TERM 3- MY NOTES MENTAL HEALTH NURSING CARE CH.2 "ETHICAL AND LEGAL ISSUES" Flashcards
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ETHICS IN NuRSING
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ETHICAL AND LEGAL ISSUES
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Ethics is the science relating to moral principles or standards that govern conduct. It is the body of knowledge that answers the question: “All things considered, what is the right thing to do in a given situation?” Nurses work with ethical issues every day.
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B)false
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All things considered, what is the right thing to do in a given situation is called
A)ethics
B)values
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Personal Values
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Nurses muse understand their own values before they make decisions related to professional ethics.
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B)false
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Values are personal beliefs abom the worrh of an idea, object, or behavior.
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B)false
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Values are an individual’s decisions about what is right, what is wrong, and what is most important.
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B)false
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People are often passionate on the subject of values.
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B)false
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It is values (such as patriotism, freedom, justice, equality, religion) that make people go To war, or march against it. People are often willing to fight or even die for their values.
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B)false
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Personal values can affect a nurse’s behavior at work.
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B)false
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A nurse who values self-sufficiency very highly may prioritize the care of an independent client over that of a client who has quadriplegia.
A nurse who puts a high value on physical appearance may answer the call lights of attractive clients first.
These nurses may not know why they behave this way unless they clarify their values for themselves.
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B)false
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Values clarification is a process of self-discovery in which people identify their own values and prioritize them. When nurses clearly understand their own attitudes about right and wrong, it is easier for them to decide on ethical professional behavior.
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B)false
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The process of values clarification has three steps:
l. Choosing from alternatives which values to hold
2. Prizing the chosen values, which means making a public commitment to the values (such as with bumper stickers, symbolic jewelry, tattoos, telling people, etc.)
3. Acting on the chosen values
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Integrity means acting on one’s values. If a person values honesty and acts consistently in an honest way, this person is said to have integrity.
If this person says he values honesty, but acts in a consistently dishonest way, he is acting with hypocrisy (behavior contrary to seated values).
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B)false
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Some personal values (such as racism) are not acceptable anywhere in rhe practice of nursing.
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B)false
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In the nursing profession, the rights of all clients to nursing care are more important than an individual nurse’s right to act according to her own values. This nurse will either need to work in a different area of the hospital or reexamine her decision to exclude certain clients from her care.
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B)false
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A person who has personal values that require excluding groups of people from nursing care should consider other career options.
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B)false
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Nurses do not need to agree wirh the behavior or values of their clients. In fact, they often disagree. However, nurses must provide care to people with respect for their human dignity and regardless of their personal attributes
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B)false
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Codes of Ethics for Nurses
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The American Nurses Association (2001) has established an ethical guide for the entire nursing profession, the Code of Ethics for Nurses. Notice that the code provides principles and guidelines, but no specific directions for nursing interventions.
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B)false
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Professional ethical codes must be general in order to cover the variety of situations in which they will be used.
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B)false
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The ethics of the profession evolve over time as societal attitudes and sociological circumstances change.
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B)false
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The Code was first written in 1950
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B)false
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The National Federation of Licensed Practical Nurses (NFLPN) ;
The organization has standards for education, legal/ethical status, practice, continuing education, and specialized nursing practice for Licensed Pracrical/Vocarional Nurses
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American Nurses Association Code of Ethics for Nurses
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1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with all other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
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Legal/Ethical Standards for the Licensed Practical/Vocational Nurse
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The Licensed Practical/Vocational Nurse:
1. Shall hold a current license to practice nursing as an LP/VN in accordance with the law of the state wherein employed.
2. Shall know the scope of nursing practice authorized by the Nursing Practice Act in the state wherein employed.
3. Shall have a personal commitment to fulfill the legal responsibilities inherent in good nursing practice.
4. Shall take responsible actions in situations wherein there is unprofessional conduct by a peer or other health care provider.
5. Shall recognize and have a commitment to meet the ethical and moral obligations of the practice of nursing.
6. Shall not accept or perform professional responsibilities which the individual knows (s)he is not competent to perform.
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Standards of Care
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Standards of nursing care are the ethical and legal expectations for practice; they are the level of work quality considered adequate by the profession.
A)true
B)false
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Society expects that nurses will use at least ordinary and reasonable care to see that no unnecessary harm comes to the client. When there is a question about a nurse's care, the nurse's actions can be compared with professional standards.
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B)false
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These internal standards often consist of written policies and procedures for doing nursing tasks. Nurses are held responsible for knowing and following the policies and procedures of their employer.
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B)false
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There are also external standards, which are set by state and national organizations. State boards of nursing, professional nursing organizations such as the ANA and the NFLPN, and the federal government all provide external standards. Nurses are expected to know about and adhere ro these standards.
