Upgrade to remove ads
Only $2.99/month

Mental Health chapter 5 legal and Ethical aspects

Terms in this set (35)

Which of the following ethical principles is in jeopardy when segments of the mentally ill population do not have access to care?


a) Paternalism
b) Justice
c) Autonomy
d) Fidelity
Justice

Explanation:
Justice becomes an issue in mental health when a segment of a population does not have access to health care. Fidelity is faithfulness to obligations and duties. Autonomy is the fundamental right of self-determination. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client
A psychiatric nurse is assigned to perform observation of a client in restraints. The nurse knows that this client must be checked on how often?

a) Every 4 hours
b) Every shift
c) Constantly for the first hour
d) Every hour
Constantly for the first hour

Explanation:
A client in restraints must be observed 1:1 constantly for the first hour at which time the client must be assessed by a licensed independent practitioner.
Which court decision or act states that psychotherapists have a duty to exercise reasonable care in protecting the foreseeable victims of their clients' violent actions?

a) Tarasoff v. Regents of the University of California
b) The Mental Health Systems Act of 1980
c) The Patient Self-Determination Act
d) Public Law 99-319, The Protection and Advocacy for Mentally Ill Individuals Act of 1986
Tarasoff v. Regents of the University of California

Explanation:
In Tarasoff v. Regents of the University of California, the high court said that psychotherapists have a duty to warn the foreseeable victims of their clients' violent actions. The acts listed do not specify a duty to warn.
A client 22 years old with schizophrenia is refusing his antipsychotic medication. He states, "I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it." The nurse explains to him, "Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better." This conversation reflects a conflict between which two types of ethical principles?


a) Paternalism and veracity
b) Autonomy and beneficence
c) Autonomy and justice
d) Justice and nonmaleficence
Autonomy and beneficence

Explanation:
Ethical conflicts can occur when the client is being guided by the principle of autonomy and the nurse by the principle of beneficence. According to the principle of autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, the health care provider uses knowledge of science, and incorporates the art of caring, to develop an environment in which individuals achieve their maximal health care potential. Justice involves a duty to treat all fairly. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client. Veracity is the duty to tell the truth. Nonmaleficence is the duty to cause no harm
A client with a depression is undergoing a colonoscopy tomorrow is receiving preoperative education regarding the procedure. Which of the following nursing tasks best describes the explanation of the procedure and the associated risks and benefits?

a) Acquiring informed consent
b) Encouraging the client to be self-determined
c) Acting in a beneficent manner
d) Ascertaining the client's privacy
Acquiring informed consent

In accordance with the ethical principle of veracity, the client can only provide informed consent if the nurse applies the principle of veracity- the duty to be honest and truthful. Informing the client of the risks and benefits of a procedure is best described as obtaining informed consent. Informed consent involves the client's right of self-decision. Client privacy is defined as the right to be left alone and free from intrusion or control by the health care providers. Self-determination allows the client to indicate what treatments he would accept or refuse. Acting in a beneficent manner encompasses doing good acts by the nurse
A client with a complex medical and psychiatric history is hospitalized for the treatment of traumatic injuries that she received when she was hit by a car. The client consistently rates her pain level at 10/10, and most members of the care team suspect that she overstates her pain. Which of the following considerations should be the highest priority in the management of the client's pain?

a) Limiting the liability of the care providers
b) Relieving the client's pain
c) Verifying the client's complaints of pain
d) Preventing the risk of adverse effects of long-term opiate use
Relieving the client's pain

Explanation:
While there are many considerations and potential ethical dilemmas surrounding the assessment and treatment of pain, the ultimate priority is to effectively treat the client's pain.
A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which of the following ethical principles?

a) Veracity
b) Beneficence
c) Justice
d) Autonomy
Autonomy

Explanation:
Self-determinism can be defined as being empowered or having the free will to make moral judgments. Autonomy is the right to make one's own decisions. Personal autonomy and avoidance of dependence on others are key values of self-determinism. Veracity is truthfulness. Justice encompasses equal treatment for all. Beneficence is doing no harm
The Tarasoff decision has resulted in the mental health clinician having a responsibility to do what?

a) Mandated outpatient treatment (MOT)
b) Placement of the client in the least restrictive environment
c) A duty to warn
d) Appointment of a legal guardian
A duty to warn

Explanation:
The Tarasoff decision involves an exception to the client's right to confidentiality as being a duty to warn or inform.
As a result of the increasing severity of her delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?

