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Highest Answer Letter: D
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Chapter: Chapter 05: Legal and Ethical Aspects
Multiple Choice
1. A psychiatric–mental health nurse has been consistently aware of the need to adhere to standards of practice during interactions with clients and their families. What is a standard of nursing practice?
2. A) The body of text in the state nurse practice act
3. B) A document outlining minimum expectations for safe nursing practice
4. C) Unwritten but traditional practices that constitute safe nursing care
5. D) Part of the federal nurse practice act
Ans: B
Chapter: 05
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 06
Page and Header: 76, Nurse Practice Acts and the Expanding Role of Nursing
Feedback: Standards of nursing practice are written documents that outline minimum expectations for safe nursing care. They are used to guide and evaluate nursing care, and courts look to them for guidance when malpractice cases are deliberated.
2. Nursing students are reviewing the nurse practice act in the state where they reside. A state’s nurse practice act has which of the following functions?
3. A) Makes recommendations for how nurses should practice
4. B) Defines the scope and limit of nursing practice
5. C) Defines specific situations that constitute malpractice
6. D) Follows federal laws about nursing practice
Ans: B
Chapter: 05
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Nursing process
Objective: 02
Page and Header: 76, Nurse Practice Acts and the Expanding Role of Nursing
Feedback: The nurse practice act in each state defines nursing, describes its scope, and identifies its limits within that state.
3. A psychiatric–mental health nurse has been named in a malpractice suit in which certain criteria have to be demonstrated by the client’s legal team. Which of the following lists includes the correct criteria?
4. A) Duty of care, professional performance, injury related to the nurse’s action, action foreseeably could have caused the injury, and proven injury
5. B) Duty of care, professional performance, injury related to the nurse’s action, failure to document injury, and proven injury
6. C) Professional performance, injury related to the nurse’s action, action foreseeably could have caused the injury, and proven injury
7. D) Duty of care, professional performance, injury related to the nurse’s action, and action foreseeably could have caused the injury
Ans: A
Chapter: 05
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 03
Page and Header: 77, Malpractice
Feedback: Malpractice includes the following elements of nursing negligence: The nurse professional had a duty of due care toward the plaintiff; the nurse professional’s performance fell below the standard of care and was, therefore, a breach of that duty; as a result of the failure to meet the standard of care, the plaintiff consumer was injured, and the nurse’s action was the proximate cause of the injury; and the plaintiff consumer must prove his or her injuries.
4. A class of nursing students are learning how to protect themselves from liability for malpractice. How can the students best do this once they begin providing care for clients?
5. A) Know and follow the statutory and professional standards.
6. B) Avoid documenting incriminating information.
7. C) Carry individual malpractice insurance.
8. D) Request legal consultation from their employers.
Ans: A
Chapter: 05
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 03
Page and Header: 77, Malpractice
Feedback: To decrease their chances of liability for malpractice, psychiatric nurses must ensure that their professional practice is within the bounds of statutory and professional standards. Documentation should be thorough and malpractice insurance does not necessarily prevent liability.
5. A physician would like to include a client with schizophrenia in a research study testing a new medication. What is the nurse’s primary obligation in this situation?
6. A) Ensure the client knows what he or she is agreeing to when providing consent.
7. B) Help the client with revoking consent once the study has started.
8. C) Obtain informed consent when the primary provider cannot be present.
9. D) Persuade the client to consent, because the new drug has shown promising results.
Ans: A
Chapter: 05
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Documentation
Objective: 03
Page and Header: 78, Informed Consent
Feedback: The nurse serves as the client’s advocate, the team’s colleague, and the facility’s excellent employee by continually evaluating the client’s ability to give informed consent and his or her willingness to participate and continue with a treatment modality. Unless serving as the primary provider, the nurse is not responsible for obtaining informed consent: that is the role of the primary provider or researcher.
6. An adolescent client has refused to wash or change his clothes for several days. He smells and looks filthy. Three male staff members approach him to escort him to the shower. The client resists and becomes combative when staff members insist. They place the client in seclusion and restraints and tell him that they will release him when he is calm and willing to shower. The client’s rights have been which of the following?
7. A) Not been violated, because a degree of cleanliness is important
8. B) Been violated, primarily because he should not be forced to shower
9. C) Been violated, primarily because of the inappropriate use of restraints
10. D) Not been violated, because his combative behavior warranted seclusion and restraint to protect others
Ans: C
Chapter: 05
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 04
Page and Header: 83, Right to Treatment in the Least Restrictive Environment
Feedback: Clients have the right to treatment in the least restrictive environment. No staff member can confine a person with mental illness
who is not a threat to self or others. Nurses must assess a client’s condition and status constantly so that health care professionals can initiate more or less restrictive treatment alternatives based on the client’s evolving needs.
