Question 1

A nurse is explaining advance care directives, or "living wills," to a client and the client's spouse. Which detail would the nurse include in the description of an advance care directive?

Accepted Answer

Advance care directives, or "living wills," state what treatment should be omitted or refused if the client is unable to make those decisions. An advance care directive requires any two witnesses and notarization but does not require an attorney.

Question 2

A psychiatric-mental health nurse is providing care to a client diagnosed with depression. The nurse determines that a client is competent when the client is able to engage in what action?

Accepted Answer

A client who is competent and able to give informed consent should be able to communicate choices, understand relevant information, appreciate the situation and its consequences, and use a logical thought process to compare the risks and benefits of treatment. The ability to speak coherent English, write a living will, or comply with the medical regimen are not criteria for competence.

Question 3

A client receives a court order for commitment. Which concept exemplifies a "least restrictive environment?"

Accepted Answer

An example of the concept "least restrictive environment" is the involuntary commitment of a client to an outpatient mental health center. Medications cannot be given unnecessarily to keep a client in bed. An individual cannot be restrained or locked in a room unless all other "less restrictive" interventions are attempted first. Placing a client in a locked inpatient unit would also not be considered "least restrictive."

Question 4

A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client makes which statement?

Accepted Answer

When there is suspicion that a client has harmed someone or is about to injure someone, a nurse is mandated to breach confidentiality and report this to the authorities. The statement "I'm going to make my neighbor sorry" is an example. Thinking that the federal government is spying on the person reflects paranoid thinking. The statement about being "turned on" reflects manipulative behavior. The statement about feeling angry about the doctor provides information about the client's feelings. The nurse would be mandated to report this statement only if the client went on to say that he or she was planning to "hurt" the doctor.

Question 5

Which client would a nurse determine to be the most likely candidate for involuntary commitment?

Accepted Answer

A client who is screaming obscenities is more likely to be judged as a danger to oneself or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy do not pose an immediate danger to oneself or to others.

Question 6

A nurse is providing care to a client who is hospitalized with a diagnosis of schizophrenia. Which statement would be appropriate for the nurse to include in the client's medical record?

Accepted Answer

The most appropriate statement to record is, "Reports being unable to sleep because of voices heard throughout the night." This statement clearly depicts the client's problem and the reason why. The nurse should avoid jargon and stereotypical statements, such as having a good night with no issues or acting crazily. Only meaningful, accurate, objective descriptions of the behavior should be used.

Question 7

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 the client's medical records in employee health can be updated. Based on the nurse's knowledge of breach of confidentiality, which response would be the appropriate?

Accepted Answer

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 this employee is a client on the unit would be such a breach. Even if the nurse explains that he or she 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.

Question 8

A client is going to be discharged this afternoon from the mental health unit. The client asks the nurse if a copy of the medical record could be sent to the outpatient psychologist. Which response by the nurse is appropriate?

Accepted Answer

The release of information related to psychotherapy requires client permission. The underlying intent is to prevent the release of information to agencies not related to health care, such as employers, without the client's consent. For information to be released, HIPAA regulations require client authorization.

Question 9

A psychiatrist recommends that a client should participate in a 3-month outpatient aftercare program after being discharged. What would protect the client's right to request a second opinion before agreeing to this suggestion?

Accepted Answer

The right of self-determinism entitles all clients to refuse treatment, to obtain other opinions, and to choose other forms of treatment. It is one of the basic clients' rights established by Title II, Public Law 99-139, outlining the Universal Bill of Rights for Mental Health Patients. "Least restrictive environment" means that an individual cannot be restricted to an institution when he or she can be successfully treated in the community. Confidentiality is an ethical duty of nondisclosure. Mandates to inform is a term referring to the legal obligation to breach confidentiality when there is a judgment that the client has harmed, or is about to injure, another person.

Question 10

A nurse is preparing to administer an as-needed (PRN) medication. What would the nurse need to keep in mind when documenting its administration?

Accepted Answer

Medications prescribed on a PRN basis require a separate entry, including reason for administration, dosage, route, and response to the medication. Documenting responses is the only way to document treatment outcomes, and because the outcome may be different each time, the response along with the reason for administration, dosage, and route should be documented every time the PRN medication is given.

