Chapter 8: Legal and Ethical Context of Psychiatric Nursing Care My Nursing Test Banks

Chapter 8: Legal and Ethical Context of Psychiatric Nursing Care

Test Bank

MULTIPLE CHOICE

1. A patient with severe depression signed permission for electroconvulsive therapy (ECT). Later, the patient tells the nurse, I signed permission for treatment after my spouse told me I could be deported if my depression cant be cured. The nurse assesses that:

a.

the patients consent may have been coerced.

b.

all the elements of informed consent were met.

c.

the patient may not fully understand the risks and benefits.

d.

the patient is not competent to sign permission for treatment.

ANS: A

The decision may have been coerced based on family pressure. Informed consent requires that the choice be freely made.

DIF: Cognitive Level: Analysis REF: Text Page: 120

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. When a patient who immigrated to the United States tells a nurse that consent to electroconvulsive therapy (ECT) was only given because the patients spouse said, They will deport you if you didnt do what they said to do, the nurse should initially:

a.

reassure the patient that the decision is sound.

b.

discuss the reasons the spouse believed they must consent.

c.

explain that consenting to treatment will not stop deportation.

d.

document the comment and notify the health care provider immediately.

ANS: D

When requirements for making an informed decision are not met, the health care provider will need to confer with the patient.

DIF: Cognitive Level: Application REF: Text Page: 120

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. A patient with a history of assaulting several family members is voluntarily admitted for alcohol detoxification. A nurse suggests use of physical restraints to minimize the risk to the milieu and to manage the patients anticipated aggressive behavior. The primary principle guiding the managers response is:

a.

the right to the least restrictive measure of restriction possible.

b.

that legal considerations exist when physical restraints are used.

c.

the limitations for the use of physical restraints on voluntarily admitted patients.

d.

that thorough documentation is needed whenever physical restraints are applied.

ANS: A

The primary concern is a patients right to be treated using the least restrictive setting and method.

DIF: Cognitive Level: Application REF: Text Page: 121

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

4. A patient was admitted involuntarily. What assumption can the nurse make about the patient?

a.

The patient may leave the unit whenever he or she chooses to do so.

b.

For the first 48 hours, the patient may be compelled to take prescribed medication.

c.

The patient has, through informed consent, agreed to accept treatment and participate fully in care planning.

d.

When admitted, the patient was an imminent danger to self or others or was deemed unable to provide for his or her own basic needs.

ANS: D

Involuntary commitment means that the patient did not request hospitalization and may have opposed it or was indecisive but did not resist it. Further, most involuntary commitments are made on the grounds that the patient is dangerous to self or others, is mentally ill and in need of treatment, or is unable to provide for his or her own basic needs.

DIF: Cognitive Level: Application REF: Text Page: 113

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. What is the new staff nurses immediate duty when a patient discloses a plan to kill a family member upon release from the hospital?

a.

Discuss the statement with the patients mental health team but otherwise keep the information confidential.

b.

Immediately contact the family member and provide a verbal warning concerning his or her physical safety.

c.

Inform the patient that the local police department will be called and that oral and written reports will be filed.

d.

Document the information in the patients medical record, and notify the nursing supervisor of the statement.

ANS: D

The Tarasoff decision gives mental health professionals a duty to warn prospective victims. The initial step in this process is to document the statement and to notify the nursing supervisor that the statement was made and documented.

DIF: Cognitive Level: Application REF: Text Page: 119

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

6. A patient was admitted voluntarily to the psychiatric unit. A nurse must understand that voluntary status confers the right of the patient to:

a.

have visitors at any desired time.

b.

come and go from the unit at will.

c.

choose the nursing staff assigned to the patients care.

d.

accept or refuse any recommended treatment modalities.

ANS: D

Patients who are admitted voluntarily lose none of their civil rights; they retain the right to make decisions to accept or reject specific treatments. The other items are matters that are unit policy rather than individual rights.

DIF: Cognitive Level: Comprehension REF: Text Page: 113

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. An individual is advised to seek psychiatric hospitalization and agrees to receive treatment and abide by hospital rules. What type of admission is this?

a.

Legal

b.

Informal

c.

Voluntary

d.

Involuntary

ANS: C

Under voluntary admission, any citizen of lawful age may apply in writing for admission to a public or private psychiatric hospital. The person agrees to receive treatment and abide by hospital rules. Voluntary admission is similar to medical hospitalization.

DIF: Cognitive Level: Comprehension REF: Text Page: 113

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

8. Regardless of the type of commitment, which right is guaranteed to a hospitalized psychiatric patient?

a.

The right to consult a lawyer

b.

The right to release after 72 hours

c.

The right to choose agency caregivers

d.

