NCLEX questions for legal and ethical aspects in clinical practice

Question 1

An advanced practice nurse evaluates a patient for emergency commitment because of the likelihood the patient will do serious harm to others. Which statement best reflects the nurse’s role as patient advocate during the assessment process?

a. “Tell me about any delusions you are experiencing.”
b. “I understand you have had some difficulty today.”
c. “Tell me why you need to threaten or hurt others around you.”
d. “Threatening to hurt others will require that you be committed to the hospital.”

Answer 1

B
The advocacy role of nurses to help patients to obtain, maintain, and fully make use of mental health benefits is critical. Assessment for commitment requires data collection from the patient. This statement is the most neutral of the options given and the most open ended; therefore it will be most likely to elicit a response. It is an unfounded assumption that the patient is delusional. “Why” questions will usually elicit rationalizations from the patient. Making a statement about the resulting hospitalization is not information gathering.

Question 2

A patient was placed in restraints for 2 hours in order to help manage impulsive, destructive, unsafe behavior. Which statement made by the charge nurse during a meeting to discuss the incident shows an understanding of the need to use restraints only as a last resort?

a. “How did this situation get so out of control?”
b. “You all know that restraints are used only as a last resort.”
c. “Can anyone tell me why restraints were used on this patient?”
d. “Let’s review what exactly happened that led to the use of restrains.”

Answer 2

D
To facilitate an open, honest review of the incident that will permit learning to take place, the charge nurse must not place the staff on the defensive. Reviewing the events leading up to the patient being restrained in a nonaccusatory manner shows an understanding of proper restraint use. The other options imply the nurse manager does not believe the situation was handled in an appropriate way.

Question 3

The nurse is explaining the advantage of advanced directives to a patient diagnosed with schizophrenia. Which psychiatric outcome is a result of such preplanning?

a. Allows healthcare providers to manage the patient’s mental health care
b. Decreases the possibility that the patient will be committed involuntarily
c. Directly impacts the type of care the patient will receive as the disease progresses
d. Assures that the patient will retain continued autonomy and independence of living

Answer 3

B
The implementation of psychiatric advance directives significantly decreases involuntary commitments. Healthcare management and treatments are not affected by psychiatric advanced directives. The patient’s continued autonomy and independence is more related to the condition not the directives.

Question 4

A patient is being treated in the inpatient unit for paranoid delusions that his wife is unfaithful resulting in threats to “get her for this whenever I get out.” Which intervention to assure his wife’s safety will his primary therapist include in the discharge plan?

a. Sharing the threats he has made with his wife
b. Requiring mandatory day hospital attendance
c. Advising the patient that he needs continued outpatient services
d. Informing the patient of the consequences of harming his wife

Answer 4

A
The Tarasoff ruling established the necessity for a mental health professional treating a patient who threatens to harm another individual to warn the person against whom the threat is made. The remaining options are not directly related to affecting his wife’s safety

Question 5

A patient who has schizoaffective disorder is being treated with lithium carbonate. He repeatedly resists his medication based on his fine hand tremors as proof of drug poisoning. Which nursing intervention addresses both the patient’s need to comply with treatment and patient rights?

a. Informing staff that the patient is exhibiting manipulative behavior
b. Providing the patient with effective education regarding medication side effects
c. Assuring the patient the tremors are a result of the disorder, not of the medication
d. Providing an assessment to determine if the patient is exhibiting paranoia as well

Answer 5

B
Although the patient has a legal right to refuse medication, medication compliance is vital to successful treatment. Patient and family medication education by nurses and a reassuring therapeutic relationship will greatly assist with medication adherence while preserving the patient’s rights. Identifying manipulative behavior or paranoia does not address compliance or patient rights. The assurance about the tremors is not true.

