Question 1

Which nursing intervention demonstrates false imprisonment?

Accepted Answer

False imprisonment involves holding a competent person against his or her will.Actual force is not a requirement of false imprisonment.The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat.If a patient is not competent (confused),then the nurse should act with beneficence.Patients admitted involuntarily should not be allowed to leave without permission of the treatment team.

Question 2

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:

Accepted Answer

Patients have a right to treatment in the least restrictive setting.Safety is important,but less restrictive measures should be tried first.Unnecessary seclusion may result in a charge of false imprisonment.Seclusion violates the patient's autonomy.The principle by which the nurse is motivated is beneficence,not justice.The tort represented is false imprisonment.

Question 3

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

Accepted Answer

Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs.Involuntary commitment also protects other individuals in society.The behaviors described in the other options are not sufficient to require involuntary hospitalization.

Question 4

A nurse prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot)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.

Accepted Answer

Patients with mental illness retain their civil rights unless there is clear,cogent,and convincing evidence of dangerousness.The patient in this situation presents no evidence of dangerousness.The nurse,as an advocate and educator,should seek more information about the patient's decision and not force the medication.

Question 5

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.

Accepted Answer

Breach of nurse-patient confidentiality does not pose a legal dilemma for nurses in these circumstances because a team approach to delivery of psychiatric care presumes communication of patient information to other staff members to develop treatment plans and outcome criteria.The patient should also know that the team has a duty to warn the father of the risk for harm.

Question 6

A psychiatric nurse best applies the ethical principle of autonomy by:

Accepted Answer

Autonomy is the right to self-determination,that is,to make one's own decisions.By exploring alternatives with the patient,the patient is better equipped to make an informed,autonomous decision.The distracters demonstrate beneficence,fidelity,and justice.

Question 7

Insurance will not pay for continued private hospitalization of a mentally ill patient.The family considers transferring the patient to a public hospital but expresses concern that the patient will not get any treatment if transferred.Select the nurse's most helpful reply.

Accepted Answer

The right to medical and psychiatric treatment was conferred on all patients hospitalized in public mental hospitals with the enactment of the federal Hospitalization of Mentally Ill Act in 1964.

Question 8

A voluntarily hospitalized patient tells the nurse,"Get me the forms for discharge.I want to leave now." Select the nurse's best response.

Accepted Answer

A voluntarily admitted patient has the right to demand and obtain release in most states.However,as a patient advocate,the nurse is responsible for weighing factors related to the patient's wishes and best interests.By asking for information,the nurse may be able to help the patient reconsider the decision.Facilitating discharge without consent is not in the patient's best interests before exploring the reason for the request.

Question 9

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?

Accepted Answer

The nurse is concerned about justice,that is,fair distribution of care,which includes treatment with the least restrictive methods for both patients.Beneficence means promoting the good of others.Autonomy is the right to make one's own decisions.Fidelity is the observance of loyalty and commitment to the patient.

Question 10

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

Accepted Answer

Throwing a heavy plate is likely to harm the waiter and is evidence of dangerousness to others.This behavior meets the criteria for emergency or involuntary hospitalization for mental illness.The behaviors in the other options evidence mental illness but not dangerousness.See related audience response question.

Question 11

Select the example of a tort.

Accepted Answer

A tort is a civil wrong against a person that violates his or her rights.Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient; thus,false imprisonment is a possible charge.The other options do not exemplify torts.

Question 12

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.

Accepted Answer

Laws regarding child abuse reporting discovered by a professional during the suspected abuser's alcohol or drug treatment differ by state.Federal law supersedes state law and prohibits disclosure without a court order except in instances in which the report can be made anonymously or without identifying the abuser as a patient in an alcohol or drug treatment facility.

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 when the patient was stable and competent.The nurse should:

Accepted Answer

The nurse has an obligation to honor the right to self-determination.An advanced psychiatric directive supports that goal.Since the patient is currently psychotic,the terms of the directive now apply.

Question 14

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?

Accepted Answer

Nurses are professionally bound to uphold standards of practice regardless of lesser standards established by a health care agency or a state.Conversely,if the agency standards are higher than standards of practice,the agency standards must be upheld.The courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.

Question 15

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

Accepted Answer

Although the nurse is accountable to the health care provider,the agency,the patient,and the profession,the duty of care is owed to the patient.

Question 16

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

Accepted Answer

Release of information without patient authorization violates the patient's right to privacy.The other options are acceptable nursing practices.See relationship to audience response question.

Question 17

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:

Accepted Answer

The duty to warn a person whose life has been threatened by a psychiatric patient overrides the patient's right to confidentiality.The right to confidentiality is not suspended at the discretion of the therapist or for legal investigations.

Question 18

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.The psychiatrist:

Accepted Answer

It is the health care professional's duty to warn or notify an intended victim after a threat of harm has been made.Informing a potential victim of a threat is a legal responsibility of the health care professional.It is not a violation of confidentiality.

Question 19

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:

Accepted Answer

The dose of antidepressants for elderly patients is often less than the usual adult dose.The nurse should withhold the medication and consult the health care provider who wrote the order.The nurse's duty is to practice according to professional standards as well as intervene and protect the patient.

Question 20

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:

Accepted Answer

Battery is an intentional tort in which one individual violates the rights of another through touching without consent.Forcing a patient to take medication after the medication was refused constitutes battery.The charge of battery can be brought against the nurse.The medication may not necessarily harm the patient; harm is a component of malpractice.

Quiz 6: Legal and Ethical Guidelines for Safe Practice