The right to keep all personal effects

ANS: A

Consulting a lawyer is the right of all psychiatric patients. Release is determined by the type of commitment; choice of agency caregiver and keeping all personal effects are not basic patient rights. Safety considerations override the right to personal property.

DIF: Cognitive Level: Knowledge REF: Text Page: 114

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

9. The staff members notify the police that a court-committed patient has eloped. What is the initial action for the staff to take when the patient is returned to the hospital?

a.

Discuss with the patient the reason for the elopement.

b.

Ask the patient to sign an against medical advice release.

c.

Request that the patient give written notice of intent to leave.

d.

Readmit the patient under the original court-ordered commitment.

ANS: D

Elopement does not cancel court commitment.

DIF: Cognitive Level: Application REF: Text Page: 115

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. Two nurses are discussing the rights of hospitalized psychiatric patients. Which of their beliefs requires follow-up by the nurse manager?

a.

The hospital is responsible for the patients safety.

b.

If a committed patient is judged to be incompetent, he or she retains the right of habeas corpus.

c.

Privileged communication does not apply to hospital charts, so they can be used in court.

d.

Disclosure of patient information to law enforcement agencies is permitted without patient consent.

ANS: D

Information about patients may not be shared with individuals outside the circle of confidentiality.

DIF: Cognitive Level: Comprehension REF: Text Page: 118

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

11. Which action by a nurse violates the rights of a psychiatric patient?

a.

Arranging for a patient to work in the hospital kitchen for minimum wage

b.

Refusing to mail letters to the local newspaper written by a committed patient

c.

Placing the wristwatch of a patient with delusions in the hospitals main safe

d.

Discouraging a patient with paranoid delusions to sign a contract to sell a home

ANS: B

Psychiatric patients have the right to communicate with others outside the hospital.

DIF: Cognitive Level: Application REF: Text Pages: 116-117

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. A patient tells a nurse, My children had me ruled incompetent. Im going to ask the doctor to reverse that ruling. The nurses reply should be based on the fact that:

a.

incompetency may only be reversed by a court.

b.

competency is automatically restored upon discharge from the hospital.

c.

being declared incompetent is associated with specific medical diagnoses.

d.

competency is not a major issue since it does not interfere with the right to vote, marry, and divorce.

ANS: A

Competence or incompetence is determined in a court; it is not a medical decision.

DIF: Cognitive Level: Application REF: Text Page: 117

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

13. A psychiatric nurse working in a community health center receives a call asking whether a family friend has been a patient in the facility. The nurse should:

a.

ask why the information is being sought.

b.

suggest that the caller speak to the patients therapist.

c.

state that he or she is unable to give any information to the caller.

d.

state that the patient has been seen at the center but should give no further information.

ANS: C

Confidentiality requires that the nurse impart no information whatsoever, including acknowledging whether or not the person has been a patient at the facility.

DIF: Cognitive Level: Application REF: Text Page: 118

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

14. While making a home visit, a community health nurse sees evidence that the child of a patient has been abused. What rationale should be the basis for the nurses nursing action?

a.

Privileged patient communication prevents the nurse from reporting the abuse.

b.

Documenting the evidence in the medical record supports the observation.

c.

A federal ruling requires that the nurse report the suspected abuse.

d.

A signed patient release is needed before action can be taken.

ANS: C

Nurses are mandated reporters of suspected child abuse. To report or not is not discretionary.

DIF: Cognitive Level: Application REF: Text Pages: 119-120

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

15. A patient is about to receive electroconvulsive therapy (ECT) when a nurse sees that a consent form for treatment has not been signed. Which fact should determine the nurses immediate action?

a.

Verbal consent by the patient is sufficient.

b.

A staff member is needed to witness the consent form.

c.

Failure to obtain the patients written consent constitutes battery.

d.

Permission was implied when the patient signed the hospitals admission form.

ANS: C

A consent form for the specific treatment is required. Unless informed consent is given, the patient may sue the agency, the health care provider, and all who participated in the treatment.

DIF: Cognitive Level: Application REF: Text Page: 119

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

16. Although not assessed to be dangerous to self or others, a patient diagnosed with borderline personality disorder has created many problems on the unit and consistently refuses to accept prescribed medication. Nursing actions must be guided by the realization that legally this patient may:

a.

refuse any type of treatment.

b.

receive forced treatment if the treatment team concurs.

c.

be medicated if family members sign permission for treatment.

d.

be made to accept treatment recommendations through the loss of privileges.

ANS: A

Patients have the right to refuse treatment, even when treatment would be in their best interest.

DIF: Cognitive Level: Application REF: Text Page: 112

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

17. A nurse was sued for malpractice but not convicted. Which fact from the case would have been decisive in determining its outcome?

a.

