6 (Legal & Ethical Guidelines)

Question 1

You are working on an inpatient psychiatric unit and caring for Elizabeth, who is becoming agitated. You speak with Elizabeth one to one in a private setting, find out the reason for the agitation, and then assist Elizabeth with ways to calm down, possibly including prn medication to prevent further escalation of Elizabeth’s agitation, which could lead to seclusion and/or restraints. You are making care decisions based on:

a. ) writ of habeas corpus.
b. ) least restrictive alternative doctrine.
c. ) veracity.
d. ) bioethics.

Answer 1

b.) least restrictive alternative doctrine.

Least restrictive alternative doctrine is described as using the least drastic means of achieving a specific goal. By doing the actions described you are possibly preventing the more restrictive setting of seclusion and/or restraints.

Writ of habeas corpus is a legal term meaning a written order “to free the person.”

Veracity is one of the five ethical principles or guidelines. Bioethics refers to ethics in a health care setting.

Question 2

Which of the following patients may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)?

a. ) 37-year-old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn’t agree and wishes to be discharged
b. ) 75-year-old patient with dementia who demands to be allowed to go back to his own home
c. ) 21-year-old actively suicidal patient on the psychiatric unit who wants to be discharged to home and do outpatient counseling
d. ) 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

Answer 2

a.) 37-year-old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn’t agree and wishes to be discharged

Against medical advice discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others.

The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA.

A patient who wishes to stay in the hospital can make that decision; a family member’s opinion doesn’t impact an AMA discharge.

Question 3

Sophie, aged 27 years, has a diagnosis of paranoid schizophrenia. She stopped taking her medications and believes that she is to be taken by the aliens to live with them on another planet. She was observed walking through traffic on a busy road, and then was found climbing the railing on a bridge, to “be ready for them to take me in their ship.” Sophie is hospitalized. During your shift she begins running up and down the halls, banging her head on the walls, and yelling, “Get them out of my head!” On what basis can Sophie be medicated against her will?

a. ) If Sophie has taken the medication in the past and has had no adverse effects
b. ) If Sophie may cause imminent harm to herself or others
c. ) If Sophie still has the capacity to make an informed decision regarding medication
d. ) If Sophie is provided education regarding the medication before administration of the medication

Answer 3

b.) If Sophie may cause imminent harm to herself or others

A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient’s will.

Question 4

Jonas is a 29-year-old patient with anxiety and a history of alcohol abuse who is an inpatient on the psychiatric unit. He becomes angry and aggressive, strikes another patient, and then attacks a staff member. He is taken to seclusion and medicated with haloperidol and lorazepam. In this case, the haloperidol and lorazepam may be considered:

a. ) a restraint.
b. ) a medication time-out.
c. ) false imprisonment.
d. ) malpractice.

Answer 4

a.) a restraint.

Chemical restraints are defined by those medications or doses of medication that are not being used for the patient’s condition.

Medication time-out is incorrect; false imprisonment and malpractice refer to specific legal terms that do not have any bearing on this medication scenario.

Question 5

Which of the following scenarios describe a HIPAA violation?

a. ) Janie, the ED nurse, gives report to Amanda, a nurse on the intensive care unit, regarding Joel, who is being admitted.
b. ) Mark, a nurse on the medical-surgical floor, calls his patient’s primary care provider to obtain a list of current medications.
c. ) Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step-down unit, regarding the patient Lyla, who will be transferring, while they are walking in the hospital hallway.
d. ) Tony, a nurse on the psychiatric unit, gives discharge information to the counseling office where his patient will be going to outpatient treatment after discharge.

Answer 5

c.) Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step-down unit, regarding the patient Lyla, who will be transferring, while they are walking in the hospital hallway.

Discussing a patient’s information in public places where it may be overheard is a violation of a patient’s confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team.

Question 6

The intervention that will be most effective in preventing a nurse from making decisions that will lead to legal difficulties is

a. ) asking a peer to review nursing intervention related decisions.
b. ) balancing the rights of the client and the rights of society.
c. ) maintaining currency in state laws affecting nursing practice.
d. ) seeking value clarification about fundamental ethical principles.

Answer 6

c.) maintaining currency in state laws affecting nursing practice.

Each nurse’s practice is governed by the Nurse Practice Act of the state in which the nurse practices. The nurse should always be aware of its provisions.

Question 7

Which ethical principle refers to the individual’s right to make his or her own decisions?

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

Answer 7

b.) Autonomy

Autonomy refers to self-determination, or the right to make one’s own decisions.

Question 8

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse’s behavior has violated the ethical principle of

a. ) autonomy.
b. ) veracity.
c. ) fidelity.
d. ) justice.

Answer 8

c.) fidelity.

Fidelity refers to being “true” or faithful to one’s obligations to the client.

Client abandonment would be a violation of fidelity.

