Deck 8: Ethical Responsibilities and Legal Obligations for Psychiatric Mental Health Nursing Practice

Question 1

A new antidepressant is prescribed for an elderly patient with major depression, but the dose is more than the usual geriatric dose. What should the nurse do?

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.
D) Encourage the patient to increase oral fluids to reduce drug concentration.

Answer 1

Withhold the medication and confer with the health care provider.

Question 2

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 in which of the following circumstances, if any?

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

Answer 2

If the patient threatens the life of another person

Question 3

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) Report the abuse to the local child welfare 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.

Answer 3

Report the abuse to the local child welfare agency.

Question 4

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."

Question 5

A nurse prepares to administer a scheduled injection of haloperidol decanoate (Haldol) to an outpatient 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."

Question 6

Select the response that is an 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 change from involuntary to voluntary after the patient's hallucinations subside.

Question 7

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."

Question 8

Which of the following patients meets criteria for involuntary hospitalization for psychiatric treatment?

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

Question 9

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.

A) The psychiatrist released information without proper authorization.
B) The psychiatrist demonstrated the duty to warn and protect.
C) The psychiatrist violated the patient's confidentiality.
D) The psychiatrist avoided charges of malpractice.

Question 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.

Question 11

Which action by a nurse constitutes a breach of a patient's right to privacy?

A) Documenting the patient's daily behaviour during hospitalization
B) Releasing information to the patient's employer without consent
C) Discussing the patient's history with other staff during care planning
D) Asking family to share information about a patient's pre-hospitalization behaviour

Question 12

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

A) Review the directive with the patient to ensure it is current.
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.

Question 13

A registered nurse requests that the unlicensed health care worker give a patient his or her medication at 1000 hrs as the nurse will be at coffee break. This represents an example of which of the following?

A) Malpractice
B) Intentional tort
C) Vicarious liability
D) Defamation of character

Question 14

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.

Question 15

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

Question 16

A newly admitted acutely psychotic patient is a private patient of the medical director and has private medical insurance. To whom does the psychiatric nurse assigned to the patient owe the duty of care?

A) Medical director
B) Hospital
C) Profession
D) Patient

Question 17

A psychiatric nurse best applies the ethical principle of autonomy by doing which of the following?

A) Exploring alternative solutions with a 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.

Question 18

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 does which of the following?

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

Question 19

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?

A) The nurse has been negligent.
B) The nurse has committed malpractice.
C) The nurse has fulfilled the standard of care.
D) The nurse can be charged with battery.

Question 20

Which individual with mental illness may need emergency or involuntary admission?

A) An individual who resumes using heroin while still taking naltrexone (ReVia).
B) An individual who reports hearing angels playing harps during thunderstorms.
C) An individual who does not keep an outpatient appointment with the mental health nurse.
D) An individual who throws a heavy plate at a waiter at the direction of command hallucinations.

Question 21

Which documentation of a patient's behaviour best demonstrates a nurse's observations?

A) Isolates self from others. Frequently fell asleep during group. Vital signs stable.
B) Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking.
C) Appeared to hallucinate. Frequently increased volume on television, causing conflict with others.
D) Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin."

Question 22

An unlicensed health care worker in a psychiatric hospital says to the nurse, "We don't have time every day to help each patient complete a menu selection. Let's tell dietary to prepare popular choices and send them to our unit." Select the nurse's best response.

A) "Thanks for the suggestion, but that idea may not work because so many patients take MAOI (monoamine oxidase inhibitor) antidepressants."
B) "Thanks for the idea, but it's important to treat patients as individuals. Giving choices is one way we can respect patients' individuality."
C) "Thank you for the suggestion, but the patients' bill of rights requires us to allow patients to select their own diet."
D) "Thank you. That is a very good idea. It will make meal preparation easier for the dietary department."

Question 23

Which actions violate the civil rights of a psychiatric patient? Select all that apply.

A) The nurse performs mouth checks after overhearing a patient say, "I've been spitting out my medication."
B) The nurse begins suicide precautions before a patient is assessed by the health care provider.
C) The nurse opens and reads a letter a patient left at the nurse's station to be mailed.
D) The nurse places a patient's expensive watch in the hospital business office safe.
E) The nurse restrains a patient who uses profanity when speaking to the nurse.

Question 24

In which situations would a nurse have the duty to intervene and report? Select all that apply.

A) A peer has difficulty writing measurable outcomes.
B) A health care provider gives a telephone order for medication.
C) A peer tries to provide patient care in an alcohol-impaired state.
D) A team member violates relationship boundaries with a patient.
E) A patient refuses medication prescribed by a licensed health care provider.

Question 25

After leaving work, a nurse realizes documentation of administration of a PRN medication was omitted. This off-duty nurse phones the nurse on duty and says, "Please document administration of the medication for me. My password is alpha1." The nurse receiving the call should do which of the following?

A) Fulfill the request promptly.
B) Document the caller's password.
C) Refer the matter to the charge nurse to resolve.
D) Report the request to the patient's health care provider.

Question 26

A patient experiencing psychosis asks a psychiatric technician, "What's the matter with me?" The technician replies, "Nothing is wrong with you. You just need to use some self-control." The nurse who overheard the exchange should take action based on which of the following?

A) The technician's unauthorized disclosure of confidential clinical information.
B) Violation of the patient's right to be treated with dignity and respect.
C) The nurse's obligation to report caregiver negligence.
D) The patient's right to social interaction.

Question 27

Which individual diagnosed with a mental illness may need involuntary hospitalization?

A) An individual who has a panic attack after her child gets lost in a shopping mall
B) An individual with visions of demons emerging from cemetery plots throughout the community
C) An individual who takes 38 acetaminophen tablets after his or her stock portfolio becomes worthless
D) An individual diagnosed with major depression who stops taking prescribed antidepressant medication

Question 28

In order to release information to another health care facility or third party regarding a patient diagnosed with a mental illness, the nurse must obtain which of the following?

A) A signed consent by the patient for release of information stating specific information to be released.
B) A verbal consent for information release from the patient and the patient's guardian or next of kin.
C) Permission from members of the health care team who participate in treatment planning.
D) Approval from the attending psychiatrist to authorize the release of information.

Question 29

A patient with psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation.

A) Patient struck another patient who attempted to leave day room to go to bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two patients away from each other for 24 hours.
B) Seclusion ordered by physician at 1415 after command hallucinations told the patient to hit another patient. Careful monitoring of patient maintained during period of seclusion.
C) Seclusion ordered by physician for aggressive behaviour. Begun at 1415. Maintained for 2 hours without incident. Outcome: Patient calmer and apologized for outburst.
D) Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, “I’ll punch anyone who gets near me,” and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained from physician at 1430.

Question 30

A person in the community asks, "Why aren't people with mental illness kept in institutions anymore?" Select the nurse's best response.

A) "Less restrictive settings are available now to care for individuals with mental illness."
B) "There are fewer people with mental illness, so fewer hospital beds are needed."
C) "Most people with mental illness are still in psychiatric institutions."
D) "Psychiatric institutions violated patients' rights."