a) The client's psychiatrist
b) A hospital-appointed interdisciplinary committee
c) A guardian appointed by the court
d) The client's primary nurse
A guardian appointed by the court

Explanation:
If individuals admitted to a psychiatric facility are judged to be incompetent to make decisions, the court will appoint a guardian to make decisions for them.
A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

a) Paternalism
b) Justice
c) Veracity
d) Nonmaleficence
Justice

Explanation:
Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue when some portion of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth
A client is being seen in the mental health clinic because of relapse. He has been non adherent with his medication regimen. The nurse reinforces the advantages of taking his medications. The nurse is using which of the following ethical principles?

a) Justice
b) Veracity
c) Autonomy
d) Beneficence
Beneficence

Explanation:
According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which people achieve their maximal health care potential. According to the principle of autonomy, each person has the fundamental right of self-determination. Justice is the duty to be treated fairly. Veracity is the duty to tell the truth.
Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members?

a) Extremely aggressive.
b) Danger to others.
c) Suicidal ideation.
d) Unwilling to take medications.
Danger to others.

Duty to warn refers to the responsibility of the nurse or the health care provider to warn identifiable third parties of threats made by clients. If the client is dangerous to any other member, the nurse is supposed to notify the person in danger immediately about the client's ideation. This law is not applicable to the client who has suicidal ideation, is extremely aggressive, or is unwilling to take medications. Client's confidentiality is a very strict policy that should be abided by the nurses in any other circumstances. (less)
Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who:

a) refuses to take the prescribed medication.
b) refuses to participate in the planned therapy.
c) is screaming in the street disturbing neighbors.
d) is homeless and has been diagnosed with a mental disorder.
is screaming in the street disturbing neighbors.

Explanation:
A client who is screaming in the street is more likely to be judged as a danger to himself or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy does not pose an immediate danger to oneself or others
A psychiatric nurse is assigned to perform observation of a client in restraints. The nurse knows that this client must be checked on how often?

a) Constantly for the first hour
b) Every shift
c) Every 4 hours
d) Every hour
Constantly for the first hour

Explanation:
A client in restraints must be observed 1:1 constantly for the first hour at which time the client must be assessed by a licensed independent practitioner.
In which of the cases below could the legal theory of "respondeat superior" NOT apply?

a) If the nurse made a medication error that resulted in the client's death
b) If the nurse accidentally tripped, fell on an elderly client, and broke the client's hip
c) If the nurse had contact with and hurt a client in her own home.
d) If the nurse slapped a client while running an inpatient group
If the nurse had contact with and hurt a client in her own home.

Explanation:
The nurse was not acting as an agent of a larger system in her own home.
A nurse working in a mental health facility is precepting a new graduate and explaining the types of admissions. Which of the following does the preceptor include as types of "voluntary" admission? (Select all that apply.)

a) Patients are committed by parens patriae.
b) Patients give parental consent for children to seek care.
c) Patients are committed by police authority.
d) Patients make autonomous decisions to seek care.
e) Patients are committed by a nurse.
• Patients make autonomous decisions to seek care.
• Patients give parental consent for children to seek care.

Explanation:
With voluntary admission, patients make autonomous decisions or give parents or mental health or legal guardians the authority to seek care as inpatients. Involuntary admission requires proof that the patient is dangerous to self or to others. Police power provides for those who are dangerous to self to be committed. Parens patriae power allows the state to take responsibility for those who cannot care for and are considered a danger to themselves
A nursing student is initiating a relationship with an assigned client. After meeting and spending approximately 20 minutes talking with the client, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of clients to play volleyball. The student starts to go with them but then remembers the promise to meet with the client. The student decides to forgo volleyball and talk with her client. The student's decision reflects which ethical principle?

a) Fidelity
b) Autonomy
c) Veracity
d) Beneficence
Fidelity
Explanation:
Fidelity is faithfulness to obligations and duties. It is keeping promises. Fidelity is important in establishing trusting relationships. With autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, a health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Veracity is the duty to tell the truth.
The psychiatric nurse is particularly concerned about securing informed consent for an invasive procedure from which of the following clients?

a) 60-year-old female visiting from England who experienced a panic attack
b) 21-year-old African American female with a history of both physical and sexual abuse
c) 45-year-old newly immigrated Asian male who is diagnosed with psychosis
d) 25-year-old Caucasian male who has just completed alcohol withdrawal therapy
45-year-old newly immigrated Asian male who is diagnosed with psychosis

