Essentials of Psychiatric Mental Health Nursing 7th Edition By Mary C-Test Bank
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Sample Test
Chapter 3: Ethical and Legal Issues
Multiple Choice
Identify the choice that best completes the statement or answers
the question.
____ 1. In response to a student’s
question regarding choosing a psychiatric specialty, a charge nurse states,
“Mentally ill clients need special care. If I were in that position, I’d want a
caring nurse also.” From which ethical framework is the charge nurse operating?
|
1. |
Kantianism |
|
2. |
Christian ethics |
|
3. |
Ethical egoism |
|
4. |
Utilitarianism |
____ 2. During a hiring interview,
which response by a nursing applicant should indicate that the applicant
operates from an ethical egoism framework?
|
1. |
“I would want to be treated
in a caring manner if I were mentally ill.” |
|
2. |
“This job will pay the
bills, and the workload is light enough for me.” |
|
3. |
“I will be happy caring for
the mentally ill. Working in med/surg kills my back.” |
|
4. |
“It is my duty in life to
be a psychiatric nurse. It is the right thing to do.” |
____ 3. Without authorization, a
nurse administers an extra dose of narcotic tranquilizer to an agitated client.
The nurse’s coworker observes this action but does nothing for fear of
retaliation. What is the ethical interpretation of the coworker’s lack of
involvement?
|
1. |
Taking no action is still
considered an unethical action by the coworker. |
|
2. |
Taking no action releases
the coworker from ethical responsibility. |
|
3. |
Taking no action is advised
when potential adverse consequences are foreseen. |
|
4. |
Taking no action is
acceptable, because the coworker is only a bystander. |
____ 4. Group therapy is strongly
encouraged, but not mandatory, in an inpatient psychiatric unit. The unit
manager’s policy is that clients can make a choice about whether or not to
attend group therapy. Which ethical principle does the unit manager’s policy
preserve?
|
1. |
Justice |
|
2. |
Autonomy |
|
3. |
Veracity |
|
4. |
Beneficence |
____ 5. Which is an example of an
intentional tort?
|
1. |
A nurse fails to assess a
client’s obvious symptoms of neuroleptic malignant syndrome. |
|
2. |
A nurse physically places
an irritating client in four-point restraints. |
|
3. |
A nurse makes a medication
error and does not report the incident. |
|
4. |
A nurse gives patient
information to an unauthorized person. |
____ 6. An involuntarily committed
client is verbally abusive to the staff, repeatedly threatening to sue. The client
records the full names and phone numbers of the staff. Which nursing action is
most appropriate to decrease the possibility of a lawsuit?
|
1. |
Verbally redirect the
client, and then refuse one-on-one interaction. |
|
2. |
Involve the hospital’s
security division as soon as possible. |
|
3. |
Notify the client that
documenting personal staff information is against hospital policy. |
|
4. |
Continue professional
attempts to establish a positive working relationship with the client. |
____ 7. Which statement should a
nurse identify as correct regarding a client’s right to refuse treatment?
|
1. |
Clients can refuse
pharmacological but not psychological treatment. |
|
2. |
Clients can refuse any
treatment at any time. |
|
3. |
Clients can refuse only
electroconvulsive therapy (ECT). |
|
4. |
Professionals can override
treatment refusal by an actively suicidal or homicidal client. |
____ 8. Which potential client
should a nurse identify as a candidate for involuntarily commitment?
|
1. |
The client living under a bridge
in a cardboard box |
|
2. |
The client threatening to
commit suicide |
|
3. |
The client who never bathes
and wears a wool hat in the summer |
|
4. |
The client who eats waste
out of a garbage can |
____ 9. A client diagnosed with schizophrenia
refuses to take medication, citing the right of autonomy. Under which
circumstance would a nurse have the right to medicate the client against the
client’s wishes?
|
1. |
A client makes
inappropriate sexual innuendos to a staff member. |
|
2. |
A client constantly demands
attention from the nurse by begging, “Help me get better.” |
|
3. |
A client physically attacks
another client after being confronted in group therapy. |
|
4. |
A client refuses to bathe
or perform hygienic activities. |
____ 10. A psychiatric nurse working on an
inpatient unit receives a call asking if an individual has been a client in the
facility. Which nursing response reflects appropriate legal and ethical
obligations?