Question 6

A patient diagnosed with schizophrenia is hospitalized under an emergency commitment. Which nursing explanation is most effective when the patient asks, “Why am I being kept here?”

a. “The court believed you needed mental health care.”
b. “Your mental condition became unstable and you relapsed.”
c. “You couldn’t stop doing things that could likely have hurt you.”
d. “I’d suggest that you exercise your patient right to speak to a lawyer.”

Answer 6

C
When the effects of the patient’s mental illness result in an immediate risk of self-harm or harm to others, an emergency commitment is appropriate. While it is correct that such a commitment is court ordered and may be a result of a relapse, these options do not appropriately respond to the patient’s question. The patient does have a right to a lawyer, but this option fails to answer the patient’s question as well.

Question 7

A patient has been hospitalized and is now being mandated outpatient mental health treatment as a condition for discharge. Which intervention best addresses the nurse’s role of patient advocate when this patient resists the recommendation?

a. Helping the patient identify advantages of outpatient versus inpatient therapy
b. Sharing that outpatient therapy is less expensive than inpatient hospitalization
c. Stressing that outpatient therapy can minimize the need for future hospitalization
d. Discussing the patient’s opposition to outpatient treatment with the treatment team

Answer 7

C
The purpose of mandating outpatient mental health treatment is to break the cyclic pattern of patients who, when discharged from an inpatient treatment facility, subsequently require readmission to the acute psychiatric care setting. While the other options reflect the nurse as advocate, they do not best address this patient’s situation.

Question 8

A patient admitted for treatment of symptoms related to paranoid schizophrenia refuses to sign a consent form allowing the nurse to discuss any aspect of his hospitalization with his parents. Which statement by the nurse best respects the patient’s rights while providing effective care?

a. Reminding the parents that, “I can’t discuss your son even though I want to.”
b. Asking the patient to, “please talk with me about why you don’t trust your parents?”
c. Telling the patient that, “Keeping your parents uninvolved in your care is very painful for them.”
d. Telling the parents that, “While I can’t discuss his care with you, you can tell me anything you think I need to know.”

Answer 8

D
This option provides the family the ability to communicate important medical or behavioral history to the treatment facility without the nurse releasing any information about the patient without that patient’s permission. It is inappropriate for the nurse to express such personal feelings about the patient’s wishes. Challenging the patient’s decision in these manners does not fulfill the nurse’s role as advocate.

Question 9

Electroconvulsive therapy (ECT) has been prescribed for a patient diagnosed with chronic depression. Which statement by the patient helps assure the nurse that the patient’s right to informed consent has been respected?

a. “ECT treatment will cure my depression.”
b. “ECT is dangerous but I’m almost out of treatments.”
c. “I may not remember things that happened just before the ECT treatment.”
d. “I’m likely to permanently lose memory of things like dates and numbers.”

Answer 9

C
A potential side effect is memory loss that is usually temporary but that can rarely be irreversible. It is not true that ECT either cures depression or that the treatment is considered physically dangerous

Question 10

A 15-year-old who shows poor impulse control and resistance to authority is prescribed outpatient therapy. The parents are insistent that the treatment include commitment to an inpatient facility. Which response by the nurse best supports the outpatient treatment modality?

a. “Your child has a right to receive treatment in the least restrictive manner.”
b. “Outpatient therapy is better accepted by teens that are authority resistant.”
c. “This form of treatment is less expensive and usually covered by insurance.”
d. “Short-term therapy like this is usually done in an outpatient environment setting.”

Answer 10

A
An important concept related to the location and nature of mental health treatment is the concept of the least restrictive alternative; this involves providing mental health treatment in the least restrictive environment with the use of the least restrictive treatment. The remaining options do not reflect the criteria upon which appropriate care is based upon.

Question 11

A patient, who has been charged with assault with intent to commit murder, has been hallucinating. Which question when answered correctly by the patient would show competency to stand trial for the crime?

a. “Can you describe your hallucinations?”
b. “Were you ever sexually abused as a child?”
c. “Can you describe for me the charges against you?”
d. “Can you explain why you wanted to assault your brother?”