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B)false
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Ethical Principles
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Ethical principles provide a basis for discussion and ethical decision making. These principles may be used alone, but are usually used in combination wirh each other
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B)false
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The seven ethical principles most pertinent to nursing are:
* Justice. Justice means that people have the right to be treated equally and fairly. All resources available for health care should be distributed equally to people.
* Beneficence. Beneficence means to do good for others. This is the foundation for most nursing actions: doing good.
* Nonmaleficence. Nonmaleficence means doing no harm. Health care providers should not harm their clients either intentionally or unintentionally
* Autonomy: Autonomy involves personal freedom and self-determination. It is the right to choose what will happen to oneself.
* Paternalism: Paternalism allows someone to act "in the best interest" of other people, making decisions for others when they lack the full information or ability on which to base decisions
* Veracity: Veracity means truth telling. This principle says that the whole truth should always be told.
* Fidelity. Fidelity means keeping promises. When you are loyal you keep your promises.
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Beneficence is the foundation for most nursing actions: doing good.
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B)false
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ETHICAL DILEMMAS
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An ethical dilemma exists when there are conflicting moral alternatives to consider for action. In an ethical dilemma, some evidence exists that a particular course of action may be right, and some evidence exists that it may be wrong.
A)true
B)false
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ETHICAL DECISION MAKING
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In the healthcare culture in the United States, the client's autonomy is highly valued. If a client is old enough to make legal decisions (the age varies by scare), has not been declared legally incompetent by a court of law, or has not had a legal guardian appointed, the client is considered the decision maker in medical treatment situations
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B)false
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beneficence (doing good)
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B)false
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paternalism (knowing better for clients than they know for themselves)
A)true
B)false
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So, what good are nurses if we can't make clients do anything, you might ask. Clients don't need nurses to force them to act in a healthy way. Nurses create a relationship with their clients. In the nurse-client relationship we foster trust and we reach clients what they need to know so they can make informed decisions for themselves.
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B)false
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We care for clients, reach them, and advocate for them. We do not have to approve of their behavior or ideas, we just care, reach, and advocate. The only behavior we can control is our own.
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B)false
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LEGAL AsPECTS OF MENTAL HEALTH NuRSING
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Although the ethical principles of nursing care protect the rights of clients, the law protects the needs of society. The legal context of care concerns the rights of clients and the quality of care they receive.
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B)false
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Types of Law
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Two types of law apply most directly to nurses. They are sracutory law, which is law that is passed by a legislative body, and common law, which is derived from previous court decisions.
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B)false
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Both statutory and common laws have civil and criminal components.
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B)false
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Civil law protects private and property rights.
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B)false
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Torts are violations of civil law in which an individual has been wronged. Malpractice is a tort.
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B)false
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Criminal law protects people from conduct injurious to the public welfare and provides for punishmem of people who break these laws
A)true
B)false
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Statutory Law is Passed by a legislative body
A)true
B)false
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Common Law is Derived from previous court cases
A)true
B)false
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Civil Law Protects private and property rights
A)true
B)false
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Criminal Law ;Protects people from conduce injurious to the public welfare and provides punishment for people who break these laws
A)true
B)false
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Torts are Violations of civil law in which an individual has been wronged
A)true
B)false
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Intentional tort is an Assault, Battery, False imprisonment and Abandonment
A)true
B)false
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Unintentional tort is an Malpractice and Negligence
A)true
B)false
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Nurse Practice Acts
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The legal definitions and scope of practice of registered and practical/vocational nurses are in each state's nurse practice act. These are statutory law (enacted by the state legislatures).
A)true
B)false
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It is important for nurses to understand the extent of their responsibilities when they practice nursing in their state
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B)false
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These laws vary from one state to another. They usually include:
* Definitions of nursing and the various types of nurses
* Requirements for educational preparation for each type of nursing
* Conditions for revoking a license
* A statement about the state agency (the Stare Board of Nursing) that has jurisdiction over nurses
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Psychiatric Hospitalization
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Voluntary admission for mental illness treatment is similar to medical hospitalization. The client signs a routine form requesting admission to the hospital and may leave at any time. Ideally, all treatment should be on a voluntary basis. However, mental illnesses are sometimes characterized by symptoms that make it impossible for affected clients to understand their condition or need for treatment.