|
1. |
The nurse refuses to give
any information to the caller, citing rules of confidentiality. |
|
2. |
The nurse hangs up on the
caller. |
|
3. |
The nurse confirms that the
person has been at the facility but adds no additional information. |
|
4. |
The nurse suggests that the
caller speak to the client’s therapist. |
____ 11. A client requests information on
several medications in order to make an informed choice about management of
depression. A nurse should provide this information to facilitate which ethical
principle?
|
1. |
Autonomy |
|
2. |
Beneficence |
|
3. |
Nonmaleficence |
|
4. |
Justice |
____ 12. An inpatient psychiatric physician
refuses to treat clients without insurance and prematurely discharges those
whose insurance benefits have expired. Which ethical principle should a nurse
determine has been violated based on these actions?
|
1. |
Autonomy |
|
2. |
Beneficence |
|
3. |
Nonmaleficence |
|
4. |
Justice |
____ 13. Which situation reflects violation of
the ethical principle of veracity?
|
1. |
A nurse discusses with a
client another client’s impending discharge. |
|
2. |
A nurse refuses to give
information to a physician who is not responsible for the client’s care. |
|
3. |
A nurse tricks a client
into seclusion by asking the client to carry linen to the seclusion room. |
|
4. |
A nurse does not treat all
of the clients equally, regardless of illness severity. |
____ 14. A client who will be receiving ECT
must provide informed consent. Which situation should cause a nurse to question
the validity of the informed consent?
|
1. |
The client is paranoid. |
|
2. |
The client is 87 years old. |
|
3. |
The client incorrectly
reports his or her spouse’s name, date, and time of day. |
|
4. |
The client relies on his or
her spouse to interpret the information. |
____ 15. A client diagnosed with schizophrenia
receives fluphenazine decanoate (Prolixin Decanoate) from a home-health nurse.
The client refuses medication at one regularly scheduled home visit. Which
nursing intervention is ethically appropriate?
|
1. |
Allow the client to decline
the medication and document the decision. |
|
2. |
Tell the client that if the
medication is refused, hospitalization will occur. |
|
3. |
Arrange with a relative to
add the medication to the client’s morning orange juice. |
|
4. |
Call for help to hold the
client down while the injection is administered. |
____ 16. Which situation exemplifies both
assault and battery?
|
1. |
The nurse becomes angry,
calls the client offensive names, and withholds treatment. |
|
2. |
The nurse threatens to “tie
down” the client and then does so, against the client’s wishes. |
|
3. |
The nurse hides the
client’s clothes and medicates the client to prevent elopement. |
|
4. |
The nurse restrains the
client without just cause and communicates this to family. |
____ 17. A geriatric client is confused and
wandering in and out of every door. Which scenario reflects the least
restrictive alternative for this client?
|
1. |
The client is placed in
seclusion. |
|
2. |
The client is placed in a
geriatric chair with tray. |
|
3. |
The client is placed in
soft Posey restraints. |
|
4. |
The client is monitored by
an ankle bracelet. |
____ 18. A brother calls to speak to his
sister, who has been admitted to a psychiatric unit. The nurse connects him to
the community phone, and the sister is summoned. Later the nurse realizes that
the brother was not on the client’s approved call list. What law has the nurse
broken?
|
1. |
The National Alliance for
the Mentally Ill Act |
|
2. |
The Tarasoff Ruling |
|
3. |
The Health Insurance
Portability and Accountability Act |
|
4. |
The Good Samaritan Law |
Multiple Response
Identify one or more choices that best complete the statement or
answer the question.
____ 19. After disturbing the peace, an
aggressive, disoriented, unkempt, homeless individual is escorted to an
emergency department. The client threatens suicide. Which of the following
criteria would enable a physician to consider involuntary commitment? (Select all that apply.)
|
1. |
Being dangerous to others |
|
2. |
Being homeless |
|
3. |
Being disruptive to the
community |
|
4. |
Being gravely disabled and
unable to meet basic needs |
|
5. |
Being suicidal |
Completion
Complete each statement.
20. A
valid, legally recognized claim or entitlement, encompassing both freedom from
government interference or discriminatory treatment and an entitlement to a
benefit or a service is defined as a _______________________.
21. A
branch of philosophy that addresses methods for determining the rightness or
wrongness of one’s actions is defined as _______________________.
