Chapter 6

Question 1

Which action by a psychiatric nurse best applies the ethical principle of autonomy?

a. Exploring alternative solutions with the client, who then makes a choice.
b. Suggesting that two clients who were fighting be restricted to the unit.
c. Intervening when a self-mutilating client attempts to harm self.
d. Staying with a client demonstrating a high level of anxiety.

Answer 1

a. Exploring alternative solutions with the client, who then makes a choice.

Question 2

A nurse finds a psychiatric advance directive in the medical record of a client currently experiencing psychosis. The directive was executed during a period when the client was stable and competent. What is the appropriate nursing action?

a. review the directive with the client to ensure it is current.
b. ensure that the directive is respected in treatment planning.
c. consider the directive only if there is a cardiac or respiratory arrest.
d. encourage the client to revise the directive in light of the current health problem.

Answer 2

b. ensure that the directive is respected in treatment planning.

Question 3

Two hospitalized clients 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 clients to be secluded to keep them from injuring each other. What would be the outcome of this assertion?

a. reinforcement of the autonomy of the two clients.
b. violation of the civil rights of both clients.
c. commission of an intentional tort of battery.
d. Correct placement on emphasis on safety.

Answer 3

b. violation of the civil rights of both clients.

Question 4

In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by using restraint to prevent one client from self-mutilation, while the care plan for another self-mutilating client requires one-on-one supervision.” Which ethical principle most clearly applies to this situation?

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

Answer 4

d. Justice

Question 5

Which scenario best demonstrates an example of a tort?

a. The plan of care for a client is not completed within 24 hours of the client’s admission.
b. A nurse gives a prn dose of an antipsychotic drug to an agitated client because the unit is short-staffed.
c. An advanced practice nurse recommends hospitalization for a client who is dangerous to self and others.
d. A client’s admission status changed from involuntary to voluntary after the client’s hallucinations subside.

Answer 5

b. A nurse gives a prn dose of an antipsychotic drug to an agitated client because the unit is short-staffed.

Question 6

What is the legal significance of a nurse’s action when a client verbally refuses medication and the nurse gives the medication over the client’s objection?

a. Negligence
b. Malpractice
c. Standard of care.
d. Battery.

Answer 6

d. Battery.

Question 7

Which nursing intervention demonstrates false imprisonment?

a. A confused and combative client says, “I’m getting out of here, and no one can stop me.” The nurse restrains this client without a health care provider’s order and then promptly obtains an order.
b. A client has been irritating and attention seeking much of the day. A nurse escorts the client down the hall saying, “Stay in your room, or you’ll be put in seclusion.”
c. An involuntarily hospitalized client with suicidal ideation runs out of the psychiatric unit. The nurse rushes after the client and convinces the client to return to the unit.
d. An involuntarily hospitalized client with homicidal ideation attempts to leave the facility. A nurse calls the security team and uses established protocols to prevent the client from leaving.

Answer 7

b. A client has been irritating and attention seeking much of the day. A nurse escorts the client down the hall saying, “Stay in your room, or you’ll be put in seclusion.”

Question 8

Which client meets criteria for involuntary hospitalization for psychiatric treatment?

a. The client who is noncompliant with the treatment regimen.
b. The client who fraudulently files for bankruptcy.
c. The client who sold and distributed illegal drugs.
d. The client who threatens to harm self and others.

Answer 8

d. The client who threatens to harm self and others.

Question 9

A nurse prepares to administer a scheduled intramuscular (IM) injection of an antipsychotic medication to an out-patient diagnosed with schizophrenia. As the nurse swabs the site, the client shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.” What is the nurse’s best action?

a. Assemble other staff for a show of force and proceed with the injection, using restraint if necessary.
b. Stop the medication administration procedure and say to the client, “Tell me more about the side effects you’ve been having.”
c. Proceed with the injection but explain to the client that there are medications that will help reduce the unpleasant side effects.
d. Say to the client, “Since I’ve already drawn the medication in the syringe, I’m required to give it, but let’s talk to the doctor about delaying next month’s dose.”

Answer 9

b. Stop the medication administration procedure and say to the client, “Tell me more about the side effects you’ve been having.”

Question 10

Which understanding about the relationship between substandard institutional policies and individual nursing practice should guide nursing practice?

a. Agency policies do not exempt an individual nurse of responsibility to practice according to professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
c. Faced with substandard policies, a nurse has a responsibility to inform the supervisor and discontinue client care immediately.
d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.

Answer 10

a. Agency policies do not exempt an individual nurse of responsibility to practice according to professional standards of nursing care.

