Deck 9: Legal and Ethical Aspects in Clinical Practice

Question 1

Upon voluntary admission,the nurse will ensure that the patient's rights are preserved.Which interventions are directly related to a patient's civil right? Select all that apply.

A) Arranging for the patient to vote in city election by absentee ballot
B) Respecting the patient's right to refuse a dose of a prescribed medication
C) Arranging for the patient to have a private area in which to visit with friends
D) Deferring to a patient's expressed wish to "not share a room with anyone else"
E) Changing the assignment because a patient "doesn't like" a particular staff member

Answer 1

Arranging for the patient to vote in city election by absentee ballot
Respecting the patient's right to refuse a dose of a prescribed medication
Arranging for the patient to have a private area in which to visit with friends

Question 2

A patient diagnosed with paranoid schizophrenia has been charged with murder.The patient's mother asks,"What will happen if my son is found not guilty by reason of insanity?" Which response shows that the nurse understands the outcome of this plea?

A) "Your son will not receive the death penalty."
B) "He will receive the mental treatment he deserves."
C) "The court will order that he be involuntary committed for treatment."
D) "He is considered innocent and will be released to the care of his physician."

Answer 2

"The court will order that he be involuntary committed for treatment."

Question 3

A 15-year-old who shows poor impulse control and resistance to authority is prescribed outpatient therapy.The parents are insistent that the treatment include commitment to an inpatient facility.Which response by the nurse best supports the outpatient treatment modality?

A) "Your child has a right to receive treatment in the least restrictive manner."
B) "Outpatient therapy is better accepted by teens that are authority resistant."
C) "This form of treatment is less expensive and usually covered by insurance."
D) "Short-term therapy like this is usually done in an outpatient environment setting."

Answer 3

"Your child has a right to receive treatment in the least restrictive manner."

Question 4

A patient is being treated in the inpatient unit for paranoid delusions that his wife is unfaithful resulting in threats to "get her for this whenever I get out." Which intervention to assure his wife's safety will his primary therapist include in the discharge plan?

A) Sharing the threats he has made with his wife
B) Requiring mandatory day hospital attendance
C) Advising the patient that he needs continued outpatient services
D) Informing the patient of the consequences of harming his wife

Question 5

Which nursing interventions are required by The Joint Commission (TJC)when the decision is made that a patient will benefit from the use of physical restraints? Select all that apply.

A) The patient's family is telephoned and told that restraints were applied.
B) The restraints are removed when the patient agrees to cooperate with staff.
C) A staff member is assigned to sit next to the patient until the restraints are removed
D) The nurse provides the patient with a timetable that identifies when the restraints will be removed.
E) The nurse notifies the patient's mental health care provider that a face-to-face assessment is needed

Question 6

After the nurse discovered a medication error had been made,the patient was carefully observed and effectively treated for symptoms of a headache.What element of malpractice is most critical in determining the nurse's liability?

A) The nurse owed a legal duty to the patient.
B) The nurse breached the recognized duty.
C) The patient suffered harm as a result of the act.
D) The harm was a direct result of the nursing act.

Question 7

Electroconvulsive therapy (ECT)has been prescribed for a patient diagnosed with chronic depression.Which statement by the patient helps assure the nurse that the patient's right to informed consent has been respected?

A) "ECT treatment will cure my depression."
B) "ECT is dangerous but I'm almost out of treatments."
C) "I may not remember things that happened just before the ECT treatment."
D) "I'm likely to permanently lose memory of things like dates and numbers."

Question 8

A patient was placed in restraints for 2 hours in order to help manage impulsive,destructive,unsafe behavior.Which statement made by the charge nurse during a meeting to discuss the incident shows an understanding of the need to use restraints only as a last resort?

A) "How did this situation get so out of control?"
B) "You all know that restraints are used only as a last resort."
C) "Can anyone tell me why restraints were used on this patient?"
D) "Let's review what exactly happened that led to the use of restrains."

Question 9

A patient diagnosed with schizophrenia is hospitalized under an emergency commitment.Which nursing explanation is most effective when the patient asks,"Why am I being kept here?"

A) "The court believed you needed mental health care."
B) "Your mental condition became unstable and you relapsed."
C) "You couldn't stop doing things that could likely have hurt you."
D) "I'd suggest that you exercise your patient right to speak to a lawyer."

Question 10

A chronically depressed patient has been asked to participate in a research project focusing on effectiveness of alternative therapies.The nurse determines that the patient has an appropriate understanding of the guidelines that directs a research project when he states (select all that apply):

A) "I hope they find a treatment that doesn't involve drugs."
B) "I plan to use all the money I get to pay off some of my bills."
C) "Helping to find a treatment for depressed people is a good thing."
D) "My doctor told me that I had a responsibility to get involved in this."
E) "I'm confident that this research project has very little risk involved."

