Chapter 3 Flashcards
A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get drunk. The client’s friends see nothing wrong with their drinking habits. The client states that he was taught by his parents and agrees that underage drinking is not acceptable. Also, he has never seen his parents drunk; therefore, he refuses to drink with his friends. Which mode of transmission best describes how this client’s particular value was formed?
a. Moralizing
b. Modeling
c. Reward-punishment
d. Laissez-faire
ANS: B
Modeling best describes how the teenage client developed this value because his parents not only discussed this issue but behaved in a way for the teen to copy. Moralizing sets standards of right and wrong with no choices allowed; the reward-punishment model rewards valued behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction or direction on choices.
A female client becomes combative when the nurse attempts to administer routine medications. The nurse would like to ignore the client but chooses to talk with the client to calm her. The nurse is successful in calming the client, and the client takes her medications. What process best describes how the nurse decided on the course of action taken?
a. Values clarification
b. Nurse’s rights
c. Beliefs
d. Morals
ANS: A
Values clarification consists of the steps of choosing, prizing, and acting. This most accurately describes how the nurse made the proper decision. The nurse chose the best action, reaffirmed the choice, and then enacted the choice. The nurse’s rights were not violated, and beliefs and morals do not describe the entire decision-making process that occurred.
Twenty-three states have enacted mental health parity laws. The most accurate description of these laws is that they require insurance companies to:
a. Include coverage for mental illness
b. Include coverage for substance abuse treatment
c. Include coverage for mental illness that is equal to coverage for physical illness
d. Include coverage for outpatient therapy for individuals with substance abuse
ANS: C
The mental health parity laws require insurance companies to include coverage for mental illness that is equal to coverage for physical illness. Only nine states include treatment for substance abuse in their parity laws.
The client is feeling very anxious and has requested that a p.r.n. antianxiety medication be ordered. The nurse informs the client that the medication can be administered only every 4 hours and was given 3 hours ago. The nurse promises to give the client the medication as soon as it is due, but the nurse goes to lunch 1 hour later without giving the client the medication. Which ethical principle did the nurse violate?
a. Fidelity
b. Veracity
c. Confidentiality
d. Justice
ANS: A
Fidelity refers to the obligation to keep one’s word. The nurse violated this principle in this situation, which leads to mistrust from the client. Veracity is the duty to tell the truth, confidentiality is the duty of keeping the client’s information private, and justice indicates that all clients must be treated fairly, equally, and respectfully.
A male client is seeking help in a mental health clinic for anger management problems. He voices that he is fearful that his wife may divorce him because of his anger problem, and he is willing to do “whatever it takes” to control his anger. Later in the week, the client’s wife also seeks assistance because she is going to divorce her husband. The nurse who is caring for both of these clients tries to decide the correct action to take. The nurse is experiencing:
a. A moral dilemma
b. Value clarification
c. An ethical conflict (or dilemma)
d. A breach of confidentiality
ANS: C
This is an example of an ethical conflict or ethical dilemma. The nurse wants to help both clients but must maintain confidentiality for each. Use of guidelines for ethical decision making can assist the nurse in making an ethical decision. A moral dilemma is simply a dilemma associated with making a decision between right and wrong. Value clarification is a process that helps to identify an individual’s values.
The psychiatrist asks the nurse to perform a procedure that she is not familiar with, and the nurse is unsure whether this is something within the scope of practice. Where can the nurse find the answer to her question?
a. National nurse practice act
b. State nurse practice act
c. Regional nurse practice act
d. Community nurse practice act
ANS: B
Each state’s board of nursing determines the scope of practice in that state through a series of regulations that are called nurse practice acts. It is the nurse’s responsibility to know his or her scope of practice. The other options do not exist.
An order written by a physician is reviewed by the nursing staff, and no one is familiar with the treatment instructions. A nurse who was recently hired knows that this treatment is covered by the state’s nurse practice act. What is the nurse’s best course of action?
a. Call the physician to ask for clarification
b. Check the state’s nurse practice act again
c. Contact the nursing supervisor for approval to carry out the treatment
d. Refer to the facility’s policy and procedure to determine the course of action
ANS: D
Because this treatment is covered under the state’s nurse practice act, the next step is to refer to the facility’s policy and procedure manual to determine whether the ordered treatment is allowed by the facility. Calling the physician is not necessary because there was no question about how the order was written, and the state’s nurse practice act has already been checked. Contacting the nursing supervisor would be acceptable only after the facility’s policy has been checked.
