Chapter 06 Legal and Ethical Considerations PDF

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Varcarolis' Foundations of Psychiatric-Mental Health Nursing 8th Edition Test Banks...

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VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Chapter 06: Legal and Ethical Considerations Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. Which action by a psychiatric nurse best applies the ethical principle of autonomy? a. Exploring alternative solutions with the patient, who then makes a choice. b. Suggesting that two patients who were fighting be restricted to the unit. c. Intervening when a self-mutilating patient attempts to harm self. d. Staying with a patient demonstrating a high level of anxiety. ANS: A Autonomy is the right to self-determination, that is, to make one’s own decisions. By exploring alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. The distracters demonstrate beneficence, fidelity, and justice. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-3, 4 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 2. A nurse finds a psychiatric advance directive in the medical record of a patient currently experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should a. review the directive with the patient to ensure it is current. NURSINGTB.COM b. ensure that the directive is respected in treatment planning. c. consider the directive only if there is a cardiac or respiratory arrest. d. encourage the patient to revise the directive in light of the current health problem. ANS: B The nurse has an obligation to honor the right to self-determination. An advanced psychiatric directive supports that goal. Since the patient is currently psychotic, the terms of the directive now apply. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 6-16 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 3. Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion a. reinforces the autonomy of the two patients. b. violates the civil rights of both patients. c. represents the intentional tort of battery. d. correctly places emphasis on safety. ANS: B

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Patients have a right to treatment in the least restrictive setting. Safety is important, but less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion violates the patient’s autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-16 to 18, 53 (Table 6-3) TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 4. In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision.” Which ethical principle most clearly applies to this situation? a. Beneficence b. Autonomy c. Fidelity d. Justice ANS: D The nurse is concerned about justice, that is, fair distribution of care, which includes treatment with the least restrictive methods for both patients. Beneficence means promoting the good of others. Autonomy is the right to make one’s own decisions. Fidelity is the observance of loyalty and commitment to the patient. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 6-3 TOP: Nursing Process: Planning NURSINGTB.COM MSC: Client Needs: Safe, Effective Care Environment 5. Select the example of a tort. a. The plan of care for a patient is not completed within 24 hours of the patient’s admission. b. A nurse gives a prn dose of an antipsychotic drug to an agitated patient because the unit is short-staffed. c. An advanced practice nurse recommends hospitalization for a patient who is dangerous to self and others. d. A patient’s admission status changed from involuntary to voluntary after the patient’s hallucinations subside. ANS: B A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient; thus, false imprisonment is a possible charge. The other options do not exemplify torts. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 6-26, 27 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 6. What is the legal significance of a nurse’s action when a patient verbally refuses medication and the nurse gives the medication over the patient’s objection? The nurse

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

a. b. c. d.

has been negligent. committed malpractice. fulfilled the standard of care. can be charged with battery.

ANS: D Battery is an intentional tort in which one individual violates the rights of another through touching without consent. Forcing a patient to take medication after the medication was refused constitutes battery. The charge of battery can be brought against the nurse. The medication may not necessarily harm the patient; harm is a component of malpractice. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 6-27, 53 (Table 6-3) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 7. Which nursing intervention demonstrates false imprisonment? a. A confused and combative patient says, “I’m getting out of here, and no one can stop me.” The nurse restrains this patient without a health care provider’s order and then promptly obtains an order. b. A patient has been irritating and attention seeking much of the day. A nurse escorts the patient down the hall saying, “Stay in your room, or you’ll be put in seclusion.” c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. The nurse rushes after the patient and convinces the patient to return to the unit. d. An involuntarily hospitalized patient with homicidal ideation attempts to leave the facility. A nurse calls the security team and uses established protocols to prevent the patient from leaving. NURSINGTB.COM ANS: B False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. If a patient is not competent (confused), then the nurse should act with beneficence. Patients admitted involuntarily should not be allowed to leave without permission of the treatment team. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Apply (Application) Page 6-27 | Page 6-53 (Table 6-3) | Page 6-59 (Box 6-4) Nursing Process: Evaluation Client Needs: Safe, Effective Care Environment