A)true
B)false
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Involuntary admission, or commitment, means that the client is hospitalized without the individual's consent. The rules regulating involuntary commitment are based on state laws and vary among the states
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B)false
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The basic criteria for involuntary commitment to psychiatric treatment facilities usually include that the client muse be mentally ill and (as a result of this mental illness) be:
* Dangerous to self or others
* In need of treatment
* Unable to provide for own basic needs
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An emergency psychiatric hospitalization is indicated when a person appears to be dangerous to self or others and refuses treatment. States can allow a brief (2- to 5-day) involuntary hospitalization for further evaluation and allow time for a court hearing on determining the need for a longer commitment
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B)false
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The states usually require that by the time the emergency hospitalization period has elapsed, mental health providers (usually psychiatrists) must petition the court for an extended commitment if they decide that the client needs further treatment. This extended involuntary hospitalization is called civil commitment.
A)true
B)false
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Civil commitmencs may vary in length of time, but may not last more than 1 year. If a client's condition improves during the commitment period, the client may be discharged.
A)true
B)false
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OUTPATIENT COMMITMENT
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Outpatient commitment is a court order requiring the mentally ill person to take medication and to comply with a treatment plan as a condition of release from the hospital.
A)true
B)false
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Outparient commitment reduces rehospitalization, increases client compliance with medication, and decreases violence. However, outpatient commitment is not available in all states
A)true
B)false
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CONDITIONAL RELEASE
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Conditional release is another type of involuntary commitment available in some states. In this system, the committed client is released from the hospital on the condition that he or she participate in treatment in the community. This can be a day treatment or medication management program. A client who fails to comply with the conditions is rehospitalized.
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B)false
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Legal Rights for Mental Health Clients
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People with mental illnesses are vulnerable to abuse and mistreatment. To protect the mentally ill, the U.S. Congress passed the Mental Health Systems Act of 1980, which passed into law the Universal Bill of Rights for Mental Health Patients.
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B)false
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CIVIL RIGHTS
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People who are voluntarily hospitalized for mental health treatment retain all their civil rights. Clients have the right go vote, hold office, conduct business, hold licenses, and practice their professions. States may abridge the rights of people who are committed. In some states, committed clients retain all their civil rights, including the right to refuse treatment.
A)true
B)false
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Right to Least Restrictive Treatment Alternative
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As stated in the Bill of Rights for Mental Health Patients, people have the right to the least restrictive alternative (treatment that restricts their personal freedom as little as possible). Treatment settings include community outpatient clinics, foster care homes, respire care, day treatment programs, home health care, and a variety of levels of inpatient care.
A)true
B)false
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Restraint and Seclusion
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In psychiatry, "restraints·refers to leather or other secure restraining devices on all extremities and around the body of the client to prevent the client from harming self or others
A)true
B)false
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Cliems in psychiarric settings have been injured and even killed by restraints.
A)true
B)false
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Restraints may never be used for the convenience of the staff or to punish the client.
A)true
B)false
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Other less restrictive alternatives must be attempted to decrease the client's agitation before restraints are considered. less restrictive approaches include redirecting the client to his room or away from a stressful situation, talking with the client, and intervening with medications.
A)true
B)false
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In psychiatry, seclusion means that the client is confined in a room alone. The seclusion room is usually furnished only with a bed or mattress for safety.
A)true
B)false
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Seclusion is a type of restraint. A physician must order restraints and seclusion, except in an emergency situation. Even in an emergency the physician must be consulted and provide an order for the restraint as soon as possible.
A)true
B)false
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It can be a stressful, frightening, and powerless experience to be restrained. Clients who have experienced being controlled in leather restraints reponed feeling vulnerable, helpless, coerced, and dehumanized.
A)true
B)false
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In a study of clients' experiences with restraints in psychiatric emergency situations, clients were asked how they would prefer to be created if they were unable to control their behavior. The vast majority (around 70%) said that they would prefer to be treated with medications, some would prefer seclusion (around 20%), and few would prefer restraint (around 10%)
A)true
B)false
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Clienrs must be assessed every 15 minutes while they are restrained
A)true
B)false
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Restraints are only used in behavioral emergencies when safety of the client or others is at risk.
A)true
B)false
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Clients have been injured and even killed by restraints
A)true
B)false
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Universal Bill of Rights for Mental Health Patients·
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The mental health patient has:
1. The right to appropriate treatment and related services in a setting that is most supportive of personal liberty, restricting liberty only as needed for treatment and legal requirements.
2. The right to an individualized written treatment plan; the right to treatment based on the plan; and the right to periodic review and revision of the plan, including a plan for treatment after discharge.
3. The right to ongoing participation in planning mental health services, consistent with the person's capabilities.
4. The right to receive an explanation that the patient can understand of the nature and risks of treatment, the reasons a treatment is considered, any alternative treatments, and reasons for limitation of certain visitors.