Question 9

If a client with psychiatric illness is determined to be incompetent to make decisions affecting his care

a. ) Staff members are required to use their best judgment when defining care.
b. ) No treatment other than custodial care can be provided.
c. ) The court appoints a guardian to make decisions on his behalf.
d. ) The doctrine of least restrictive alternative is null and void.

Answer 9

c.) The court appoints a guardian to make decisions on his behalf.

An incompetent client is unable to make legal decisions that would affect his care, such as consenting to surgery. A court-appointed guardian functions on behalf of the client.

Question 10

Which statement is true regarding mail sent to an involuntarily admitted client residing on a psychiatric inpatient unit?

a. ) The client can receive mail from only family and legal sources.
b. ) Mail must first be opened and inspected by staff.
c. ) Receipt of mail is considered a privilege accorded the client for compliance.
d. ) Mail is a form of social interaction and so receiving mail is a client’s civil right.

Answer 10

d.) Mail is a form of social interaction and so receiving mail is a client’s civil right.

The client’s civil rights are intact, despite hospitalization. The right to communicate with those outside the hospital is ensured.

Question 11

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents

a. ) assault.
b. ) battery.
c. ) defamation.
d. ) invasion of privacy.

Answer 11

b.) battery.

Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.

Question 12

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual?

a. ) Confidentiality is now reserved to the immediate family.
b. ) Only HIV status continues to be protected and privileged.
c. ) Nothing may be disclosed that would have been kept confidential before death.
d. ) The nurse must confer with the next of kin before divulging confidential, sensitive information.

Answer 12

c.) Nothing may be disclosed that would have been kept confidential before death.

Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive.

Question 13

Which right of the client has been violated if he is medicated without being asked for his permission?

a. ) Right to dignity and respect
b. ) Right to treatment
c. ) Right to informed consent
d. ) Right to refuse treatment

Answer 13

c.) Right to informed consent

Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication.

The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated.

Question 14

A nurse is adequately representing the stated bioethical principle when valuing

a. ) autonomy by respecting a client’s right to decide to refuse cancer treatment.
b. ) justice by staying with a client who is suicidal.
c. ) fidelity by informing the client about the negative side effects of a proposed treatment.
d. ) beneficence when advocating for a client’s right to enter into a clinical trial for a new medication.

Answer 14

a.) autonomy by respecting a client’s right to decide to refuse cancer treatment.

Autonomy refers to self-determination.

Self-determination can be exercised when one makes his or her own decisions without interference from others.

Question 15

What ethical principle is supported when a nurse witnesses the informed consent for electroconvulsive therapy from a depressed client?

a. ) Beneficence
b. ) Autonomy
c. ) Justice
d. ) Fidelity

Answer 15

b.) Autonomy

Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one’s care.

Question 16

The charge nurse shares with the psychiatric technician that negligence of a patient

a. ) is an act or failure to act in a way that a responsible employee would act.
b. ) applies only when the client is abandoned or mistreated.
c. ) is an action that puts the client in fear of being harmed by the employee.
d. ) means the employee has given malicious false information about the client.

Answer 16

a.) is an act or failure to act in a way that a responsible employee would act.

Behaving as a wise and prudent person would act under the same circumstances is one way of judging whether the standard of care has been violated. Employers typically hope that staff will prevent clients from striking each other.

Question 17

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between the ethical principles of

a. ) autonomy and beneficence.
b. ) advocacy and confidentiality.
c. ) veracity and fidelity.
d. ) justice and humanism.

Answer 17

a.) autonomy and beneficence.

Autonomy refers to self-determination and beneficence refers to doing good.

When a client is restrained or secluded, the need to do good and prevent harm outweighs the client’s autonomy.

Question 18

What assumption can be made about the client who has been admitted on an involuntary basis?

a. ) The client can be discharged from the unit on demand.
b. ) For the first 48 hours, the client can be given medication over objection.
c. ) The client has agreed to fully participate in treatment and care planning.
d. ) The client is a danger to self or others or unable to meet basic needs.

Answer 18

d.) The client is a danger to self or others or unable to meet basic needs.

Involuntary admission implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently.

Question 19

When the nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rules, the correct assumption is that the client was admitted

a. ) per legal requirements.
b. ) for a non-emergency.
c. ) voluntarily.
d. ) involuntarily.

Answer 19

c.) voluntarily.

Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules.

Question 20

A client reports to the nurse that once he’s released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take?

a. ) None, because no explicit threat has been made.
b. ) Ask the client if he is threathening his wife.
c. ) Call the client’s wife and report the threat.
d. ) Report the incident to the client’s therapist and document.

Answer 20

d.) Report the incident to the client’s therapist and document.

The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made.

Question 21

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced

a. ) battery.
b. ) defamation of character.
c. ) false imprisonment.
d. ) assault.

Answer 21

c.) false imprisonment.

False imprisonment is the arbitrary holding of a client against his or her will.

When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons.