Deck 3: Legal Issues

Question 1

A patient backs into a corner of the room and shouts at the nurse, "Stay away from me." Select the best initial nursing intervention in this situation.

A) Obtain an order for seclusion.
B) Administer a PRN antipsychotic drug.
C) Call for assistance to physically restrain the patient.
D) Talk to the patient in a calm, nonthreatening manner.

Answer 1

Talk to the patient in a calm, nonthreatening manner.

Question 2

Which patient should be considered for involuntary commitment for psychiatric treatment?

A) A patient who is noncompliant with the treatment regimen
B) A patient who sold and distributed illegal drugs
C) A patient who threatens to harm self and others
D) A patient who fraudulently filed for bankruptcy

Answer 2

A patient who threatens to harm self and others

Question 3

To help preserve patients' rights to freedom from restraint and seclusion, the most important interventions that the nurse can use are based on which principle?

A) Therapeutic management
B) Reality-based communication
C) Confidentiality of documentation
D) Effective use of ancillary personnel

Answer 3

Therapeutic management

Question 4

A gravely disabled psychiatric patient has a guardian. What is the essential implication for nursing care?

A) The patient can override the guardian's judgment at any time.
B) Guardianship is a legal matter that does not affect clinical care.
C) The guardian's rights apply only to a patient's financial interests.
D) The guardian participates in treatment planning on behalf of the patient.

Question 5

A patient tells the nurse, "When I get out, I'm going to get even with a lot of people." With respect to the nurse's duty to warn, the nurse should:

A) take no action on a general threat.
B) notify local law enforcement officials.
C) warn close relatives and significant other.
D) document and discuss the threat with the clinical team.

Question 6

A crisis team led by a psychiatric nurse is called to a home because a patient with a history of paranoid schizophrenia is standing on the lawn shouting, "People are poisoning my water." The nurse should advise the police officer to institute procedures for:

A) emergency care.
B) long-term commitment.
C) a probable-cause hearing.
D) short-term observation and treatment.

Question 7

Which situation is an example of a tort?

A) The primary nurse does not complete the plan of care for a patient within 24 hours of the patient's admission.
B) An advanced-practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized.
C) A patient's admission status is changed from involuntary to voluntary after the patient's hallucinations subside.
D) A nurse gives a PRN dose of an antipsychotic drug to a patient to prevent violent acting out because the unit is short staffed.

Question 8

An involuntarily admitted inpatient with paranoid schizophrenia repeatedly calls the local mayor. The patient verbally abuses the person who reply the phone as well as the mayor. Select the most appropriate initial nursing intervention.

A) Allow the patient to continue to use the phone.
B) Include the patient in a social skills building group.
C) Suspend the patient's phone privileges temporarily, and document the reason.
D) Ask the patient advocate to review the limits of the patient's rights with the patient.

Question 9

Which individual would be the most likely candidate to have a guardian appointed?

A) A patient with panic attacks
B) A bipolar patient who refuses medication
C) A patient with frequent admissions for drug abuse
D) A gravely disabled patient with paranoid schizophrenia

Question 10

A nurse in a community mental health center receives a call asking for information about a patient. Under which condition can the nurse release information to the caller?

A) The caller is related to the patient.
B) The psychiatrist approves the request.
C) The caller is a mental health professional.
D) The patient has given written consent for release of information.

Question 11

A patient was restrained after assaulting a staff member. Which nursing measure has priority?

A) Monitor the patient every 30 minutes.
B) Maintain constant supervision of the patient.
C) Administer a sedating medication after applying the restraints.
D) Distract the patient at frequent intervals while restraints are in use.

Question 12

How many violations of Medicare and Medicaid guidelines are evident in this documentation?
Patient assaulted nurse in hall at 1730. Staff provided verbal intervention, but patient continued to strike out. Patient placed in seclusion at 1745. Observation instituted at hourly intervals. Order received from physician at 1930. Patient sleeping soundly at 2100. Patient released from seclusion at 2230 and returned to own room.

A) Two
B) Three
C) Four
D) Five

Question 13

A nurse finds a psychiatric advance directive in the medical record of a patient experiencing psychosis. The directive was executed during a period in which the patient was stable and competent. The nurse should:

A) ensure that the directives are respected in treatment planning.
B) review the directive with the patient to ensure that it is current.
C) consider the directive only if there is a cardiac or respiratory arrest.
D) realize that such directives address only the use of psychotropic medication.

Question 14

To reduce the risk of a lawsuit based on false imprisonment, mental health nurses must give the highest priority to which intervention?

A) Educating patients about unit protocols
B) Providing adequate treatment during hospitalization
C) Selecting the least restrictive treatment environment that will be effective
D) Ensuring that patients have probable-cause hearings within 24 hours of admission

Question 15

A patient shouts, "I'm holding you responsible for mistreatment based on Rogers v. Orkin." The nurse can conclude that the patient is objecting to:

A) loss of privileges to leave the unit.
B) inability to make phone calls.
C) taking medication.
D) hospitalization.