5. The right to informed, voluntary, written consent for treatment except in an emergency situation.
6. The right not to be involved in experimentation without informed, voluntary, written consent.
7. The right to freedom from restraint or seclusion except in an emergency situation.
8. The right to a humane treatment that provides reasonable protection from harm and appropriate privacy.
9. The right to access to own mental health care records.
10. The right, when admitted to an inpatient unit, to converse with others privately, to have access to telephone and mail, and to see visitors, unless contraindicated by the patient's condition.
11 . The right to be informed promptly and in writing of these rights at the time of admission.
12. The right to assert grievances if these rights are infringed.
13. The right to exercise these rights without reprisal.
14. The right of referral to other providers.
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Competency
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Competency is a legal assessment that a person is able to make reasonable judgments and decisions. A person who is cognitively able to understand the information given in the consent process is considered competent for the purpose of medical care.
A)true
B)false
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Competency is an important concept because it is a foundation of the legal rights of people with mental illnesses. A competency verdict determines whether a person is capable of making informed decisions to consent or to refuse treatment.
A)true
B)false
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Clients who are committed to psychiatric hospitalization are assumed to be competent and therefore maintain their civil rights
A)true
B)false
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Incompetence must be determined by a court. It refers to the inability to make judgmems and be responsible for one's own decisions. A court ruling of incompetence deprives the person of some rights such as voting, entering into contracts, and driving.
A)true
B)false
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Competency to stand trial is a different issue. This assessment determines whether the person is capable of understanding the significance and consequences of his/her actions, whether this person understands what is right and wrong, and if the person can assist a lawyer in his/her defense.
A)true
B)false
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RIGHTTO INFORMED CONSENT
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Clienrs have the right to freedom from potentially hazardous treatment unless they give informed consent.
A)true
B)false
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Informed consent means that the physician has explained the treatment in terms the client fully understands (including the potential outcomes and the likely outcome without treatment) and that the client agrees and permits the treatment. Clients may also change their minds and stop a treatment that has already been started.
A)true
B)false
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Before consenting to treatment, the client should understand:
* The diagnosis
* The description and purpose of the proposed treatment
* The risks and benefits of the treatment
* The alternatives to this treatment (including doing nothing) and their risks and benefits
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Nurses may witness the client's signature on a consent form. They may help answer the client's questions. However, informed consent itself is the physician's responsibility.
A)true
B)false
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If the client has been deemed mentally incompetent, the legal guardian may give consent for treatment. If the client has severe symptoms (such as psychosis) and is unable to understand treatment but has no guardian, the client's nearest relative may be consulted. It is also possible for the physician to ask the court to appoint a guardian.
A)true
B)false
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RIGHT TO REFUSE TREATMENT
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A nurse can be charged with battery for touching a client in the of treatment that the client refuses. Threatening to force treatment may constitute assault.
A)true
B)false
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Ultimately, competent clients who are voluntarily admitted or committed involuntarily have the right to refuse medications. When an emergency occurs and the client is a danger to self or others, clients may be medicated against their will if professional judgement is used and due process guidelines are followed.
A)true
B)false
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A trusting nurse-client relationship may decrease the likelihood that forced medication will be necessary.
A)true
B)false
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RIGHT TO CONFIDENTIALITY
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Nurses are responsible for protecting clients' right to confidentiality (limits on access to information about a client).
A)true
B)false
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Only those within the inner circle of confidentiality may have access to treatment information about the client without the d
Clients written consent
-client
-members of treatment team
-supervisors of staff
-directly involved healthcare students and faculty
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There are a few exceptions to the confidentiality rule. The most notable is those who fall within the Tarasoff rule. In the Tarasoff case, a client informed his psychologist that he planned to kill a young woman. The psychologist informed the police, but neither informed the woman, who was later murdered by the client. Her parents successfully sued the psychologist and others for failure to warn.
A)true
B)false
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The Tarasoff rule, or Tarasoff duty to warn, requires healrhcare providers to assess the violence potential of their clients, and if specific victims are in imminent danger, to take some form of protective action.
A)true
B)false
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Other situations when a nurse may give client information to a third party without the clients consent are emergency situations for client care, court-ordered requests for information, child abuse proceedings, commitment proceedings, and reports required by law (such as communicable diseases, child abuse, or gunshot wounds)
A)true
B)false
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RIGHT TO KEEP PERSONAL ITEMS
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People who are in a hospital, nursing home, foster care home, or other treatment facility retain the right to keep their personal possessions. Certain items of safety concern (such as guns, knives, scissors, g lass bottles, or lighters) may be held in a secure place until the client's discharge, but they continue to be the property of the client.