Chapter 3: Ethical and Legal Issues
Answer Section
MULTIPLE CHOICE
1. ANS:
2
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss ethical theories including utilitarianism,
Kantianism, Christian ethics, natural law, theories, and ethical egoism.
Page: 42
Heading: Ethical Considerations > Theoretical Perspectives
Integrated Processes: Teaching and Learning
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Self
Difficulty: Easy
|
|
Feedback |
|
1 |
Kantianism states that
decisions should be made based on moral law and that actions are bound by a
sense of moral duty. |
|
2 |
The charge nurse is
operating from a Christian ethics framework. The imperative demand of
Christian ethics is that all decisions about right and wrong should be
centered in love for God and in treating others with the same respect and
dignity with which we would expect to be treated. |
|
3 |
Ethical egoism promotes the
idea that what is right is good for the individual. |
|
4 |
Utilitarianism holds that
decisions should be made focusing on the end result being happiness. |
PTS:
1
CON: Self
2. ANS:
2
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss ethical theories including utilitarianism,
Kantianism, Christian ethics, natural law, theories, and ethical egoism.
Page: 42
Heading: Ethical Considerations > Theoretical Perspectives
Integrated Processes: Teaching and Learning
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Self
Difficulty: Easy
|
|
Feedback |
|
1 |
This statement reflects Christian
ethics. |
|
2 |
The applicant’s comment
reflects the ethical egoism framework. This framework promotes the idea that
decisions are made based on what is good for the individual and may not take
the needs of others into account. |
|
3 |
This statement does not
accurately reflect the ethical egoism framework. |
|
4 |
This statement reflects
Kantianism. |
PTS:
1
CON: Self
3. ANS:
1
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Define ethical dilemma.
Page: 42
Heading: Ethical Dilemmas
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Ethics
Difficulty: Easy
|
|
Feedback |
|
1 |
The coworker’s lack of
involvement can be interpreted as an unethical action. The coworker is
experiencing an ethical dilemma in which a decision needs to be made between
two unfavorable alternatives. The coworker has a responsibility to report any
observed unethical actions. |
|
2 |
The coworker is not
released from responsibilities by taking no action. |
|
3 |
Taking no action is never
advised when harm could come to the client. |
|
4 |
The coworker has a
responsibility to report any observed unethical actions. |
PTS:
1
CON: Ethics
4. ANS:
2
Chapter: Chapter 3, Ethical and Legal Issues
Objective: 4. Discuss the ethical principles of autonomy,
beneficence, nonmaleficence, justice, and veracity.
Page: 42
Heading: Ethical Principles
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Ethics
Difficulty: Easy
|
|
Feedback |
|
1 |
The principle of justice
requires individuals to be treated fairly. |
|
2 |
The unit manager’s policy
regarding voluntary client participation in group therapy preserves the
ethical principle of autonomy. The principle of autonomy presumes that
individuals are capable of making independent decisions for themselves and
that health-care workers must respect these decisions. |
|
3 |
Veracity refers to one’s
duty to always be truthful. |
|
4 |
Beneficence refers to the
duty to promote the good of others. |
PTS:
1
CON: Ethics
5. ANS:
2
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Differentiate between civil and criminal law.