Question 16

A patient tells the nurse, "You better take good care of me or I'll sue you using the precedent established in Wyatt v. Stickney." The nurse can interpret this as:

A) intellectualization.
B) concern about rights to adequate treatment.
C) a warning about being coerced into treatment.
D) a request for immediate discharge from the facility.

Question 17

A patient tells the nurse, "I still have suicidal thoughts, but don't tell anyone because I am supposed to be discharged today." Select the nurse's best course of action.

A) Have the patient sign a "no suicide" contract.
B) Respect the patient's request related to confidentiality.
C) Inform the health care provider and other team members.
D) Search the patient's belongings for potentially hazardous items.

Question 18

A patient who is admitted involuntarily with bipolar disorder, manic phase, refuses a prescribed dose of lithium. The nurse assembles a show of force and intimidates the patient into taking the medication. As an outcome of this action, the patient:

A) will experience lessened mania.
B) can bring civil suit for assault and battery.
C) can sue the hospital for false imprisonment.
D) has no recourse, because the medication is in the interest of the patient's welfare.

Question 19

Considering that a state uses the M'Naghten Rule when an individual is on trial for a crime, what would be most important to document for a nurse caring for a patient who will soon be tried on murder charges?

A) The patient's participation in treatment planning
B) The patient's comments about commission of the crime
C) Examples of behaviors that support psychiatric diagnoses
D) The patient's perceptions of the need for hospitalization and treatment

Question 20

A patient constantly interferes with activities on an inpatient unit. The nurse, speaking in a loud voice, tells the patient, "If you don't go to your room immediately, I will give you medication that will make you sleep." The nurse's behavior demonstrates:

A) assault.
B) battery.
C) negligence.
D) false imprisonment.

Question 21

A patient diagnosed with bipolar disorder is admitted involuntarily during a manic phase. Lithium 300 mg PO t.i.d. is prescribed. The patient refuses the morning dose. What are the nurse's best actions? Select all that apply.

A) Get the prescription changed to an elixir, and administer it in juice.
B) Assemble adequate help to force the patient to take the medication.
C) Educate the patient about the importance of lithium in stabilizing the mood.
D) Allow the patient to refuse the medication, and document the patient's comments.
E) Inform the patient that unit privileges are contingent on taking prescribed medications.

Question 22

An example of a breach of a patient's right to privacy occurred when a nurse:

A) released information to the patient's employer without consent.
B) documented the patient's daily behaviors during hospitalization.
C) discussed the patient's history with other staff during care planning.
D) asked a family to share information about a patient's behavior prior to admission.

Question 23

A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot injection) to a patient diagnosed with schizophrenia. As the nurse swabs the site, the patient shouts, "Stop, stop. I don't want to take that medicine anymore. I hate the side effects." Select the nurse's first action.

A) Stop the medication administration procedure and say to the patient, "Tell me more about the side effects you've been having."
B) Proceed with the injection but explain to the patient that there are medications that may help reduce the unpleasant side effects.
C) 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."
D) Notify other staff to report to the room for a show of force, and proceed with the injection, using restraint if necessary.

Question 24

A patient diagnosed with paranoid schizophrenia believes that evil spirits are being stirred by a local minister and verbally threatens to bomb a local church. The psychiatrist notifies the minister. What is the basis for this action?

A) Information cannot be released without proper authorization.
B) There is a duty to warn and protect.
C) No action can violate the patient's confidentiality.
D) Charges of malpractice must be avoided.

Question 25

Which interventions apply to the care plan of a patient being secluded? Select all that apply.

A) Seclusion instituted when verbal intervention ineffective in stopping threatening behavior
B) Written medical order obtained within 2 hours
C) Patient debriefed when seclusion discontinued
D) Patient offered bathroom privileges hourly
E) Fluids offered every 4 hours

Question 26

An adolescent is hospitalized after a violent physical outburst and tells the nurse, "I'm going to kill my parents, but you can't tell them." Select the nurse's initial response.

A) "You're right. Federal law requires me to keep information private."
B) "Those kinds of threats will make your hospitalization longer."
C) "You really should share this thought with your psychiatrist."
D) "I am required to talk to the treatment team about your threats."

Question 27

A patient's insurance will not pay for continuing hospitalization at a private facility, so the family considers transferring the patient to a public psychiatric hospital. They express concern that the patient will "never get any treatment." Select the nurse's most helpful reply.

A) "Under the law, treatment must be provided. Hospitalization without treatment violates patients' rights."
B) "That's a justifiable concern, because the right to treatment extends only to provision of food, shelter, and safety."
C) "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."
D) "All patients in public hospitals have the right to choose both a primary therapist and a primary nurse."