A)true
B)false
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Americans with Disabilities Act
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The Americans with Disabilities Act of 1990 (ADA) makes it unlawful to discriminate in employment against a qualified person with a mental or physical disability. The ADA defines an individual with a disability as a person who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment.
A)true
B)false
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Employers select the most qualified applicants for jobs, and if the most qualified applicant has a disability, the employer must accommodate that employee if reasonably possible. A history of mental illness cannot be used to deny a person employment.
A)true
B)false
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Advance Care Directives
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Advance directives are instructions from clients, documented when they are well, about what should be done in situations when they are unable to speak for themselves.
A)true
B)false
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Advance directives include documents such as living wills or powers of arrorney for health care. They relate ro end-of-life decisions or healthcare decisions when a person is incapacitated
A)true
B)false
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Nurse's Responsibility in Documentation
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The first is documenting the administration of medications. When a nurse decides to administer a p.r.n. psychotropic medication (a drug affecting the mind), it is imporrant to document the situation and the assessment findings that led to the decision to give the medication. This documenrarion should include the client behavior (including verbal statements) and less restrictive treatment alternatives tried before medication was given (such as talking to the client or redirecting the clienc to his/her room for a less stimulating environment). The clients' response to all p.r.n. medications should be documented.
A)true
B)false
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The client's symptoms and how the client responds to the medication should be documented on a regular basis. The client's side effects and adverse drug reactions should also be documented. In the mental health care setting, clients often have difficulty explaining their side effects to the physician. Thus, it is especially important for the nurse to assess for and document these effects, to improve the quality of medication management.
A)true
B)false
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Nurses should pay special concern to clients at risk for suicide. These clients require frequent assessment of mental status. These assessments should be carefully documented to show changes in status that might indicate attend toward increased risk.
A)true
B)false
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Behavior indicates the severity of the client's disease process and response to treatment. The nurse must describe the behavior clearly, concisely, and specifically, without judgment. For example, It would be appropriate to chart: "The client was offered juice and refused. He was pacing and yelling and was asked to go to his room. He stared 'the demons are after me."'
A)true
B)false
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Nursing documentation in the mental healrhcare setting and elsewhere should be:
• Clear
• Concise (keep ir complete bur simple)
• Accurate
• Specific
• Descriptive
• Legible (penmanship is a communication issue)
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Malpractice
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Malpractice is the failure of a professional person to act according to accepted professional standards, or failure to act as a reasonable member of the profession would act.
A)true
B)false
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In order for nursing malpractice to exist all of the following conditions must be present:
l . The nurse must have a duty to the client, which is established by the person being a client in a treatment facility where the nurse works.
2. There must be a breach of duty. A standard of care is not followed.
3. Foreseeability. The client's injury must be a reasonable. expectation under the circumstances of the nurse's action.
4. Injury '· The client must be injured or harmed.
5. Causation. The injury to the client must be caused by the nurse's breach of duty.
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CASE EXAMPLE
A client in a mental healthcare setting was showing the following behavior: pacing, irritability, clenched fists, and loud talking. The nurse asked him how he was feeling and he yelled "None of your business!"The nurse looked at his chart and found a physician's order for a medication p.r.n. for agitation. The nurse asked the client if he was agitated and he said "No!"The nurse decided not to give the p.r.n. medication and went to work on charting. Meanwhile the client struck and injured another client. Was the injury to the second client the result of malpractice by the nurse? Review the tests for malpractice:
I. Did the nurse have a duty to the injured client? (Yes, even if he was not her assigned client.)
2. Did the nurse breach her duty? (Yes, protection from injury is a basic standard of care.)
3. Was the client's injury foreseeable? (Yes. The nurse did not need to be able to predict the future to see that the first client was becoming agitated. Agitated people are less able to control their impulses and are more likely to act out violently.)
4. Was the client injured? (Yes. He suffered a bruise on his head when the agitated client hit him with a book.)
5. Was the injury caused by the nurse's failure to intervene with the agitated client? (Yes. The nurse could have redirected the agitated client to his room. If that did not work she could have medicated him.)
6. Did malpractice occur? (Yes. The injured client may or may not take this case to court, but the nurse reasonably could have protected the injured client from harm.)
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The best way for nurses to avoid malpractice is to know the standards of care and the scope of nursing practice for the states where they work and to adhere to those standards.
A)true
B)false
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Finally, and most important, the nurse should put the client's well-being first and develop a trusting nurse client relationship
A)true
B)false
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Standards of Culturally Appropriate Care
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CULTURAL PULSE POINTS
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National Standards for Culturally and Linguistically Appropriate Services in Health Care
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* Ensure that clients receive effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.