Page: 47
Heading: Classifications Within Statutory and Common Law >
Civil Law
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Legal
Difficulty: Easy
|
|
Feedback |
|
1 |
Failing to assess a client
is an example of an unintentional tort. |
|
2 |
A tort, which can be
intentional or unintentional, is a violation of civil law in which an
individual has been wronged. A nurse who intentionally physically places an irritating
client in restraints has touched the client without consent and has committed
an intentional tort. |
|
3 |
Failing to report a medical
error is an example of an unintentional tort. |
|
4 |
Giving patient information
to an unauthorized person is a violation of the Health Insurance Portability
and Accountability Act (HIPAA). |
PTS:
1
CON: Legal
6. ANS:
4
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 55
Heading: Nursing Liability > Avoiding Liability
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Ethics
Difficulty: Moderate
|
|
Feedback |
|
1 |
The involuntarily committed
client should be respected and has the right to assert grievances if rights
are infringed. |
|
2 |
This option is likely
important, but it is not the most appropriate action for decreasing the
possibility of a lawsuit. |
|
3 |
This option is not therapeutic
for the client. |
|
4 |
The most appropriate
nursing action is to continue professional attempts to establish a positive
working relationship with the client. |
PTS:
1
CON: Ethics
7. ANS:
4
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 50
Heading: Informed Consent
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Ethics
Difficulty: Moderate
|
|
Feedback |
|
1 |
Clients can refuse both
pharmacological and psychological treatment. |
|
2 |
Clients may not be able to
refuse emergency treatment. |
|
3 |
Clients can refuse
pharmacological and psychological treatment in a nonemergent situation. |
|
4 |
The nurse should understand
that health-care professionals can override treatment refusal when a client
is actively suicidal or homicidal. A suicidal or homicidal client who refuses
treatment may be in danger or a danger to others. This situation should be
treated as an emergency, and treatment may be performed without informed
consent. |
PTS:
1
CON: Ethics
8. ANS:
2
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 52
Heading: Involuntary Commitment
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Safety
Difficulty: Easy
|
|
Feedback |
|
1 |
This client’s personal
safety is not in jeopardy. |
|
2 |
The nurse should identify
the client threatening to commit suicide as eligible for involuntary
commitment. The suicidal client who refuses treatments is in danger and needs
emergency treatment. |
|
3 |
This client seems capable
of making decisions regarding personal safety. |
|
4 |
This client does not meet
the requirements for involuntary commitment. |
PTS:
1
CON: Safety
9. ANS:
3
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 44
Heading: The Right to Refuse Treatment Including Medications
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Safety
Difficulty: Easy
|
|
Feedback |
|
1 |
Making inappropriate sexual
innuendos does not give the nurse reason to medicate the client against
wishes. |
|
2 |
Demanding attention does
not give the nurse reason to medicate the client against wishes. |
|
3 |
The nurse would have the
right to medicate a client against his or her wishes if the client physically
attacks another client. This client poses a significant risk to safety and is
incapable of making informed choices. The client’s refusal to accept
treatment can be challenged, because the client is endangering the safety of
others. |
|
4 |
Refusing to bathe does not
give the nurse reason to medicate the client against wishes. |
PTS:
1
CON: Safety
10. ANS:
1
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 48
Heading: HIPAA
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Legal
Difficulty: Easy
|
|
Feedback |
|
1 |
The most appropriate action
by the nurse is to refuse to give any information to the caller. |
|
2 |
This would be an
inappropriate and unprofessional action by the nurse. |
|
3 |
Admission to the facility
would be considered protected health information and should not be disclosed
by the nurse without prior client consent. |
|
4 |
Giving this information
would violate the client’s right to privacy. |
PTS:
1
CON: Legal
11. ANS:
1
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss the ethical principles of autonomy,
beneficence, nonmaleficence, justice, and veracity.
Page: 50
Heading: Informed Consent
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Ethics
Difficulty: Easy
|
|
Feedback |
|
1 |
The nurse should provide
the information to support the client’s autonomy. A client who is capable of
making independent choices should be permitted to do so. In instances when
clients are incapable of making informed decisions, a legal guardian or
representative would be asked to give consent. |
|
2 |
The principle of
beneficence refers to one’s duty to promote the good of others. |
|
3 |
Nonmaleficence means to do
no harm. |
|
4 |
Justice refers to the right
of individuals to be treated fairly. |
PTS:
1
CON: Ethics
12. ANS:
4
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss the ethical principles of autonomy,
beneficence, nonmaleficence, justice, and veracity.
Page: 43
Heading: Ethical Principles > Justice
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Ethics
Difficulty: Easy
|
|
Feedback |
|
1 |
Autonomy refers to an
individual’s right to make informed decisions. |
|
2 |
Beneficence refers to one’s
duty to promote the good of others. |
|
3 |
Nonmaleficence means to do
no harm. |
|
4 |
The nurse should determine
that the ethical principle of justice has been violated by the physician’s
actions. The principle of justice requires that individuals should be treated
equally, regardless of race, sex, marital status, medical diagnosis, social
standing, economic level, or religious belief. |
PTS:
1
CON: Ethics
13. ANS:
3
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss the ethical principles of autonomy,
beneficence, nonmaleficence, justice, and veracity.
