Chapter 8: Legal and Ethical Context of Psychiatric Nursing Care

Chapter 8: Legal and Ethical Context of Psychiatric Nursing Care

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient with severe depression signed permission for electroconvulsive therapy (ECT). Later, the patient tells the nurse, “I signed permission for treatment after my spouse told me I could be deported if my depression can’t be cured.” The nurse assesses that:

a.	the patient’s consent may have been coerced.
b.	all the elements of informed consent were met.
c.	the patient may not fully understand the risks and benefits.
d.	the patient is not competent to sign permission for treatment.

 

 

ANS:  A

The decision may have been coerced based on family pressure. Informed consent requires that the choice be freely made.

 

DIF:    Cognitive Level: Analysis                REF:   Text Page: 120

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

2. When a patient who immigrated to the United States tells a nurse that consent to electroconvulsive therapy (ECT) was only given because the patient’s spouse said, “They will deport you if you didn’t do what they said to do,” the nurse should initially:

a.	reassure the patient that the decision is sound.
b.	discuss the reasons the spouse believed they must consent.
c.	explain that consenting to treatment will not stop deportation.
d.	document the comment and notify the health care provider immediately.

 

 

ANS:  D

When requirements for making an informed decision are not met, the health care provider will need to confer with the patient.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 120

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

3. A patient with a history of assaulting several family members is voluntarily admitted for alcohol detoxification. A nurse suggests use of physical restraints to minimize the risk to the milieu and to manage the patient’s anticipated aggressive behavior. The primary principle guiding the manager’s response is:

a.	the right to the least restrictive measure of restriction possible.
b.	that legal considerations exist when physical restraints are used.
c.	the limitations for the use of physical restraints on voluntarily admitted patients.
d.	that thorough documentation is needed whenever physical restraints are applied.

 

 

ANS:  A

The primary concern is a patient’s right to be treated using the least restrictive setting and method.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 121

TOP:   Nursing Process: Planning

MSC:  NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

4. A patient was admitted involuntarily. What assumption can the nurse make about the patient?

a.	The patient may leave the unit whenever he or she chooses to do so.
b.	For the first 48 hours, the patient may be compelled to take prescribed medication.
c.	The patient has, through informed consent, agreed to accept treatment and participate fully in care planning.
d.	When admitted, the patient was an imminent danger to self or others or was deemed unable to provide for his or her own basic needs.

 

 

ANS:  D

Involuntary commitment means that the patient did not request hospitalization and may have opposed it or was indecisive but did not resist it. Further, most involuntary commitments are made on the grounds that the patient is dangerous to self or others, is mentally ill and in need of treatment, or is unable to provide for his or her own basic needs.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 113

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

5. What is the new staff nurse’s immediate duty when a patient discloses a plan to kill a family member upon release from the hospital?

a.	Discuss the statement with the patient’s mental health team but otherwise keep the information confidential.
b.	Immediately contact the family member and provide a verbal warning concerning his or her physical safety.
c.	Inform the patient that the local police department will be called and that oral and written reports will be filed.
d.	Document the information in the patient’s medical record, and notify the nursing supervisor of the statement.

 

 

ANS:  D

The Tarasoff decision gives mental health professionals a duty to warn prospective victims. The initial step in this process is to document the statement and to notify the nursing supervisor that the statement was made and documented.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 119

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care