* Recruit, retain, and promote a diverse staff and leadership that are representative of the people served by the organization.
* Provide ongoing education in culturally and linguistically appropriate service delivery to all staff.
* Provide language assistance including bilingual staff and interpreter service at no cost to all clients with limited English proficiency at all hours and points of contact.
* Provide written information in the client's native language about the right to receive language assistance services.
* Ensure the competence of language assistance. Family and friends should not be used to interpret, except on request by the client.
* Make written information and signs available in the commonly used languages of clients represented in the service area.
* Have a comprehensive plan for providing culturally and linguistically appropriate services.
* Collect information about clients' race, ethnicity, and spoken and written languages and keep it updated.
* Maintain a demographic, cultural, and epidemiological profile of the community served, as well as a needs profile.
* Involve the community in creating programs for culturally and linguistically appropriate services.
* Ensure that conflict and grievance procedures are sensitive to cultural and language issues, and capable of resolving crosscultural conflicts or client complaints.
* Make information available to the public about their progress and innovations in implementing these standards.
True
143
KEYTERMS
,
144
Beneficence is promoting good for others
A)true
B)false
A
145
Civil commitment is involuntary hospitalization
A)true
B)false
A
146
Competency is legal assessment that a person is able to make reasonable judgements and decisions
A)true
B)false
A
147
Competency to stand trail- is the ability of a person to understand the significance and consequences of his/her actions, to understand what is right or wrong, to assist a lawyer in his/her defense
A)true
B)false
A
148
Fidelity means faithfulness, and keeping promises
A)true
B)false
A
149
Least restrictive alternative-treatment that restricts personal freedom as little as possible
A)true
B)false
A
150
Nonmaleficence means doing no harm
A)true
B)false
A
151
Outpatient commitment means court order requiring the mentally ill person to take medications and to comply with the individual treatment plan as a condition of release from the hospital
A)true
B)false
A
152
Paternalism means acting "in the best interest" of other people, making decision for others
A)true
B)false
A
153
Standards of nursing care means ethical and legal expectations for practice; they are the level of work quality considered adequate by the profession
A)true
B)false
A
154
Veracity means truth telling
A)true
B)false
A
155
KEY Points
,
156
Through values clarification nurses can understand themselves better and avoid inflicting their personal biases on clients
A)true
B)false
A
157
* Clients make their own decisions about treatment options and health behavior; nurses support the client through the decision-making process.
* Clients can be treated voluntarily or committed involuntarily to mental health treatment.
* Mentally ill clients have a variety of rights. Hospitals and nurses must honor them.
* Mental health clients maintain their civil rights.
* For nursing malpractice to exist, the nurse must have a duty to the client, the nurse must breach that duty, the client must be harmed as a result, and the potential of the injury must have been foreseeable.
* The nurse may be charged with assault and battery for threatening to or actually forcing treatment on a client who refuses it.
* Documentation of the nursing process is important in mental health nursing
True key points of this chapter
158
NCLEX PREP
,
159
Which of the following statements about ethical decision making is true for the nurse?
1. Intuition is not an acceptable way for the novice nurse to make ethical decisions.
2. The nurse's personal value system should not enter into ethical decision making.
3. The client's personal value system should not enter into ethical decision making.
4. Ethical decisions should be based strictly on the duty of the nurse with no other areas of concern considered.
1
160
Which principle of healthcare ethics is being violated in the following scenario? A client has told the nurse that he no longer wants to receive chemotherapy for his cancer and the nurse insists that he continue.
1. Beneficence
2. Justice
3. Paternalism
4. Autonomy
4
161
Making sure that the nurse follows good hand washing technique when caring for clients is following the ethical principle of:
1. Nonmaleficence.
2. Autonomy.
3. Justice.
4. Paternalism.
1
162
Family members of a depressed client asks the nurse whether or not they should go to court and have the client declared mentally
incompetent. The best response by the nurse would be:
1. "This is none of my concern. It's all up to you."
2. "I think this is unfair to the client. She is not incompetent."
3. "Let's talk about why you think this is the best option."
4. "I don't think I'm the best person to ask."
3
163
Which of the following would be a legal reason for an involuntary admission or commitment of client to a psychiatric facility?