Question 11

An advanced practice nurse evaluates a patient for emergency commitment because of the likelihood the patient will do serious harm to others.Which statement best reflects the nurse's role as patient advocate during the assessment process?

A) "Tell me about any delusions you are experiencing."
B) "I understand you have had some difficulty today."
C) "Tell me why you need to threaten or hurt others around you."
D) "Threatening to hurt others will require that you be committed to the hospital."

Question 12

Which actions show the nurse has an understanding of the role documentation plays in minimizing the risk of malpractice? Select all that apply.

A) Including patient quotes to document subjective symptomology
B) Supporting documentation with personal opinions of the patient's behaviors
C) Being mindful to use correct spelling and punctuation in the documentation
D) Using common abbreviations in order to keep documentation brief and concise
E) Documenting the nursing evaluation of the patient's understanding of all instructions

Question 13

The nurse is explaining the advantage of advanced directives to a patient diagnosed with schizophrenia.Which psychiatric outcome is a result of such preplanning?

A) Allows healthcare providers to manage the patient's mental health care
B) Decreases the possibility that the patient will be committed involuntarily
C) Directly impacts the type of care the patient will receive as the disease progresses
D) Assures that the patient will retain continued autonomy and independence of living

Question 14

A patient admitted for treatment of symptoms related to paranoid schizophrenia refuses to sign a consent form allowing the nurse to discuss any aspect of his hospitalization with his parents.Which statement by the nurse best respects the patient's rights while providing effective care?

A) Reminding the parents that, "I can't discuss your son even though I want to."
B) Asking the patient to, "please talk with me about why you don't trust your parents?"
C) Telling the patient that, "Keeping your parents uninvolved in your care is very painful for them."
D) Telling the parents that, "While I can't discuss his care with you, you can tell me anything you think I need to know."

Question 15

Privileged communication is a legal concept that in some states protects the confidentiality of the nurse-patient relationship.Which information is not protected by this statute? Select all that apply.

A) A threat to "kill that man if he even thinks about leaving me"
B) The patient's admission to having a sexually transmitted disease
C) The fact that a patient knows who was responsible for her brutal rape
D) The discussion about how the patient sold his prescription drugs to friends
E) Suspicion by the nurse that the patient has been physically abused by a spouse

Question 16

A patient has been hospitalized and is now being mandated outpatient mental health treatment as a condition for discharge.Which intervention best addresses the nurse's role of patient advocate when this patient resists the recommendation?

A) Helping the patient identify advantages of outpatient versus inpatient therapy
B) Sharing that outpatient therapy is less expensive than inpatient hospitalization
C) Stressing that outpatient therapy can minimize the need for future hospitalization
D) Discussing the patient's opposition to outpatient treatment with the treatment team

Question 17

A patient who has schizoaffective disorder is being treated with lithium carbonate.He repeatedly resists his medication based on his fine hand tremors as proof of drug poisoning.Which nursing intervention addresses both the patient's need to comply with treatment and patient rights?

A) Informing staff that the patient is exhibiting manipulative behavior
B) Providing the patient with effective education regarding medication side effects
C) Assuring the patient the tremors are a result of the disorder, not of the medication
D) Providing an assessment to determine if the patient is exhibiting paranoia as well

Question 18

What actions by a nurse identify an understanding of the nursing responsibility to treat the patient with consideration to the ethical component of beneficence? Select all that apply.

A) Frequently self-reflecting on whether the nursing interventions are actually helping the patient
B) Evaluating whether the intervention is causing the patient unacceptable levels of anxiety or pain
C) Recognizing that the moral rule of primum non nocere does not apply to the mentally ill patient
D) Being willing to influence the patient in making decisions concerning the need for unpleasant treatments
E) Consistently setting boundaries to effectively deflect a patient's inappropriate sexually-oriented behaviors

Question 19

Which statement helps assure the nurse that the patient has an understanding of how their health information is managed to assure their right to confidentiality? Select all that apply.

A) "I had to sign a paper saying my information could be released."
B) "My records will be released to only people who really need to know."
C) "All the doctors will have access to my medical records when I'm here."
D) "No one can see my information unless I say it's okay for them to see it."
E) "My insurance company will get what they need in order to cover the bill."

Question 20

A patient,who has been charged with assault with intent to commit murder,has been hallucinating.Which question when answered correctly by the patient would show competency to stand trial for the crime?

A) "Can you describe your hallucinations?"
B) "Were you ever sexually abused as a child?"
C) "Can you describe for me the charges against you?"
D) "Can you explain why you wanted to assault your brother?"