 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 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. The client must attend community health care lectures on the disorder. 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. 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 nurse professional had a duty of due care toward the plaintiff. The nurse's performance fell below the standard of care. The client must be injured physically as a result of the nurse's action. The client must prove the existence of injury.

The client must be injured physically as a result of the nurse's action. 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 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 nursing school from which the student graduated The facility where the graduate now works The graduate nurse The American Nurses Association

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

A nurse will be witnessing a client sign an informed consent document for an upcoming procedure. How can the nurse protect the client's right to autonomy? The nurse includes the client's family to be involved in the decision. The nurse assesses the client's decisional capacity. The nurse involves the interdisciplinary team in the decision. The nurse assessed the client's orientation status.

The nurse assesses the client's decisional capacity. The principle of respect for autonomy is based on the understanding that each person has the fundamental right to make voluntary decisions about their health care and life decisions. The psychiatric-mental health (PMH) nurse protects the client's autonomy by assessing a person's decisional capacity and ability to act in their own best interest. The nurse including the client's family and the interdisciplinary team in the decision-making process does not uphold the right to autonomy. The nurse assessing the client's orientation status is not sufficient to determine the client's ability to make a sound decision.

The nurse employs the ethical principle of autonomy when caring for a client. Which action(s) indicate that the nurse is using autonomy for the client? Select all that apply. The nurse does not divulge confidential information. The nurse gives the client information and allows individual decision making. The client refuses to sign a surgical permit and the nurse accepts the decision. The nurse promotes the good of others. The nurse honors the committments made to the client.

The nurse gives the client information and allows individual decision making. The client refuses to sign a surgical permit and the nurse accepts the decision. Autonomy refers to a person's right to self-determination and independence. In nursing practice this may be the client determining what they want to do or believe and make personal choices such as a client refusing to sign a permit and the nurse accepting the decision. The nurse not divulging client information is respecting the rights of confidentiality. Promoting the good in others is the ethical principle of beneficence. Honoring committments made to the client is the ethical principle of fidelity.

A client who is involuntarily admitted to the psychiatric facility refuses to take a psychotropic medication. The nurse holds the client down to give the medication. Which statement is true regarding this situation? The nurse may be held legally liable. The client cannot refuse the medication. The nurse is protected under the Nurse Practice Act. The client is unable to make competent decisions.

The nurse may be held legally liable. Just because a person is involuntarily admitted for mental health treatment does not mean that person loses their rights. This client has the right to refuse treatment and the nurse may be held legally liable for infringing on those rights. The remaining answer choices are incorrect.

Which situations depict a nurse employing the principles of fidelity while providing care? Select all that apply. The client asks questions about surgery and the nurse answers the questions completely. 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. 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. 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 nurse was responsible for a client injury that resulted in permanent disability The client's actions played a part in the nurse's reaction

The nurse was responsible for client injury 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 any sharp objects. The room should not have locked doors. The room should have a bed that is bolted to the floor. The room should have facility for direct visual monitoring.

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. 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.

A client who was admitted to a facility voluntarily is requesting to be discharged and allowed to return home, but denied permission. Which explanation will the nurse give to the client related to the denial of discharge? There is a display of suicidal ideation. Psychotherapy is required by the client. The client requires monitoring regularly for vital signs. The client requires medications to be administered on time.

There is a display of suicidal ideation. 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.

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? Autonomy Justice Veracity Fidelity

Veracity 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.

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

Warn the client's spouse, based on the Tarasoff rule. 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: patient rights durable power of attorney advance directive informed consent

advance directive Advance care directives are written instructions for health care when individuals are incapacitated. Informed consent, durable power of attorney, and patient rights are not instructions for health care when individuals are incapacitated. A durable power of attorney means that the advance care directives stays in effect if you become incapacitated and unable to handle matters on your own. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them.

A 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? autonomy beneficence justice paternalism

autonomy 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.

A nurse is witnessing a client signing an informed consent form. Which ethical principle does the nurse identify that applies to this situation? beneficence autonomy nonmaleficence justice

autonomy Autonomy is the ethical principle that is based on the understanding that each person has the fundamental right to make voluntary decisions about their health care and life decisions. The practice of informed consent is respecting the client's right of autonomy. Beneficence holds the assumption that professionals have a duty to act in ways that benefit a client or community, and they take steps necessary to minimize harm. Nonmaleficence is the duty that one must never intentionally harm another. The principle of justice encourages providers to consider how the goods of a society, including health care, are distributed.

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(s) will the nurse identify as being involved? Select all that apply. fidelity autonomy veracity beneficence justice

autonomy beneficence 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 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 justice veracity paternalism

beneficence 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.