Question 11

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

a. Medical director
b. Hospital
c. Profession
d. Client

Answer 11

d. Client

Question 12

Which action by a nurse constitutes a breach of a client’s right to privacy?

a. Documenting the client’s daily behavior during hospitalization
b. Releasing information to the client’s employer without consent
c. Discussing the client’s history with other staff during care planning
d. Asking family to share information about a client’s pre-hospitalization behavior

Answer 12

b. Releasing information to the client’s employer without consent

Question 13

An adolescent hospitalized after a violent physical outburst tells the nurse, “I’m going to kill my father, but you can’t tell anyone.” What is the nurse’s best response?

a. “You are right. Federal law requires me to keep clinical information private.”
b. “I am obligated to share that information with the treatment team.”
c. “Those kinds of thoughts will make your hospitalization longer.”
d. “You should share this thought with your psychiatrist.”

Answer 13

b. “I am obligated to share that information with the treatment team.”

Question 14

A voluntarily hospitalized client tells the nurse, “Get me the forms for discharge. I want to leave now.” What is the nurse’s best response?

a. “I will get the forms for you right now and bring them to your room.”
b. “Since you signed your consent for treatment, you may leave if you desire.”
c. “I will get them for you, but let’s talk about your decision to leave treatment.”
d. “I cannot give you those forms without your health care provider’s permission.”

Answer 14

c. “I will get them for you, but let’s talk about your decision to leave treatment.”

Question 15

When private insurance will not pay for continued private hospitalization of a mentally ill client, he family considers transferring the client to a public hospital but expresses concern that the client will not get any treatment if transferred. What is the nurse’s most helpful reply?

a. “By law, treatment must be provided. Hospitalization without treatment violates clients’ rights.”
b. “All clients in public hospitals have the right to choose both a primary therapist and a primary nurse.”
c. “You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety.”
d. “Much will depend on other clients, because the right to treatment for a psychotic client takes precedence over the right to treatment of a client who is stable.”

Answer 15

a. “By law, treatment must be provided. Hospitalization without treatment violates clients’ rights.”

Question 16

Which behavior demonstrated by an individual diagnosed with mental illness may require emergency or involuntary admission?

a. Resuming the use of heroin while still taking naltrexone.
b. Reports hearing angels playing harps during thunderstorms.
c. Not keeping an outpatient appointment with the mental health nurse.
d. Throwing a heavy plate at a waiter at the direction of command hallucinations.

Answer 16

d. Throwing a heavy plate at a waiter at the direction of command hallucinations.

Question 17

A client in alcohol rehabilitation reveals to the nurse, “I feel terrible guilt for sexually abusing my 6-year-old before I was
admitted.” What is the nurse’s most appropriate, initial action?

a. Reporting the abuse to the local child protection agency.
b. Reply, “I’m glad you feel comfortable talking to me about it.”
c. File a written report with the agency’s ethics committee.
d. Respect nurse–client relationship confidentiality.

Answer 17

a. Reporting the abuse to the local child protection agency.

Question 18

A family member of a client with delusions of persecution asks the nurse, “Are there any circumstances under which the treatment team is justified in violating a client’s right to confidentiality?” What is the nurse’s best response?’

a. Under no circumstances.
b. At the discretion of the psychiatrist.
c. When questions are asked by law enforcement.
d. If the client threatens the life of another person.

Answer 18

d. If the client threatens the life of another person.

Question 19

A new antidepressant is prescribed for an elderly client diagnosed with major depressive disorder, but the dose is more than the usual geriatric dose. What action should the nurse take?

a. Consult a reliable drug reference
b. Teach the client about possible side effects and adverse effects.
c. Withhold the medication and confer with the health care provider.
d. Encourage the client to increase oral fluids to reduce drug concentration

Answer 19

c. Withhold the medication and confer with the health care provider.

Question 20

A client diagnosed with schizophrenia believes a local minister has stirred evil spirits and threatens to bomb a local church. The psychiatrist notifies the minister based on what rationale?

a. The psychiatrist may release information at their discretion.
b. The psychiatrist demonstrated the duty to warn and protect.
c. The psychiatrist has no obligation concerning the client’s confidentiality.
d. The psychiatrist is immune from charges of malpractice.

Answer 20

b. The psychiatrist demonstrated the duty to warn and protect.

Question 21

A client experiencing psychosis became aggressive, struck another client, and so required seclusion. What is the best
documentation regarding this situation?

a. Client struck another client who attempted to leave day room to go to bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two clients away from each other for 24 hours.

b. Seclusion ordered by primary health care provider at 1415 after command hallucinations told the client to hit another client. Careful monitoring of client maintained during period of seclusion.

c. Seclusion ordered by Dr. Smith for aggressive behavior. Begun at 1415. Maintained for 2 hours without incident. Outcome: Client calmer and apologized for outburst.

d. Client pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 client yelled, “I’ll punch anyone who gets near me,” and struck another client with fist. Physically placed in seclusion at 1420. Seclusion order obtained from Dr. Smith at 1430.

Answer 21

d. Client pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 client yelled, “I’ll punch anyone who gets near me,” and struck another
client with fist. Physically placed in seclusion at 1420. Seclusion order obtained from Dr. Smith at 1430.