1. The client has not been taking his antipsychotic medications as prescribed on an outpatient basis.
2. The client has threatened suicide and describes his plan to the nurse.
3. The client tells the nurse she has been hearing voices.
4. The client cannot pay her rent and has no place to live
2
164
A client is pacing the halls, muttering and shaking his fist at other clients. The best first response by the nurse would be to:
1. Call his physician and get an immediate order to place the patient in leather restraints.
2. Call for assistance from other staff to hold the client while the nurse administers an IM tranquilizer.
3. Approach the client cautiously. Talk to him quietly and try to find the source of the behavior.
4. Assist the client to a seclusion room until the behavior passes
3
165
A nurse is caring for a severely psychotic client who is scheduled for electroshock therapy. The patient has not been declared
legally incompetent but does not understand the treatment. The physician should:
1. Consult with the client's nearest relative to obtain permission for the treatment.
2. Not proceed with the treatment until the client is competent enough to agree.
3. Proceed with the treatment regardless of permission.
4. Explain the procedure to the client anyway making sure he covers the expected outcomes and possible complications.
1
166
A physician has ordered a Phospho-soda enema for a client prior to a diagnostic test and the client tells the nurse he does not want
it. The nurse goes ahead and gives the enema. This can result in the
nurse being charged with:
1. Negligence.
2. Battery.
3. Assault.
4. Malpractice.
2
167
The nurse has attempted to administer a PO antipsychotic medication to a client who is threatening to kill anyone who comes close.
He refuses to take it and his behavior is escalating. The best action for the nurse to take next is to:
1. Have several staff members overpower him and put him in restraints.
2. Call for the hospital security guards to contact the local police to take him to jail until he"calms down."
3. Call for staff assistance to restrain him while the nurse administers an IM antipsychotic medication.
4. Do nothing. Avoid going close to the client, and keep other clients away from him as well.
3
168
A client's minister tells the nurse that he is representing the client's family who wants him to ask about the client's condition and when he might be getting released. The best response by the nurse would be:
1. "I don't know when the client will be released. We will let the family know when that has been decided."
2. "If his family wants to know that, they will have to ask themselves."
3. "I am not at liberty to give out that information without the client's permission:
4. "Why don't you call his physician and ask him?"
3
169
While working with a female client who is morbidly obese and whose behavior is highly dependent, the nurse thinks of ways to avoid the client. She decides not to go into this client's room any more than necessary, and maybe even talk the client out of taking a shower on her shift. What does this nurse most need to do first?
A)Take a few minutes to clarify her personal values
B)false
A
170
The nursing instructor asks the students to watch for ethical dilemmas in their clinical experience and to write about one that they, or someone else, experiences. How would a student or nurse recognize an ethical dilemma?
A)If the situation feels uncomfortable and the nurse is having trouble deciding on a course of action
B)If some evidence exists that a course of action is right, and some exists that it is wrong
B
171
An ethical dilemma exists when there are conflicting moral alternatives to consider before deciding on an action. Any situation may make the nurse uncomfortable but that in itself does not constitute an ethical dilemma. The ANA Code of Ethics does not delineate ethical dilemmas. A more experienced nurse will not be able to tell another nurse what is an ethical dilemma unless that nurse's personal values coincide with the nurse needing to make the decision.
A)true
B)false
A
172
A nurse is working with a client whose son has a civil commitment, for one year, to a state psychiatric hospital. The client asks the nurse when is the earliest she can expect her son to be released. She would like to ensure a therapeutic environment when he returns home. Which of the following answers would be most correct?
A)At any time it can be shown that the patient's condition has sufficiently improved
B)false
A
173
A court-committed client tells the nurse that he is registered to vote and asks the nurse if he will be allowed to vote. Which of the following answers would be the best answer by the nurse?
A)"You will need verification from your psychiatrist that you are rational."
B)"State laws differ on this matter. I will have to check to see the decision in this state."
B
174
People who are voluntarily hospitalized for psychiatric treatment retain all their civil rights, including the right to vote. However, states differ on the approach to court-committed clients and may limit any of the client's civil rights. Other states may allow committed clients to retain all their civil rights. For the nurse to answer this question, there will require more investigation into state laws.
A)true
B)false
A
175
The nurse is one of the defendants in a legal case in which a client committed suicide in a psychiatric facility. The care given by the nurse is under question. Which of the following actions is the usual and accepted method of determining if a nurse's care was/is adequate in a given situation?
A)Compare the care given by the nurse with professional standards of nursing care
B)false
A
176
When the nurse answers the telephone on the inpatient psychiatric ward, the caller describes himself as the teacher for a child on the children's unit. The teacher tells the nurse that he needs to drop off this child's homework and explain it in order for the child to be able to pass the school year. Which of the following actions would be best on the nurse's part?
A)Advise the teacher that you cannot even confirm that the child is on the unit.
B)false
A
177
A client with major depression is discharged from the psychiatric hospital and admitted to a foster care home. The client's case manager helps the client check in and go over his valuables and belongings with the admitting nurse. The client has brought with him, a .38 caliber revolver and some sharp scissors, along with clothing and a small amount of money. Which of the following actions by the nurse in regard to the gun and scissors would be best?