Answer 11

C
Competency to stand trial is a narrow concept based on the person’s awareness of the legal process and the understanding of the criminal charges. The remaining options are concerned with the individual’s symptoms, past experience, and motives rather than his ability to understand the legal processes

Question 12

A patient diagnosed with paranoid schizophrenia has been charged with murder. The patient’s mother asks, “What will happen if my son is found not guilty by reason of insanity?” Which response shows that the nurse understands the outcome of this plea?

a. “Your son will not receive the death penalty.”
b. “He will receive the mental treatment he deserves.”
c. “The court will order that he be involuntary committed for treatment.”
d. “He is considered innocent and will be released to the care of his physician.”

Answer 12

C
After a person is found not guilty by reason of insanity, he or she is usually hospitalized and sent to a psychiatric unit for evaluation of commitability. Although they have been found not guilty, they have committed a criminal act and that will require appropriate punishment

Question 13

After the nurse discovered a medication error had been made, the patient was carefully observed and effectively treated for symptoms of a headache. What element of malpractice is most critical in determining the nurse’s liability?

a. The nurse owed a legal duty to the patient.
b. The nurse breached the recognized duty.
c. The patient suffered harm as a result of the act.
d. The harm was a direct result of the nursing act.

Answer 13

D
Malpractice cannot be established unless the nurse’s action was the direct cause of the observed injury. A headache is not generally seen as an outcome of such a medication error. The remaining options reflect elements that are already recognized as being true

Question 14

Upon voluntary admission, the nurse will ensure that the patient’s rights are preserved. Which interventions are directly related to a patient’s civil right? Select all that apply.

a. Arranging for the patient to vote in city election by absentee ballot
b. Respecting the patient’s right to refuse a dose of a prescribed medication
c. Arranging for the patient to have a private area in which to visit with friends
d. Deferring to a patient’s expressed wish to “not share a room with anyone else”
e. Changing the assignment because a patient “doesn’t like” a particular staff member

Answer 14

A, B, C
When individuals enter a mental health facility, they usually retain their civil rights, unless such rights are clearly restricted via the use of due process to certify that an individual lacks the capacity or competence to have them. These individuals retain the right to vote, refuse medication, and to have visitors. A private room and selecting of staff are not civil rights that all patients are entitled to

Question 15

Which nursing interventions are required by The Joint Commission (TJC) when the decision is made that a patient will benefit from the use of physical restraints? Select all that apply.

a. The patient’s family is telephoned and told that restraints were applied.
b. The restraints are removed when the patient agrees to cooperate with staff.
c. A staff member is assigned to sit next to the patient until the restraints are removed
d. The nurse provides the patient with a timetable that identifies when the restraints will be removed.
e. The nurse notifies the patient’s mental health care provider that a face-to-face assessment is needed

Answer 15

A, C, D
The Joint Commission (TJC) standards require that the patient’s family and legal representatives be notified when restraints are used, and the licensed independent practitioner (LIP) is required to assess the patient within 1 hour of the application of the restraints. The staff is also now required to perform continuous in-person observation of any patient in restraints for the duration of the restraint procedure. The criteria for removal of the restraints is not based exclusively on the patient’s stated willingness to cooperate or is the nurse required to provide the patient with a specific time when the restraints will be removed

Question 16

Privileged communication is a legal concept that in some states protects the confidentiality of the nurse-patient relationship. Which information is not protected by this statute? Select all that apply.

a. A threat to “kill that man if he even thinks about leaving me”
b. The patient’s admission to having a sexually transmitted disease
c. The fact that a patient knows who was responsible for her brutal rape
d. The discussion about how the patient sold his prescription drugs to friends
e. Suspicion by the nurse that the patient has been physically abused by a spouse

Answer 16

A, B, E
Privileged communication allows certain information given to professionals by patients to remain secret during any litigation. These statutes exclude the mandatory reporting of violence against a child, an older adult, an impaired adult, and (in some instances) a domestic partner; some communicable diseases that affect public safety; and information that will prevent a felony (e.g., murder) from occurring. Only the patient can give the information regarding her rape and the privilege prevents the nurse from sharing information such as illegal selling of drugs to be used against the patient in a court of law.