Standards of nursing practice for mental health can best be described as helping to ensure:
a. That certain clients receive care
b. Quality and effectiveness of care
c. Proper documentation
d. Proper medication administration
ANS: B
Most health care disciplines have standards of practice documented as guidelines with measurable criteria that can be used to evaluate the quality and effectiveness of care provided. All clients have the right to receive care, so standards of nursing practice would not address who receives care. Although proper documentation and proper medication administration might be part of the evaluation process, they do not provide complete evaluation of quality and effectiveness of care.
If a client is involuntarily committed to a mental health care facility indefinitely, the law requires that the case must be reviewed every:
a. 3 months
b. 6 months
c. 12 months
d. 15 months
ANS: C
Although the case is being reviewed constantly by the mental health care team, the court must review the indefinite commitment on a yearly basis.
A male client is being argumentative during a group therapy session. The psychiatric technician warns the client that if he does not cooperate with the nurse, he will be physically restrained and taken to his room for the remainder of the day. For which action could the technician be held liable?
a. Assault
b. Battery
c. Privacy
d. Fraud
ANS: A
The technician is engaging in assault, which is any act that threatens a client. Battery of a client occurs when any physical act of touching occurs without the client’s permission. Privacy refers to issues related to the body and confidentiality, and fraud is giving false information.
Which of the following circumstances, when it occurs on an inpatient mental health unit, would be considered false imprisonment?
A. An alert and oriented client is confined to his room after being loud and argumentative with another client in the recreation area.
B. Restraints are placed on a client who has been admitted in a lethargic state because of misuse of medications and who has fallen three times since admission.
C. A client is housed in a private room with visual monitors after attempting suicide at home on the previous day.
D. An alert and oriented client who was admitted for a 72-hour involuntary commitment is prevented from leaving the facility 2 days after admission.
ANS: A
The client cannot be confined to his room if he did not pose a threat to himself or others, or if no contract was made with the client regarding consequences for inappropriate behavior. All of the other options are appropriate because they follow guidelines for client safety.
The nurse often assists in the process of obtaining informed consent from the client for treatment and/or procedures. Who has the responsibility of providing information to the client so he can give informed consent?
a. Social worker
b. Nurse
c. Physician
d. Facility’s legal representative
ANS: C
The physician is responsible for providing the client with the information necessary to give informed consent, including expectations and risks involved. The nurse can assist by obtaining the written documentation necessary for informed consent.
An important responsibility of the nurse in a mental health facility is to ensure that clients do not __________ from the facility without a discharge order, by carefully supervising and accurately documenting client behaviors and therapeutic actions.
a. Escape
b. Abandon
c. Flee
d. Elope
ANS: D
The appropriate terminology used when a client runs away from a facility without a discharge order is elopement. In the event of elopement, the caregiver can be held liable if a client becomes injured.
If a female client tells the nurse of extensive plans she has to harm the girlfriend of her ex-husband, what is the nurse’s best action?
a. Try to talk with the client to convince her not to harm the girlfriend
b. Have the client sign a contract with you stating that she will not harm the girlfriend
c. Inform the ex-husband of the intentions of the client
d. Inform the girlfriend of the intentions of the client
ANS: D
Health care providers have a duty to warn others when serious harm may occur as the result of actions taken by the client. This does not breach confidentiality because providers have an obligation to protect the public as well as the client. In addition to warning the client, the nurse should inform the client’s physician and the nursing supervisor and must document the situation and actions taken. The other options are not adequate to meet the duty to warn or to prevent harm to the girlfriend.
A female client asks the nurse if the medication risperidone (Risperdal), an antipsychotic medication for schizophrenia, has any side effects. Which response by the nurse would violate the ethical concept of veracity?
a. “I am not sure, but I will find out.”
b. “Risperdal has no documented side effects.”
c. “Risperdal does have some side effects.”
d. “Let’s talk to your physician effects.”about potential side
ANS: B
The ethical concept of veracity refers to the duty of being truthful with the client, within the scope of one’s practice. Stating that the drug has no side effects is not a truthful statement because the medication does have side effects.