7. A client was admitted to a psychiatric facility because he was found walking around the street naked and talking incoherently. He has no known next of kin and has been adjudicated incompetent for the first time following a thorough assessment. He refuses any antipsychotic medications but has not been harmful to himself or others. What action should the facility take?
8. A) Initiate court proceedings to have a guardian named
9. B) Convince the client of his need for care
10. C) Continue custodial care
11. D) Contact social services to find outpatient housing
Ans: A
Chapter: 05
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 05
Page and Header: 81, Substituted Consent
Feedback: When a client cannot give informed consent due to mental illness, health care providers must obtain substituted consent for necessary treatments or procedures. Substituted consent is authorization that another person gives on behalf of a client who needs a procedure or treatment but cannot provide such consent independently. Substituted consent can come from a court-appointed guardian or, in some instances, from the client’s next of kin. If the client has not previously been adjudicated incompetent and if the law so permits and no next of kin are available to give substituted consent, the health care agency may initiate a court proceeding to appoint a guardian so that treatment professionals can carry out the procedure or treatment. The care team may or may not be able to convince the client that he needs care.
8. A client with a diagnosis of depression has been admitted to the health care facility. From a legal standpoint, clients hospitalized as voluntary admissions differ from other types of admissions in which of the following ways?
9. A) They can dictate their own plan of care independently.
10. B) They are considered legally competent.
11. C) They are considered a danger to themselves or others.
12. D) They cannot refuse treatment.
Ans: B
Chapter: 05
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated
Process: Communication and Documentation
Objective: 05
Page and Header: 84, Voluntary Admission
Feedback: Voluntary clients have certain rights that differ from those of other hospitalized clients. Specifically, they are considered competent (unless otherwise adjudicated) and therefore have the absolute right to refuse treatment, including psychotropic medications, unless they are dangerous to themselves or others, as in a violent destructive episode within the treatment unit. Though client preferences are always considered, these clients cannot dictate their plan of care without input from the care team.
9. A 25-year-old man is seen standing on a rooftop. His employer calls the police and tells them the man had been behaving strangely. When the police arrive, the man states that he has special healing powers and no harm will come to him. The man believes the police have been provided to him as a courtesy, and he willingly accompanies them to a psychiatric facility. His admission is considered what?
10. A) Involuntary admission
11. B) Legal admission
12. C) Coerced admission
13. D) Emergency admission
Ans: D
Chapter: 05
Client Needs: A-1
Cognitive Level: Evaluation
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 05
Page and Header: 85, Emergency Admission
Feedback: Clients are considered to have emergency admission status when they act in a way that indicates that they are mentally ill and, due to the illness, likely to harm themselves or others.
10. A client with persistent depression is considering electroconvulsive therapy (ECT). The nurse has seen ECT be effective in other cases. When the client expresses fear and doubt about undergoing ECT, the nurse tries to talk him into taking it, truly believing it will help him. Which two ethical concepts are in conflict?
11. A) Beneficence and fidelity
12. B) Fidelity and paternalism
13. C) Paternalism and autonomy
14. D) Beneficence and autonomy
Ans: C
Chapter: 05
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 11
Page and Header: 88, Beneficence and Paternalism
Feedback: Paternalism and autonomy are in conflict. Paternalism is practicing with the intent to do good; however, professionals define how to do good, which may override the wishes and self-determination of the client. Autonomy is the patient’s right to make decisions for himself or herself. Beneficence is the principle of the nurse doing good, not harm. Fidelity is the nurse’s faithfulness to duties, obligations, and promises.
11. A client’s plan of care includes revoking privileges for inappropriate behavior, based on a contract between the client and the nurse who wrote the plan. Another nurse decides to ignore this, because the client promises that she will adhere to the contract in the future. The second nurse’s behavior may have violated which ethical principle?
12. A) Veracity
13. B) Beneficence
14. C) Autonomy
15. D) Fidelity
Ans: D
Chapter: 05
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 09
Page and Header: 88, Veracity and Fidelity
Feedback: Fidelity is the nurse’s faithfulness to duties, obligations, and promises. Autonomy is the patient’s right to make decisions for himself or herself. Veracity is a systematic behavior of honesty and truthfulness in speech. Beneficence is the principle of doing good, not harm.
12. A client asks if her medication has any possible negative side effects. The nurse considers the client highly suggestible, believes the medication will benefit the client, and, since the client has no history of cardiovascular disease, does not tell her of the potential for cardiac dysrhythmias. The nurse’s actions involve a conflict between which two ethical principles?