A nurse is developing a care plan for a client diagnosed with post-traumatic stress disorder (PTSD). Which domain of the biopsychosocial model is the nurse utilizing when assessing the client's sleeping and eating habits? biologic psychological neurobiological social

biologic The biopsychosocial model utilizes three domains including the biologic, psychological, and social domains. The biologic domain consists of the physiological aspects of all health conditions, including exercise, elimination, sleep, and nutrition. The psychological domain involves the thoughts, feelings, and behavior that influence one's emotions, cognition, and behavior. The social domain includes theories that describe the influences of social forces on the client, family, and community within cultural settings. Therefore, the nurse is utilizing the biologic domain when assessing the client's eating and sleeping habits. Neurobiological theories serve as a basis for understanding and administering pharmacologic agents.

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

communication 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 prepares to document care for the client in physical restraints. Which item(s) must the nurse include to ensure legal documentation? Select all that apply. detailed assessment client's emotional response to the therapy reason the client is at risk for harming self or others client's statements in response to the therapy previous unsuccessful de-escalation efforts

detailed assessment reason the client is at risk for harming self or others previous unsuccessful de-escalation efforts Restraints should be applied only when previous de-escalation efforts have failed and the client poses a risk to self or others. A detailed assessment must also be documented. The client's emotional or verbal response to therapy are not needed to legally document the use of restraints.

A client who had agreed to be hospitalized for depression has decided that he/she wants to leave the hospital. The mental health staff caring for the client realizes that at present the client can legally: be discharged if evaluated through administrative hearings. be retained in the hospital against the client's will. leave the hospital after giving written notice of the client's intent to do so. leave even if doing so is against medical advice (AMA).

leave even if doing so is against medical advice (AMA). Clients who are not dangerous to themselves or others can leave the hospital against medical advice. The client could not be legally detained in the hospital, or even detained until he/she provides written intent, because there is no indication the client was treated involuntarily. Administrative hearing are unnecessary for a voluntary client to leave the treatment setting.

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: living will durable power of attorney patient rights informed consent

living will 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.

The nurse is providing care to the clients in an inpatient psychiatric facility. When the nurse promotes good, prevents harm, and promotes maximal health care potential, which action(s) are the nurse performing? Select all that apply. autonomy non-maleficence fidelity beneficence justice

non-maleficence beneficence The principle of beneficence incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Non-maleficence is the duty to cause no harm, both individual and for all. Justice, fidelity, and autonomy are not examples of the nurse promoting good, preventing harm, or promoting maximal health care potential. Fidelity is the keeping of promises to clients. Justice is giving clients fair and impartial treatment. Autonomy is promoting the client's ability to make independant decisions.

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

present all options for treatment to the client explain all risks in a way the client can understand Client autonomy means allowing the client to make choices for themselves and recognizing their right to choose their 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 client autonomy.

A psychiatric-mental health registered nurse (PMH-RN) is considering attending graduate school to become a psychiatric-mental health advanced practice registered nurse (PMH-APRN). What aspect of client care would be within the scope of the PMH-APRN? psychotherapy health promotion and maintenance milieu therapy complimentary interventions

psychotherapy The scope of practice for the psychiatric-mental health registered nurse (PMH-RN) includes health promotion and maintenance; intake screening, evaluation, and triage; case management; provision of therapeutic and safe environments; milieu therapy; self-care activity promotion; administration of psychobiological treatments and monitoring responses; complementary interventions; crisis intervention and stabilization; and psychiatric rehabilitation. The scope of practice for the psychiatric-mental health advanced practice registered nurse (PMH-APRN) includes psychopharmacologic interventions, psychotherapy, community interventions, case management, program development and management, clinical supervision, and consultation and liaison. Therefore, psychotherapy would be added to the scope of practice for the PMH-APRN.

A nurse is caring for a client receiving psychoneuroimmunology-based interventions and does not understand the provider's orders. What is the best way for psychiatric-mental health nurses to stay abreast of new knowledge in the mental health field? reading journal articles asking the nurse manager asking the health care providers reading layman websites

reading journal articles One of the challenges that psychiatric-mental health (PMH) nurses face is staying abreast of new knowledge emerging in the mental health field. Accessing new information through journals, electronic databases, and continuing education takes time and vigilance, but provides a sound basis for application of new knowledge. Asking the nurse manager, asking the health care providers, and reading layman websites may not provide accurate, research-based information necessary to care for the client effectively and safely.

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 an absence of symptoms and improved level of functioning functioning at a moderate to high level of social integration socially acceptable interactions within the community, good self-care, and adequate nutrition

the ability to maintain stability in the community The practical goal is to maintain stability in the community. To be absent of all symptoms and improved level of functioning is not a practical goal as many are readmitted. The same for functioning at a moderate to high level, as well as good self-care and adequate nutrition.

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? budget factors unique needs placement options availability of space

unique needs 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.