The patient was verbally and physically combative.

b.

The nurse was being oriented to the mental health unit.

c.

The nurse has expressed a fear of the patient to the manager.

d.

The patient did not suffer any physical or any emotional harm.

ANS: D

Four elements are necessary to prove liability for malpractice: duty, negligent performance, harm to the patient, and proximate cause. If the patient sustained no harm, no tort liability exists.

DIF: Cognitive Level: Application REF: Text Page: 123

TOP: Nursing Process: N/A

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

18. A patient tried for the murder of a spouse and child was found guilty but mentally ill (GBMI). A psychiatric nurse is asked, Does that mean this patient will be walking the streets after a short hospitalization? Which reply shows the best understanding of GBMI?

a.

The patient will be hospitalized and released when no longer mentally ill.

b.

A person found guilty but mentally ill will be treated while serving the sentence.

c.

You sound as though you are angry with the way our criminal justice system works.

d.

It will depend on whether the American Law Institutes Test was applied or whether the Irresistible Impulse Test was used.

ANS: B

GBMI individuals who have committed capital crimes are never freed. They are usually held in penal institutions or maximum-security forensic psychiatric hospitals.

DIF: Cognitive Level: Application REF: Text Page: 122

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

19. The parents of a patient with schizophrenia ask whether their child is likely to become violent. The best answer the nurse can give is that the vast majority of mentally ill individuals are:

a.

somewhat more dangerous than ordinary people.

b.

definitely more violence-prone than others on the street.

c.

no more dangerous than other individuals in the population.

d.

considerably more dangerous than others in the population.

ANS: C

Studies show that the vast majority of people with serious mental illness are not inherently violent and are no more dangerous than people in the general population.

DIF: Cognitive Level: Comprehension REF: Text Page: 114

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

20. A patient signed a sales contract to purchase a new home and 1 week later was voluntarily hospitalized for treatment of depression. The sales contract is now most likely:

a.

invalid.

b.

still valid.

c.

postponed.

d.

in litigation.

ANS: B

If the patient is competent, the signed contracts are legal and binding. Depression does not necessarily render one incapable of handling personal affairs.

DIF: Cognitive Level: Application REF: Text Page: 117

TOP: Nursing Process: N/A

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

21. A patient in the process of being involuntarily committed demands to be evaluated by his own private psychiatrist. To preserve the patients rights, the treatment team must:

a.

stop the commitment process.

b.

notify the unit psychiatrist immediately.

c.

provide access to the private psychiatrist.

d.

determine why the patient is resisting staff care.

ANS: C

Patients rights include the right to consult with ones own private psychiatrist.

DIF: Cognitive Level: Application REF: Text Page: 113

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

22. A patient claims to have been denied the right to confidentiality. To best preserve the patients rights, the treatment team must:

a.

re-explain the guidelines for confidentiality to the patient.

b.

provide in-service to the units staff regarding confidentiality.

c.

educate the patient about the process required for the filing of a formal complaint.

d.

determine why the patient feels that the right to confidentiality has been denied.

ANS: C

Patients may file a formal complaint and are entitled to information regarding how to go about doing so.

DIF: Cognitive Level: Application REF: Text Pages: 118-119

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. A patient, who is homeless and known to be schizophrenic, was arrested after vandalizing parked cars while naked. Which behaviors will be considered when determining if the patient should be involuntarily committed for care? Select all that apply.

a.

The patient is a possible danger to others.

b.

The patient is a diagnosed schizophrenic.

c.

The patient is a disruptive factor to the community.

d.

The patient is unable to provide for his or her own basic needs.

e.

The patient is in need of either physical or mental health treatment.

ANS: A, D, E

The criteria for involuntary commitment include the following: the patient is dangerous to self or others, in need of physical and/or mental health treatment, and unable to provide for his or her own basic needs. One cannot be involuntarily committed based on being disruptive or for having a previous mental health diagnosis.

DIF: Cognitive Level: Analysis REF: Text Pages: 113-114

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. Which patient is apt to display violent behavior directed at others? (Select all that apply.)

a.

A patient with a history of obsessive compulsive behaviors who displays signs of severe depression after the loss of a job held for 20 years

b.

A patient who has a history of assaulting people when commanded to do so by the voices

c.

A patient who has been noncompliant with prescribed psychotropic medication and whose manic behavior has escalated

d.

A patient who has an antisocial personality disorder and who has been abusing amphetamines for 3 years

e.

A patient who was diagnosed with posttraumatic stress disorder (PTSD) who recently lost a limb in an automobile accident

ANS: B, C, D

The predictors of violence include prior violent behavior, noncompliance with medications, current substance abuse, and antisocial personality disorder.

DIF: Cognitive Level: Analysis REF: Text Page: 114

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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