13. A) Veracity and justice
14. B) Veracity and paternalism
15. C) Veracity and beneficence
16. D) Veracity and fidelity
Ans: B
Chapter: 05
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 09
Page and Header: 88, Beneficence and Paternalism
Feedback: The conflict is between veracity and paternalism. Veracity is a systematic behavior of honesty and truthfulness in speech. Paternalism is practicing with the intent to do good; however, professionals define how to do good, which may override the wishes and self-determination of the client. Justice in health care is seen as the equitableness of benefits, including the right to access care. Beneficence is the principle of doing good, not harm. Fidelity is the nurse’s faithfulness to duties, obligations, and promises.
13. A group of psychiatric–mental health nurses have attended an inservice that addressed the topic of “everyday ethics.” This concept is best described as an approach to care that:
14. A) Emphasizes respect, caring, and unconditional positive regard
15. B) Focuses on maintaining the client’s autonomy
16. C) Emphasizes beneficence and fidelity in all nurse–client interactions
17. D) Ensures that health care is provided justly
Ans: A
Chapter: 05
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 07
Page and Header: 86, Ethical Issues in Psychiatric–Mental Health Nursing
Feedback: “Everyday ethics” act as the center of nursing practice and give meaning and purpose to nursing care. They focus on interpersonal relationships, demand the confirmation of positive regard, and respect the search for human dignity. They involve not only caring “for” but also caring “about” the client. The other given characteristics are congruent with everyday ethics but are not the central concepts.
14. During a client’s case conference, a nurse has made reference to the Code of Ethics for Nurses of the American Nurses Association (ANA). What is the main characteristic of the ANA Code of Ethics for Nurses?
15. A) It provides descriptions of case studies in which ethical dilemmas were resolved.
16. B) It provides standards of conduct for nurses regarding ethical care.
17. C) It outlines a decision-making framework for resolving ethical dilemmas.
18. D) It provides definitions of ethical principles and how they relate to nursing practice.
Ans: B
Chapter: 05
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 08
Page and Header: 87, Nursing Spotlight 5.2
Feedback: The ANA’s Code of Ethics for Nurses lists ethical standards of conduct for nurses. It does not outline a specific decision-making process, give explicit definitions of concepts, or provide case studies.
15. A nurse has been focusing on one particular client at work. She believes she sees a side of the client no one else on the treatment team can see. As a result, the nurse is in serious conflict with the other members of the care team. This demonstrates that the nurse may have:
16. A) Exceptional caring and concern for the client
17. B) Appropriate dedication to her job
18. C) A failure to maintain appropriate boundaries
19. D) An professional relationship with the client
Ans: C
Chapter: 05
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Caring
Objective: 10
Page and Header: 89, Boundaries in Ethical Nursing Care
Feedback: Interpersonal boundaries protect clients from emotional harm that would impede their recovery. Boundary violations are usually insidious in their development. In the beginning, a health care provider may be unaware that the relationship is drifting from therapeutic interactions into a friendship or social relationship. As this relationship changes, the judgment of the health care provider becomes clouded and the therapeutic needs of the client slip from focus. During treatment, providers must conduct interactions with clients within appropriate guidelines and focus on the client’s growth and movement toward wellness. Members of the health care team must recognize that stepping outside their professional boundaries can compromise a client’s movement toward recovery.
16. A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with which of the following?
17. A) Maleficence
18. B) Battery
19. C) Beneficence
20. D) Infidelity
Ans: B
Chapter: 05
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 01
Page and Header: 78, Informed Consent
Feedback: All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client’s informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove that they did not consent to the procedure, that providers did not give adequate information for a decision, or that the treatment exceeded the scope of the consent. This action does not constitute maleficence, beneficence, or infidelity.
17. While conducting an interview with a 14-year-old mental health client, he tells you that he has a plan to kill students at his
school because they will not stop picking on him. He says, “I have everything I need all set up.” What would be your responsibility after hearing this statement?
18. A) To maintain the client’s confidentiality and not share the information with anyone
19. B) To maintain the client’s confidentiality, but try to convince him that it is the wrong thing to do
20. C) To break the client’s confidentiality because he has threatened the lives of other people
21. D) To break his confidentiality by documenting the client’s plan
Ans: C
Chapter: 05
Client Needs: A-2
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 04
Page and Header: 81, Health Insurance Portability and Accountability Act
Feedback: Providers may use and disclose protected health information without consent, authorization, or both when they are conducting treatment, payment, and health care operations. They may disclose information without consent or authorization if so mandated by state or federal reporting requirements, such as those related to public health, abuse, neglect, and domestic violence. Providers may disclose protected information to law enforcement officials under specific circumstances. Documentation does not constitute a violation of confidentiality, though the nurse should certainly document the client’s statement.