A)Secure the gun and scissors and give them back if, and when, the client is discharged.
B)false
A
178
The medication nurse on an inpatient psychiatric unit assesses one of the clients on the unit and finds that he is pacing and clenching his fists. After checking for orders, the nurse gives the client Ativan 1 mg. Thirty minutes later the client is sitting quietly in a chair and says he is feeling relaxed. The nurse documents the client's observed behavior prior to the medication, the medication and the time given, and the client's response an hour later. Which of the following nursing actions, missing from the documentation, would be most important to carry out and document?
A)Less restrictive alternatives to medication tried
B)false
A
179
A young adult client in the psychiatric inpatient unit has been diagnosed with schizophrenia and has responded well to treatment with one of the newer antipsychotic medications and psychotherapy. He is close to being discharged and tells the nurse that he is thinking of quitting graduate school as he thinks no one will hire someone with a mental illness. Based on a knowledge of The Americans with Disabilities Act, how should the nurse respond to this statement?
A)"It is unlawful to discriminate in employment against a qualified person who has a mental illness."
B)false
A
180
A young female client is admitted to the psychiatric unit with major depressive disorder and thoughts of suicide. The client refuses to participate in unit activities and speaks only when spoken to. Words are mumbled and difficult to hear. She sits in a chair all day with her head down. She does take her medication. Which of the following would be the best documentation on this client?
A)"Client is depressed and non-communicative. Uncooperative with activities."
B)"Client sits in a chair all day with her head down. Speaks only when spoken to. Words are difficult to hear. Declines participation in activities. Takes medication willingly."
B
181
Documentation should be objective. When documenting in the psychiatric setting, it is important for the nurse to describe exactly what is observed and not to characterize her behavior. People may interpret characterizations based upon their past experiences and may not have an accurate picture of their behavior
A)true
B)false
A
182
although an expert nurse may incorporate intuition into an ethical decision, the novice nurse does not have enough experience to do so.
A)true
B)false
A
183
ethical decisions should always include the clients personal value system and any other information that would affect the outcomes of the decision.
A)true
B)false
A
184
autonomy gives the client the right to choose what treatment options he\she wants to follow
A)true
B)false
A
185
protecting the client from harm is called nonmalefience. following all infection control guidelines when caring for clients is a good example of nursing ethics
A)true
B)false
A
186
the nurse should not give an opinion to a client or family member about what they should be doing. the nurse should express concern for the situation but not express an opinion as to what should be done
A)true
B)false
A
187
a client who is threatening suicide and already has a plan of action is definite and immediate threat to himself\herself and meets the criteria for involuntary admission
A)true
B)false
A
188
a client not taking His or her medication or hearing voices is in Immediate danger but certainly and bears further Observation and may need admission in the near future
A)true
B)false
A
189
Being placed in a mental health care facility is not an appropriate housing option for a homeless person
A)true
B)false
A
190
The mental health care client has the right to the use of Least restrictive approach to stopping escalating behavior first.
A)true
B)false
A
191
If the least restrictive approach does not work another option might be necessary, The next that might be seclusion.
A)true
B)false
A
192
The Client has not been declared legally incompetent but cannot understand the treatment being ordered due to severe psychosis. It will do no good to explain the therapy to the client. With no legal guardian assign the next best option would be to consult the clients closest relative to obtain permission to perform procedure
A)true
B)false
A
193
Touching a client without permission is battery
A)true
B)false
A
194
Assault would be threatening to perform an action to which the client has not agreed thereby causing fear in the client
A)true
B)false
A
195
With the severity of his escalating behavior medicating the client against his well is the best option. Because the client is a new admission only.there has not been an opportunity to establish a trusting nurse client relationship
A)true
B)false
A
196
Civil Commitment. Is taking someone rights away involuntary and placing them in the hospital
A)true
B)false
A
197
Values, personal beliefs about the worth of an object, idea,or behavior
A)true
B)false
A
198
Statutory laws-Legal definition of nursing, and scope of practice of nursing
A)true
B)false
A
199
Justice is providing the same interventions for all clients
A)true
B)false
A
200
Veracity means honesty
A)true
B)false
A
201
Ethical dilemma is a client is old enough to make legal decisions, has not been declared legally incompetent by a court of law or has not had a legal guardian appointed that client is considered the decision maker in the medical treatment situations. Autonomy is highly valued
A)true
B)false
A
202
Which of the following is the best example of an ethical dilemma for the nurse
A) a client decides not to go to the doctor for his chest
B) a legally competent client who is experiencing psychosis refuses that antipsychotic medication offered by the nurse
B