Question 11

A group of nurses is reviewing information about internal rights protection systems. The nurses demonstrate understanding of this information when they identify which example?

Accepted Answer

Mental health care systems have internal rights protection systems or mechanisms to combat any violation of their clients' rights. Each state mental health provider is required to establish and operate a system that protects and advocates for the rights of individuals with mental illnesses. The American Hospital Association and American Public Health Association serve as advocates for the rights and treatment of mental health clients and are part of an external advocacy system. Clients' rights are also assured of protection by an agency's accreditation, such as accreditation by The Joint Commission.

Question 12

After educating a class on competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as being evaluated?

Accepted Answer

A client who is competent is able to communicate choices, understand relevant information, appreciate the situation and consequences, and use a logical thought process to compare risks and benefits of treatment options. The ability to discuss what is right and wrong is not a component assessed when determining competency.

Question 13

A client is involuntarily committed without a court order. The nurse understands that the emergency, short-term hospitalization can occur for how long?

Accepted Answer

Although commitment procedures vary among states, most have provisions for an emergency, short-term hospitalization of 48 to 92 hours authorized by a certified mental health provider without a court order. At the end of that period, the individual must either agree to voluntary treatment or extended commitment procedures are initiated. This information makes all the remaining options incorrect.

Question 14

After teaching a group of nurses about confidentiality and privacy, the group leader determines that the teaching was successful when the group identifies which aspect as privacy?

Accepted Answer

Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Confidentiality refers to an ethical duty of nondisclosure. Confidentiality also involves two people: the individual who discloses the information and the person with whom the information is shared. Informed consent is a legal procedure to ensure that the client knows the benefits and costs of treatment.

Question 15

An advance 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?

Accepted Answer

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.

Question 16

A psychiatric-mental health nurse is documenting information in a client's medical record. Which would be least likely to increase the nurse's legal liability?

Accepted Answer

The entry about medication administration is the most complete and clear because it states the name of the medication, the dosage and route, and why it was administered. The nurse would then be responsible for following up this documentation with information about how the client responded to the medication. The statement about the client feeling better and the statement about talking with a staff member and screaming are both vague and general. The statement about applying restraints is incomplete. The statement needs to include information about why the restraints were applied, that an order was obtained for the restraints, and how the client responded to the restraints.

Question 17

After educating a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which as a right?

Accepted Answer

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.

Question 18

A nursing instructor is explaining to a group of nursing students that a forensic client experiences stigma associated with being mentally ill and with being a criminal. One of the students asks the instructor how the stigma associated with criminality might influence nursing care. Which response by the instructor is appropriate?

Accepted Answer

Forensic clients experience the combined effects of the stigma of mental illness and criminality. Although the stigma is an issue for all persons with mental illnesses, it is magnified for those who have committed a crime. There is often reluctance on the part of mental health professionals to treat these clients, especially if murder and child sexual abuse are involved. Even if the worry is unfounded, clinicians express safety concerns for themselves and other clients and may refuse to care for these clients.

Question 19

A nurse is giving a public presentation on the topic of forensic psychiatric care at a community center. The nurse explains that someone who is found to be unfit to stand trial is subsequently hospitalized in a forensic mental health facility. A member of the audience asks, "What is the purpose of the hospitalization?" Which response by the nurse is appropriate?

Accepted Answer

In most states, when a mentally ill individual is found unfit to stand trial (UST), hospitalization in a forensic mental health facility follows. The goal of this hospitalization is to help the person become fit to stand trial, not to treat the mental illness.

Question 20

A psychiatric nursing instructor is trying to explain to a group of students how clients identified as guilty but mentally ill (GBMI) and not guilty by reason of insanity (NGRI) differ. Which statement is appropriate for the instructor to include in the discussion?

Accepted Answer

Both GBMI and NGRI persons are treated for their mental illness, but whereas individuals found to be GBMI are treated in the correctional system, individuals who are NGRI are ordered to a forensic facility for a psychiatric evaluation and treatment recommendations. Nearly all individuals found NGRI are also subject to involuntary commitment in a secure setting. The conditions of release are different. Whereas individuals with a GBMI are subject to the correctional system's parole decisions, an NGRI individual is discharged from the hospital through the courts upon recommendations by forensic mental health professionals.

Quiz 4: Patient Rights and Legal Issues