Explanation:
Violations of the ethical principles of informed consent are committed when a consenting client is not fully informed of the details of the treatment; a 45-year-old newly immigrated Asian male who is diagnosed with psychosis may not be able to fully understand the details, due both to his disorder and his possible inability to understand the language. The other clients do not face such barriers and should be fully able to understand all information provided to them
A client who had agreed to be hospitalized for stress-related problems has decided now that she wants to leave the hospital. The mental health staff caring for her realizes that at the current time she can legally ...

a) be discharged if evaluated through administrative hearings.
b) be retained in the hospital against her will.
c) leave the hospital after giving written notice of her intent to do so.
d) leave without discussing the situation with anyone.
leave the hospital after giving written notice of her intent to do so.

Explanation:
Clients who are not dangerous to themselves or others can leave the hospital against medical advice.
Which of the following ethical principles becomes an issue in mental health when a segment of a population does not have access to health care?

a) Fidelity
b) Justice
c) Nonmaleficence
d) Veracity
Justice

Explanation:
Justice is the duty to treat all fairly, distributing the risk and benefits equally. Justice becomes an issue in mental health when a segment of a population does not have access to health care. Basic good should be distributed so the least advantaged members of society benefit. Nonmaleficence, fidelity, and veracity are not being used in this situation
The depressed client is deciding which type of treatment would be beneficial for him. The nurse would document that the client is utilizing which of the following ethical principles in this situation?

a) Beneficence
b) Veracity
c) Justice
d) Autonomy
Autonomy

Explanation:
The American Nurses Association identified four primary principles to guide ethical decisions. These principles include the client's right to autonomy, the right to beneficence (doing good) by the nurse, the right to justice or fair treatment, and the right to veracity (the truth) regarding the client's condition and treatment
A client is being seen in the mental health clinic because of relapse. He has been non adherent with his medication regimen. The nurse reinforces the advantages of taking his medications. The nurse is using which of the following ethical principles?

a) Autonomy
b) Beneficence
c) Veracity
d) Justice
Beneficence

Explanation:
According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which people achieve their maximal health care potential. According to the principle of autonomy, each person has the fundamental right of self-determination. Justice is the duty to be treated fairly. Veracity is the duty to tell the truth
A client who had agreed to be hospitalized for stress-related problems has decided now that she wants to leave the hospital. The mental health staff caring for her realizes that at the current time she can legally ...

a) be discharged if evaluated through administrative hearings.
b) be retained in the hospital against her will.
c) leave the hospital after giving written notice of her intent to do so.
d) leave without discussing the situation with anyone.
leave the hospital after giving written notice of her intent to do so.

Explanation:
Clients who are not dangerous to themselves or others can leave the hospital against medical advic
As a result of the increasing severity of her delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?

a) A hospital-appointed interdisciplinary committee
b) The client's primary nurse
c) The client's psychiatrist
d) A guardian appointed by the court
A guardian appointed by the court

Explanation:
If individuals admitted to a psychiatric facility are judged to be incompetent to make decisions, the court will appoint a guardian to make decisions for them.
A nurse working in a mental health facility is precepting a new graduate and explaining the types of admissions. Which of the following does the preceptor include as types of "voluntary" admission? (Select all that apply.)

a) Patients give parental consent for children to seek care.
b) Patients are committed by parens patriae.
c) Patients are committed by a nurse.
d) Patients are committed by police authority.
e) Patients make autonomous decisions to seek care.
• Patients make autonomous decisions to seek care.
• Patients give parental consent for children to seek care.


Explanation:
With voluntary admission, patients make autonomous decisions or give parents or mental health or legal guardians the authority to seek care as inpatients. Involuntary admission requires proof that the patient is dangerous to self or to others. Police power provides for those who are dangerous to self to be committed. Parens patriae power allows the state to take responsibility for those who cannot care for and are considered a danger to themselves.
A nurse working on a psychiatric unit receives a telephone call from the employer of one of the clients on the unit. The employer asks to be sent a copy of Mr. Murray's latest laboratory work and psychological testing results so Mr. Murray's medical records in employee health can be kept up-to-date. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate?

a) "I'll have to get the client's signed consent before we can send that information to you."
b) "Sure, give me your address, and I will see that the information is sent to you."
c) "I am unable to acknowledge whether or not a Mr. Murray is a client on this unit."
d) "I'm sorry; we're not allowed to give out that information about our client."
"I am unable to acknowledge whether or not a Mr. Murray is a client on this unit."