8. Which patient meets criteria for involuntary hospitalization for psychiatric treatment? The patient who a. is noncompliant with the treatment regimen. b. fraudulently files for bankruptcy. c. sold and distributed illegal drugs. d. threatens to harm self and others. ANS: D

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 6-7 TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment 9. A nurse prepares to administer a scheduled intramuscular injection of an antipsychotic medication to an outpatient diagnosed with schizophrenia. As the nurse swabs the site, the patient shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.” Select the nurse’s best action. a. Assemble other staff for a show of force and proceed with the injection, using restraint if necessary. b. Stop the medication administration procedure and say to the patient, “Tell me more about the side effects you’ve been having.” c. Proceed with the injection but explain to the patient that there are medications that will help reduce the unpleasant side effects. d. Say to the patient, “Since I’ve already drawn the medication in the syringe, I’m required to give it, but let’s talk to the doctor about delaying next month’s dose.” ANS: B Patients diagnosed with mental illness retain their civil rights unless there is clear, cogent, and convincing evidence of dangerousness. The patient in this situation presents no evidence of dangerousness. The nurse, as an advocate and educator, should seek more NURSINGTB.COM information about the patient’s decision and not force the medication. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-12, 13 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. A nurse is concerned that an agency’s policies are inadequate. Which understanding about the relationship between substandard institutional policies and individual nursing practice should guide nursing practice? a. Agency policies do not exempt an individual nurse of responsibility to practice according to professional standards of nursing care. b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care. c. Faced with substandard policies, a nurse has a responsibility to inform the supervisor and discontinue patient care immediately. d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted. ANS: A Nurses are professionally bound to uphold standards of practice regardless of lesser standards established by a health care agency or a state. Conversely, if the agency standards are higher than standards of practice, the agency standards must be upheld. The Courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 6-29 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 11. A newly admitted acutely psychotic patient is a private patient of the medical director and a private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of care? a. Medical director b. Hospital c. Profession d. Patient ANS: D Although the nurse is accountable to the health care provider, the agency, the patient, and the profession, the duty of care is owed to the patient. This duty reflects both legal and ethical standards of nursing practice. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 6-3, 4, 29 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 12. Which action by a nurse constitutes a breach of a patient’s right to privacy? a. Documenting the patient’s daily behavior during hospitalization b. Releasing information to the patient’s employer without consent c. Discussing the patient’s history with other staff during care planning NURSINGTB.COM d. Asking family to share information about a patient’s pre-hospitalization behavior ANS: B Release of information without patient authorization violates the patient’s right to privacy. The other options are acceptable nursing practices. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-20 to 22, 37 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 13. An adolescent hospitalized after a violent physical outburst tells the nurse, “I’m going to kill my father, but you can’t tell anyone.” Select the nurse’s best response. a. “You are right. Federal law requires me to keep clinical information private.” b. “I am obligated to share that information with the treatment team.” c. “Those kinds of thoughts will make your hospitalization longer.” d. “You should share this thought with your psychiatrist.” ANS: B Breach of nurse–patient confidentiality does not pose a legal dilemma for nurses in these circumstances because a team approach to delivery of psychiatric care presumes communication of patient information to other staff members to develop treatment plans and outcome criteria. The patient should also know that the team has a duty to warn the father of the risk for harm.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-20 to 22, 37 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 14. A voluntarily hospitalized patient tells the nurse, “Get me the forms for discharge. I want to leave now.” Select the nurse’s best response. a. “I will get the forms for you right now and bring them to your room.” b. “Since you signed your consent for treatment, you may leave if you desire.” c. “I will get them for you, but let’s talk about your decision to leave treatment.” d. “I cannot give you those forms without your health care provider’s permission.” ANS: C A voluntarily admitted patient has the right to demand and obtain release in most states. However, as a patient advocate, the nurse is responsible for weighing factors related to the patient’s wishes and best interests. By asking for information, the nurse may be able to help the patient reconsider the decision. Facilitating discharge without consent is not in the patient’s best interests before exploring the reason for the request. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-7, 8| Page 6-59 (Box 6-4) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 15. Insurance will not pay for continued private hospitalization of a mentally ill patient. The family considers transferring the patient to a public hospital but expresses concern that the patient will not get any treatment if transferred. Select the nurse’s most helpful reply. NURSINGTB.COM a. “By law, treatment must be provided. Hospitalization without treatment violates patients’ rights.” b. “All patients in public hospitals have the right to choose both a primary therapist and a primary nurse.” c. “You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety.” d. “Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable.” ANS: A The right to medical and psychiatric treatment is conferred on all patients hospitalized in public mental hospitals under federal law. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 6-5, 6, 12 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 16. Which individual diagnosed with mental illness may need emergency or involuntary admission? The individual who a. resumes using heroin while still taking naltrexone (ReVia). b. reports hearing angels playing harps during thunderstorms. c. does not keep an outpatient appointment with the mental health nurse. d. throws a heavy plate at a waiter at the direction of command hallucinations.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

