Deck 7: Legal and Ethical Guidelines for Safe Practice

Question 1

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? The nurse:

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

Answer 1

can be charged with battery.

Question 2

In a team meeting a nurse says,"I'm concerned about whether we are behaving ethically in using restraint to prevent one patient from engaging in self-mutilating behavior while the care plan for another self-mutilating patient calls for one-on-one supervision." Which ethical principle most clearly applies to this situation?

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

Answer 2

Justice

Question 3

Which patient meets criteria for involuntary commitment for psychiatric treatment? The patient who:

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

Answer 3

threatens to harm self and others.

Question 4

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

A) consult a 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.

Question 5

Which individual with mental illness may need emergency or involuntary hospitalization for mental illness? The individual who:

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

Question 6

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 knowledge."

Question 7

Several nurses are concerned that agency policies related to restraint and seclusion practices are inadequate.Which understanding about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?

A) The policies do not absolve an individual nurse of the responsibility to practice according to professional standards of nursing care.
B) Agency policies are considered the legal standard by which a professional nurse must act and therefore override other standards of care.
C) In an institution with substandard policies,the nurse has a responsibility to inform the supervisor and leave the premises without delay.
D) Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.

Question 8

A newly admitted acutely psychotic patient is a private patient of the chief of staff and a private-pay patient.To whom does the psychiatric nurse assigned to the patient owe the duty of care?

A) Health care provider
B) Hospital
C) Profession
D) Patient

Question 9

Which intervention by a psychiatric nurse best applies the ethical principle of autonomy? The nurse:

A) explores alternative solutions with a patient,who than makes a choice.
B) suggests that two patients who were fighting be restricted to the unit.
C) intervenes when a self-mutilating patient attempts to harm self.
D) stays with a patient demonstrating a high level of anxiety.

Question 10

The family of a patient whose insurance will not pay for continuing hospitalization considers transferring the patient to a public mental hospital.They express concern that the patient will be "never get any treatment." Which reply by the nurse would be most helpful?

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

Question 11

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

A) Documents the patient's daily behaviors during hospitalization
B) Releases information to the patient's employer without consent
C) Discusses the patient's history with other staff during care planning
D) Asks family to share information about a patient's prehospitalization behavior

Question 12

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

Question 13

A patient with schizophrenia believes a local minister stirred evil spirits and threatens to bomb a local church.The psychiatrist notifies the minister.Select the answer with the correct rationale.The psychiatrist:

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

Question 14

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) Anonymously report the abuse by phone to the local child protection agency.
B) Reply,"I'm glad you feel comfortable talking to me about it."
C) Respect nurse-patient relationship confidentiality.
D) File a written report on agency letterhead.

Question 15

Two hospitalized patients fight when they are in the same room.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:

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 16

Which action by a psychiatric nurse best supports the right of patients to be treated with dignity and respect?

A) Consistently addresses patients by title and surname
B) Strongly encourages a patient to participate in the unit milieu
C) Discusses a patient's condition with the health care provider in the elevator
D) Informs a treatment team that a patient is too drowsy to participate in care planning

Question 17

A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot)to a patient with schizophrenia.As the nurse swabs the site,the patient shouts,"Stop,stop.I don't want to take that medicine anymore because I hate the side effects." Select the nurse's first 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 18

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:

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.

Question 19

Select the 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 changed from involuntary to voluntary after the patient's hallucinations subside.

Question 20

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.Now 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 21

After leaving work,a nurse realizes documentation of administration of a PRN medication was omitted.This off-duty nurse phones the unit and tells the nurse,"Please document administration of the medication for me;I forgot to do it.My password is alpha1." The nurse receiving the call should:

A) fulfill the request.
B) refer the matter to the charge nurse to resolve.
C) access the record and document the information.
D) report the request to the patient's health care provider.

Question 22

A patient with psychosis asks a psychiatric technician,"What's the matter with me?" The technician replies,"Your wing nuts need tightening." The nurse who overheard the exchange will need to take action based on:

A) violation of the patient's right to be treated with dignity and respect.
B) the nurse's obligation to report caregiver negligence.
C) preventing defamation of the patient's character.
D) supervisory liability.

Question 23

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

A) A peer is unable to write measurable outcomes.
B) The health care provider consults the Physician's Desk Reference.
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 24

A community mental health nurse worked for 6 months to establish a relationship with a delusional and suspicious patient.The patient is fired from employment,has no money for medication,and decompensates within 1 week.Should the patient be hospitalized or provided with medication and allowed to remain at home? Which two ethical principle(s)are most relevant to the team's decision making?

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

Question 25

A patient approaches the charge nurse and says,"I want to talk to the mental health advocate immediately about getting released." The unit has no patient phone,and agency policy does not permit patients to enter the nurses' station.Select the nurse's best initial action(s).You may select more than one answer.

A) Tell the patient,"Get an order from your health care provider to leave the unit to make the call."
B) Give the patient a pen and paper to write a note to the advocate.
C) Provide the patient with a cell phone to make the call.
D) Document the request in the patient's medical record.
E) Promptly notify the advocate of the patient's request.

Question 26

Which actions violate the civil rights of a psychiatric patient? The nurse: You may select more than one answer.

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

Question 27

A person in the community asks,"Why aren't people with mental illness kept in state 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 persons with mental illness,so less hospital beds are needed."
C) "Most people with mental illness are still in psychiatric institutions."
D) "Psychiatric institutions violated patients' rights."

Question 28

Which documentation of a patient's behavior 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 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 MD for aggressive behavior. 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 MD at 1430.