18. A nurse has been accused by a client of breaking confidentiality. Breaching a client’s confidentiality is acceptable under which of the following circumstances?
19. A) The client’s situation is unique and unprecedented.
20. B) The client is a minor.
21. C) The client demonstrates an antisocial personality.
22. D) The client has made allegations of abuse.
Ans: D
Chapter: 05
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 04
Page and Header: 81, Health Insurance Portability and Accountability Act
Feedback: Providers may use and disclose protected health information without consent, authorization, or both when they are conducting treatment, payment, and health care operations. They may disclose information without consent or authorization if so mandated by state or federal reporting requirements, such as those related to public health, abuse, neglect, and domestic violence. A unique case does not justify a breach in confidentiality. Similarly, the nurse cannot breach confidentiality solely because the client is a minor or has an antisocial personality.
19. During a care conference, a group of nurses have made reference to principles that serve as codes of conduct about right and wrong behaviors to guide actions. These principles are known as what?
20. A) Ethics
21. B) Laws
22. C) Mores
23. D) Fiduciary guidelines
Ans: A
Chapter: 05
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 07
Page and Header: 86, Ethical Issues in Psychiatric-Mental Health Nursing
Feedback: Ethics are principles that serve as codes of conduct about right and wrong behaviors to guide actions. They are not synonymous with laws, mores, or fiduciary guidelines.
20. A client who has bipolar disorder stops taking her medication because she says she likes how she feels in a manic state. What is the client’s right to make decisions for herself known as?
21. A) Paternalism
22. B) Autonomy
23. C) Justice
24. D) Veracity
Ans: B
Chapter: 05
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 09
Page and Header: 88, Autonomy
Feedback: Autonomy is the right to make decisions for oneself. Paternalism is similar to beneficence in that the intent is to do good. Veracity is a systematic behavior of honesty and truthfulness in speech. The ethical principle of justice in health care commonly is seen as the equitableness of benefits, including the right to access care.
21. Hospital managers have emphasized the need for care providers to adhere to the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Which of the following actions may violate HIPAA?
22. A) A nurse communicates a client’s medical history to another care provider electronically.
23. B) A nurse discusses a client’s treatment plan without first eliciting the client’s input.
24. C) A nurse discusses a client’s prognosis with a visitor without obtaining the client’s permission.
25. D) A nurse fails to make copies of a client’s medical record before transferring the client to a new care facility.
Ans: C
Chapter: 05
Client Needs: A-1
Cognitive Level: Evaluation
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 01
Page and Header: 81, Health Insurance Portability and Accountability Act
Feedback: Discussing a client’s case with a non–care provider without obtaining permission is a violation of privacy and goes against the provisions of HIPAA. HIPAA allows for electronic communication and client input does not have to be obtained at every stage of care planning. A facility does not necessarily have to make copies of client records prior to transfer.
22. An adult male client has been admitted to the psychiatric care facility on an involuntary basis. In addition to being diagnosed as mentally ill, what is the main criterion for involuntary admission?
23. A) The client poses a danger to himself or others.
24. B) The client has a poor prognosis for recovery.
25. C) The client has not responded favorably to previous treatments.
26. D) The client lacks an adequate support system.
Ans: A
Chapter: 05
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 05
Page and Header: 85, Involuntary Admissions
Feedback: To deprive a person of liberty by involuntary commitment is a serious matter, and the legal protections are strict. Before involuntary commitment, clear and convincing evidence must be used as the standard of proof in a civil hearing to determine if a person is mentally ill and dangerous to self or others.
23. A man with a longstanding history of schizophrenia has been implicated in arson that destroyed a large amount of property. The man’s competency to stand trial will be primarily determined on the basis of:
24. A) His willingness to adhere to prescribed treatment
25. B) His attorney’s experience in working with clients who have mental illness
26. C) His prognosis for recovery
27. D) His mental condition at the time of the trial
Ans: D
Chapter: 05
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 01
Page and Header: 86, Competency to Stand Trial
Feedback: Competency to stand trial refers to a defendant’s mental condition at the time of the trial. It is not based on the attorney’s experience, the client’s recovery prognosis, or the client’s adherence to treatment.
Import Settings:
Base Settings: Brownstone Default
Information Field: Chapter
Information Field: Client Needs
Information Field: Cognitive Level
Information Field: Difficulty
Information Field: Integrated Process
Information Field: Objective
Information Field: Page and Header
Highest Answer Letter: D
Multiple Keywords in Same Paragraph: No