Question 22

A person in the community asks, “Why aren’t people with mental illness kept in state institutions anymore?” What is the nurse’s best response?

a. “Less restrictive settings are available now to care for individuals with mental illness.”
b. “There are fewer persons with mental illness, so less hospital beds are needed.”
c. “Most people with mental illness are still in psychiatric institutions.”
d. “Psychiatric institutions violated clients’ rights.”

Answer 22

a. “Less restrictive settings are available now to care for individuals with mental illness.”

Question 23

A client experiencing psychosis asks a psychiatric technician, “What’s the matter with me?” The technician replies, “Nothing is wrong with you. You just need to use some self-control.” On what basis should the nurse who overheard the exchange should take action?

a. The technician’s unauthorized disclosure of confidential clinical information.
b. Violation of the client’s right to be treated with dignity and respect.
c. The nurse’s obligation to report caregiver negligence.
d. The client’s right to social interaction.

Answer 23

a. The technician’s unauthorized disclosure of confidential clinical information.

Question 24

Which documentation of a client’s behavior best demonstrates a nurse’s observations?

a. Isolates self from others. Frequently fell asleep during group. Vital signs stable.
b. Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking.
c. Appeared to hallucinate. Frequently increased volume on television, causing conflict with others.
d. Wore four layers of clothing. States, “I need protection from evil bacteria trying to pierce my skin.”

Answer 24

d. Wore four layers of clothing. States, “I need protection from evil bacteria trying to pierce my skin.”

Question 25

After leaving work, a nurse realizes documentation of administration of a prn medication was omitted. This off-duty nurse telephones the nurse on duty and says, “Please document administration of the medication for me. My password is alpha1.” What action should the nurse receiving the call take?

a. Fulfill the request promptly.
b. Document the caller’s password.
c. Refer the matter to the charge nurse to resolve.
d. Report the request to the client’s health care provider.

Answer 25

c. Refer the matter to the charge nurse to resolve.

Question 26

Which individual diagnosed with a mental illness may need involuntary hospitalization?

a. The individual who has a panic attack after her child gets lost in a shopping mall.
b. The individual who with visions of demons emerging from cemetery plots throughout the community.
c. The individual who takes 38 acetaminophen tablets after the person’s stock portfolio becomes worthless.
d. The individual diagnosed with major depression who stops taking prescribed antidepressant medication.

Answer 26

c. The individual who takes 38 acetaminophen tablets after the person’s stock portfolio becomes worthless.

Question 27

An aide in a psychiatric hospital says to the nurse, “We don’t have time every day to help each client complete a menu selection. Let’s tell dietary to prepare popular choices and send them to our unit.” What is the nurse’s best response?

a. “Thanks for the suggestion, I’ll pass that along to nursing administration.”
b. “Thanks for the idea, but it’s important to treat clients as individuals. Giving choices is one way we can respect clients’ individuality.”
c. “Thank you for the suggestion, but the clients’ bill of rights requires us to allow clients to select their own diet.”
d. “Thank you. That is a very good idea. It will make meal preparation easier for the dietary department.”

Answer 27

b. “Thanks for the idea, but it’s important to treat clients as individuals. Giving choices is one way we can respect clients’ individuality.”

Question 28

In order to release information to another health care facility or third party regarding a client diagnosed with a mental illness, the nurse must take what action?

a. Obtain a signed consent by the client for release of information stating specific information to be released.
b. Secure a verbal consent for information release from the client and the client’s guardian or next of kin.
c. Get permission from members of the health care team who participate in treatment planning.
d. Secure approval from the attending psychiatrist to authorize the release of information.

Answer 28

a. Obtain a signed consent by the client for release of information stating specific information to be released.

Question 29

In which situations would a nurse have the duty to intervene and report? (Select all that apply.)

a. A peer has difficulty writing measurable outcomes.
b. A health care provider gives a telephone order for medication.
c. A peer tries to provide client care in an alcohol-impaired state.
d. A team member violates relationship boundaries with a client.
e. A client refuses medication prescribed by a licensed health care provider.

Answer 29

c. A peer tries to provide client care in an alcohol-impaired state.
d. A team member violates relationship boundaries with a client.

Question 30

Which action by the nurse violates the civil rights of a psychiatric client? The nurse (Select all that apply.)

a. performs mouth checks after overhearing a client say, “I’ve been spitting out my medication.”
b. begins suicide precautions before a client is assessed by the health care provider.
c. opens and reads a letter a client left at the nurse’s station to be mailed.
d. places a client’s expensive watch in the hospital business office safe.
e. restrains a client who uses profanity when speaking to the nurse.

Answer 30

c. opens and reads a letter a client left at the nurse’s station to be mailed.
e. restrains a client who uses profanity when speaking to the nurse.