Deck 9: Legal and Ethical Issues

Question 1

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

A) Confidentiality
B) Right to freedom
C) Periodic treatment review
D) Choice of providers

Answer 1

Right to freedom

Question 2

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

A) When a client states that he or she intends to commit suicide and is making plans to do so.
B) When a client does not bathe regularly or change clothes often.
C) When a client states that he or she intends to harm others by a deliberate act.
D) When a client who has diabetes refuses to follow the prescribed diet.
E) When a client is unable to control his or her rage and is assaulting everyone around him or her.

Answer 2

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

Question 3

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

A) Calling security and asking them to detain the client
B) Allowing the client to leave with community resources for follow-up care
C) Contacting the psychiatrist for initiation of commitment proceedings
D) Contacting the client's family to request they convince the client to stay

Answer 3

Contacting the psychiatrist for initiation of commitment proceedings

Question 4

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

A) A client who is addicted to alcohol who has two DUI offenses
B) A client with schizophrenia who lives in a single family home with siblings
C) A client with bipolar disorder who has quit three jobs in the last 6 months
D) A homeless client who has been arrested for petty theft of groceries from a convenience store.

Question 5

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

A) Gravely disabled
B) Mentally incompetent
C) Noncompliant
D) Unable to provide basic needs when resources exist
E) Act only on his or her own interests

Question 6

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

A) inappropriate; room restriction is not treatment in the least restrictive environment.
B) inappropriate; the adolescent should be offered a sedative before room restriction.
C) appropriate; room restriction is an effective behavior modification technique.
D) appropriate; the adolescent should not have conflicts with others.

Question 7

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

A) I cannot confirm or deny the existence of any client here.
B) You will need to be placed on the client's contact list before I can discuss any information with you.
C) The person you are asking for is not a client here.
D) Hold 1 minute while I get the client for you.

Question 8

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

A) An abused woman states, I have dreams that he is dead.
B) A mother states, Sometimes I feel like killing my kids!
C) A paranoid woman states, I'll get them before they get me.
D) A jealous man states, I am getting my gun and going to shoot my wife's lover!

Question 9

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

A) be coerced to accept treatment.
B) be committed by her family to receive needed treatment.
C) have her family sign permission for treatment.
D) continue to refuse treatment.

Question 10

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

A) be discharged if evaluated through administrative hearings.
B) be retained in the hospital against her will.
C) leave the hospital after giving written notice of her intent to do so.
D) leave without discussing the situation with anyone.

Question 11

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

A) Confidentiality allows for the disclosure of information under specific circumstances.
B) If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights.
C) Privileged communication does not apply to medical records, and they can be used in court.
D) Clients can never be held against their will.

Question 12

When is a nurse legally obligated to breach confidentiality?

A) At any time a client is threatening
B) If threats are made to an identifiable third party
C) Whenever the client becomes aggressive
D) When the client violates the nurse's boundaries

Question 13

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

A) Dangerous to self.
B) Dangerous to others.
C) Gravely disabled.
D) He does not meet any of the necessary criteria.

Question 14

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

A) Accept the client's decision
B) Obtain a discharge order for noncompliance
C) Tell the client that he is too sick to refuse
D) Restrain the client and give the medication IM

Question 15

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

A) beneficence.
B) confidentiality.
C) duty.
D) veracity.

Question 16

A client who is depressed and suicidal is scheduled for electroconvulsive therapy (ECT), which requires consent. Legally, who should sign the consent for this treatment?

A) A member of the treatment team
B) The client
C) The client's spouse
D) The psychiatrist

Question 17

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

A) Autonomy
B) Beneficence
C) Justice
D) Veracity

Question 18

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

A) Explaining the behavioral requirements for release of restraint to the client
B) Assuring that the restraints are not causing injury to the client
C) Applying restraints based solely on assessment findings and not on attitude toward the client
D) Releasing the client when stated behavioral control is achieved

Question 19

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

A) Review of the appropriateness of restraints every 8 hours
B) A face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint.
C) A documented nursing assessment every 4 hours
D) Constant one-on-one supervision during the first hour and then video monitoring

Question 20

Which of the following are criteria that must be adhered to when instituting the short- term use of restraint or seclusion? Select all that apply.

A) The client is aggressive.
B) The client is being punished.
C) The client is imminently dangerous to himself or herself or to others.
D) The client is physically and emotionally self-controlled.
E) All other means of calming the client have been unsuccessful.

Question 21

Placing a client in restraints before using other methods of intervention violates which of the client's rights?

A) Receive confidential and respectful care
B) Provide informed consent
C) Refuse treatment
D) Receive treatment in the least restrictive environment

Question 22

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

A) The nurse did not have a duty.
B) The nurse did not breach duty.
C) The client did not suffer some type of loss, damage, or injury.
D) There was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.

Question 23

Ensuring that the client has informed consent before agreeing to a treatment regimen displays which of the following ethical principles?

A) Fidelity
B) Nonmaleficence
C) Justice
D) Autonomy

Question 24

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

A) Utilitarianism
B) Deontology
C) Nonmaleficence
D) Veracity

Question 25

The nurse is attending an in-service training on safe take-down techniques for aggressive clients. Preparation for safe physical handling prepares the nurse to practice which ethical principle?

A) Veracity
B) Nonmaleficence
C) Justice
D) Autonomy

Question 26

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

A) When the nurse is unable to agree with the policies or common practices of an agency
B) When the nurse is faced with a decision to violate a policy that is harmful to the client
C) When the nurse is certain that clients of different racial and ethnic backgrounds are being treated the same as other clients
D) When the nurse understands that a combative client must be secluded against their will to prevent harm to others
E) When the client refuses to take medication and the nurse respects the client's right to refuse medication

Question 27

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

A) Ethical dilemmas are often charged with emotion.
B) There are no clear ethical codes established for guidance.
C) A multitude of laws must be understood to make a clear decision.
D) Clients are not familiar with the ethical code that nurses must follow.

Question 28

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

A) Code of Ethics for Nurses with Interpretive Statements
B) Licensure examinations
C) State Nurse Practice Acts
D) Agency job descriptions
E) Professional nursing organizations

Question 29

A client underwent a procedure before the nurse verified the client's signature on the consent form. The client actually did not sign the form before the procedure. If the client is dissatisfied with the outcome of the procedure and files a suit against the health-care team, which kind of case can the client file?

A) Negligence
B) Malpractice
C) Battery
D) False Imprisonment

Question 30

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

A) Malpractice
B) Breach of duty
C) Assault
D) Injury or damage