Explanation:
A breach of confidentiality is the release of client information without the client's consent in the absence of legal compulsion or authorization to release information. Acknowledging that Mr. Murray is a client on the unit would be such a breach. Even if the nurse explains that he or she cannot give the information without the client's consent, the explanation lets the employer know that Mr. Murray is receiving care in a psychiatric hospital.
Providing milieu therapy is an example of the use of which ethical principle?

a) Beneficence
b) Veracity
c) Autonomy
d) Fidelity
Beneficence

Explanation:
When using the ethical principle of beneficence, a health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential, as in milieu therapy. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties. According to the principle of autonomy, each person has the fundamental right of self-determination
The inappropriate use of restraints or seclusion is considered which form of intentional tort?

a) Battery
b) Assault
c) False imprisonment
d) Causation
False imprisonment

Explanation:
False imprisonment is defined as the unjustified detention of a client, such as the inappropriate use of restraint or seclusion. Battery involves harmful or unwarranted contact with the client. Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Causation occurs when a breach of duty was the direct cause of loss, damage, or injury.
Touching a client without consent is an example of which of the following?

a) Battery
b) False imprisonment
c) Assault
d) Causation

Submit your answer
Battery

Explanation:
Battery involves harmful or unwarranted contact with the client. Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. False imprisonment is defined as the unjustified detention of a client, such as the inappropriate use of restraint or seclusion. Causation occurs when a breach of duty was the direct cause of loss, damage, or injury.
Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who:

a) refuses to take the prescribed medication.
b) refuses to participate in the planned therapy.
c) is screaming in the street disturbing neighbors.
d) is homeless and has been diagnosed with a mental disorder.
is screaming in the street disturbing neighbors.

Explanation:
A client who is screaming in the street is more likely to be judged as a danger to himself or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy does not pose an immediate danger to oneself or others. (less)
A client receives a court order for commitment. Which of the following best exemplifies the concept of "least restrictive environment?"


a) Involuntary commitment to an outpatient community mental health center
b) Medication administration for sedation so the client cannot get out of bed
c) Allowing the client to make the decision about whether treatment is necessary
d) Placing the client in a locked, padded room in response to threats of self-harm
Involuntary commitment to an outpatient community mental health center

Explanation:
An example of the concept of "least restrictive environment" is the involuntary commitment of a client to an outpatient mental health center. Medications cannot be given unnecessarily, such as to keep a client in bed. An individual cannot be restrained or locked in a room unless all other "less restrictive" interventions are attempted first. Allowing the client to make decisions about treatment reflects his or her right for self-determination
Professional regulations and laws that govern nursing practice are in place for which of the following reasons?


a) To ensure that enough new nurses are always available
b) To ensure that practicing nurses have strong interpersonal skills
c) To limit the number of nurses in practice
d) To protect the safety of the public
To protect the safety of the public

Explanation:
Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.
A client comes to the emergency department (ED) with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which of the following principles is being ignored by discharging this client?

a) Veracity
b) Justice
c) Autonomy
d) None of the above
Justice

Explanation:
Justice is the duty to treat all clients fairly. It can become an ethical issue in mental health when a segment of the population does not have access to care, as in this case, in which access to inpatient care is warranted but denied. (
Which of the following are entitlements of self-determination? Select all that apply.

a) Right to participate in experimentation without informed consent
b) Right to refuse treatment during an emergency situation
c) Right to obtain other opinions
d) Right to refuse treatment
e) Right to choose other forms of treatment
• Right to refuse treatment
• Right to obtain other opinions
• Right to choose other forms of treatment

Explanation:
The right to self-determination entitles all clients to refuse treatment (except during an emergency situation), to obtain other opinions, and to choose other forms of treatment. A client has a right not to participate in experimentation in the absence of the client's informed, voluntary, written consent.
A client has been voluntarily admitted to the hospital. The nurse knows that which of the following statements is inconsistent with this type of hospitalization?

a) The client cannot be released without medical advice.
b) The client retains all of his or her rights.
c) The client can sign a written request for discharge.
d) The client has a right to leave if not a danger to self or others.
The client cannot be released without medical advice.

Explanation:
When a client is involuntarily admitted to the hospital, the client cannot be released without medical advice. The client does retain all of his rights, can sign a written request for discharge, and has a right to leave if not a danger to self or others.
THIS SET IS OFTEN IN FOLDERS WITH...