Question 17

Which statement helps assure the nurse that the patient has an understanding of how their health information is managed to assure their right to confidentiality? Select all that apply.

a. “I had to sign a paper saying my information could be released.”
b. “My records will be released to only people who really need to know.”
c. “All the doctors will have access to my medical records when I’m here.”
d. “No one can see my information unless I say it’s okay for them to see it.”
e. “My insurance company will get what they need in order to cover the bill.”

Answer 17

A, B, D, E
At the time of admission to a mental health facility, admission staff often request that patients sign a release-of-information document. The release of information usually includes the information that will be released; the persons or parties that the information will be shared with, such as other health care providers and insurance providers; the purpose of the release of the information; and the period of time during which the information will be released. Only the professionals who are involved with the care will have access to the patient’s medical records

Question 18

A chronically depressed patient has been asked to participate in a research project focusing on effectiveness of alternative therapies. The nurse determines that the patient has an appropriate understanding of the guidelines that directs a research project when he states (select all that apply):

a. “I hope they find a treatment that doesn’t involve drugs.”
b. “I plan to use all the money I get to pay off some of my bills.”
c. “Helping to find a treatment for depressed people is a good thing.”
d. “My doctor told me that I had a responsibility to get involved in this.”
e. “I’m confident that this research project has very little risk involved.”

Answer 18

A, C, E
Guidelines for informed consent require that the patient understands the purpose of the research, any risks and possible discomforts to the subject, and possible benefits to the individual or to others. It is most important to note that the research is voluntary and that it clearly reflects autonomy on the participants’ part. Research subjects seldom receive payment for their involvement in the project

Question 19

Which actions show the nurse has an understanding of the role documentation plays in minimizing the risk of malpractice? Select all that apply.

a. Including patient quotes to document subjective symptomology
b. Supporting documentation with personal opinions of the patient’s behaviors
c. Being mindful to use correct spelling and punctuation in the documentation
d. Using common abbreviations in order to keep documentation brief and concise
e. Documenting the nursing evaluation of the patient’s understanding of all instructions

Answer 19

A, C, E
Adequate and legible documentation is the best means of defense against a lawsuit and the best way to validate that the nurse adhered to their scope of practice and to a safe standard of care. It is important to be specific and to document symptoms by writing in quotes how the patient expresses them. The reliability of the documentation is in question if spelling and punctuation is neglected. Documentation of all patient outcomes shows affective nursing care. Documentation should not include personal opinions or abbreviations not approved by the health care facility.

Question 20

What actions by a nurse identify an understanding of the nursing responsibility to treat the patient with consideration to the ethical component of beneficence? Select all that apply.

a. Frequently self-reflecting on whether the nursing interventions are actually helping the patient
b. Evaluating whether the intervention is causing the patient unacceptable levels of anxiety or pain
c. Recognizing that the moral rule of primum non nocere does not apply to the mentally ill patient
d. Being willing to influence the patient in making decisions concerning the need for unpleasant treatments
e. Consistently setting boundaries to effectively deflect a patient’s inappropriate sexually-oriented behaviors

Answer 20

A, B, E
Individuals who work in the health care field have a special duty and responsibility to act in a manner that is going to benefit rather than harm patients. The term beneficence refers to bringing about good. Self-reflection concerning interventions and frequent evaluation of the effects of treatment on the patient is critical to beneficent care. Maintaining a therapeutic environment by providing an appropriate nurse-patient relationship is a vital component to fulfilling the obligation to act in a beneficent manner. The moral rule of primum non nocere (“first do no harm”) is vital in clinical interventions with persons with mental illnesses. The nurse should not influence patient decisions but rather provide information to support an educated decision whenever possible