ANS: D Throwing a heavy plate is likely to harm the waiter and is evidence of dangerousness to others. This behavior meets the criteria for emergency or involuntary hospitalization for mental illness. The behaviors in the other options evidence mental illness but not dangerousness. See related audience response question. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 6-7 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 17. A patient in alcohol rehabilitation reveals to the nurse, “I feel terrible guilt for sexually abusing my 6-year-old before I was admitted.” Select the nurse’s most important action. a. Anonymously report the abuse by phone to the local child protection agency. b. Reply, “I’m glad you feel comfortable talking to me about it.” c. File a written report with the agency’s ethics committee. d. Respect nurse–patient relationship confidentiality. ANS: A Laws regarding child abuse reporting discovered by a professional during the suspected abuser’s alcohol or drug treatment differ by state. Federal law supersedes state law and prohibits disclosure without a court order except in instances in which the report can be made anonymously or without identifying the abuser as a patient in an alcohol or drug treatment facility. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 6-24 TOP: Nursing Process: Implementation NURSINGTB.COM MSC: Client Needs: Safe, Effective Care Environment 18. A family member of a patient with delusions of persecution asks the nurse, “Are there any circumstances under which the treatment team is justified in violating a patient’s right to confidentiality?” The nurse should reply that confidentiality may be breached a. under no circumstances. b. at the discretion of the psychiatrist. c. when questions are asked by law enforcement. d. if the patient threatens the life of another person. ANS: D The duty to warn a person whose life has been threatened by a psychiatric patient overrides the patient’s right to confidentiality. The right to confidentiality is not suspended at the discretion of the therapist or for legal investigations. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 6-22, 43 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 19. A new antidepressant is prescribed for an elderly patient diagnosed with major depressive disorder, but the dose is more than the usual geriatric dose. The nurse should a. consult a reliable drug reference. b. teach the patient about possible side effects and adverse effects. c. withhold the medication and confer with the health care provider.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

d. encourage the patient to increase oral fluids to reduce drug concentration. ANS: C The dose of antidepressants for elderly patients is often less than the usual adult dose. The nurse should withhold the medication and consult the health care provider who wrote the order. The nurse’s duty is to practice according to professional standards as well as intervene and protect the patient. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-30, 31, 55 (Box 6-1) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 20. A patient diagnosed with schizophrenia believes a local minister stirred evil spirits. The patient threatens to bomb a local church. The psychiatrist notifies the minister. Select the answer with the correct rationale. The psychiatrist a. released information without proper authorization. b. demonstrated the duty to warn and protect. c. violated the patient’s confidentiality. d. avoided charges of malpractice. ANS: B It is the health care professional’s duty to warn or notify an intended victim after a threat of harm has been made. Informing a potential victim of a threat is a legal responsibility of the health care professional. It is not a violation of confidentiality. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 6-22, 43 TOP: Nursing Process: Implementation NURSINGTB.COM MSC: Client Needs: Safe, Effective Care Environment 21. A patient experiencing psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation. a. Pat...