Page: 43
Heading: Ethical > Veracity
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Ethics
Difficulty: Easy
|
|
Feedback |
|
1 |
Discussing a client’s
personal information with another client is a HIPAA violation. |
|
2 |
Discussing another client’s
personal information with uninvolved health-care providers is a HIPAA
violation. |
|
3 |
The nurse who tricks a
client into seclusion has violated the ethical principle of veracity. The
principle of veracity refers to one’s duty to always be truthful and not intentionally
deceive or mislead clients. |
|
4 |
Not treating all clients
equally violates the principle of justice. |
PTS:
1
CON: Ethics
14. ANS:
3
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 50
Heading: Informed Consent
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Legal
Difficulty: Easy
|
|
Feedback |
|
1 |
This would not lead the
nurse to believe that the client is incompetent to make informed choices. |
|
2 |
If the client is oriented,
then informed consent can be obtained. |
|
3 |
The nurse should question
the validity of informed consent when the client incorrectly reports the
spouse’s name, date, and time of day. This indicates that this client is
disoriented and may not be competent to make informed choices. |
|
4 |
The use of an interpreter
does not make the informed consent invalid. |
PTS: 1
CON: Legal
15. ANS:
1
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 44
Heading: The Right to Refuse Treatment (Including Medications)
Integrated Processes: Teaching and Learning
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Ethics
Difficulty: Easy
|
|
Feedback |
|
1 |
It is ethically appropriate
for the nurse to allow the client to decline the medication and provide
accurate documentation. The client’s right to refuse treatment should be
upheld, unless the refusal puts the client or others in harm’s way. |
|
2 |
It would be unethical for
the nurse to force hospitalization. |
|
3 |
It would be unethical for
the nurse to trick the client into taking the medication. |
|
4 |
It would be unethical for
the nurse to force the client to take the medication. |
PTS:
1
CON: Ethics
16. ANS:
2
Chapter: Chapter 3, Ethical and Legal Issues
Objective: 9. Discuss legal issues relevant to
psychiatric/mental health nursing.
Page: 55
Heading: Types of Lawsuits that Occur in Psychiatric Nursing
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Legal
Difficulty: Easy
|
|
Feedback |
|
1 |
This action is unethical. |
|
2 |
The nurse in this situation
has committed both the acts of assault and battery. Assault refers to an
action that results in fear and apprehension that the person will be touched
without consent. Battery is the touching of another person without consent. |
|
3 |
This action is unethical by
the nurse, but is not considered assault and battery. |
|
4 |
This action would be
considered battery because the nurse touched the client, but it is not
considered assault. |
PTS:
1
CON: Legal
17. ANS:
4
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 44–46
Heading: The Right to the Least-restrictive Treatment
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Legal
Difficulty: Easy
|
|
Feedback |
|
1 |
The client does not pose a
direct dangerous threat to self or others, so seclusion would not be
justified. |
|
2 |
This is not the least
restrictive option. |
|
3 |
The client does not pose a
direct dangerous threat to self or others, so physical restraints would not
be justified. |
|
4 |
The least-restrictive
alternative for this client would be monitoring by an ankle bracelet. |
PTS:
1
CON: Legal
18. ANS:
3
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 48
Heading: Legal Issues in Psychiatric/Mental Health Nursing >
HIPAA
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Legal
Difficulty: Easy
|
|
Feedback |
|
1 |
This act does not require
consent to discuss private medical information. |
|
2 |
This is incorrect wording
for the protection of private health information. |
|
3 |
The nurse has violated
HIPAA by revealing that the client had been admitted to the psychiatric unit.
The nurse should not have provided any information without proper consent
from the client. |
|
4 |
This law protects
individuals who help others in a time of need. |
PTS:
1
CON: Legal
MULTIPLE RESPONSE
19. ANS:
1, 4, 5
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 44–45
Heading: The Right to the Least-Restrictive Treatment
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Legal
Difficulty: Easy
|
|
Feedback |
|
1. |
The physician could
consider involuntary commitment when a client is dangerous to others. |
|
2. |
Being homeless is not
enough for involuntary commitment. |
|
3. |
Being disruptive to the
community is not enough for involuntary commitment. |
|
4. |
The physician could
consider involuntary commitment when a client is gravely disabled. |
|
5. |
The physician could
consider involuntary commitment when a client is suicidal. |
PTS: 1
CON: Legal
COMPLETION
20. ANS:
right
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Discuss legal issues relevant to psychiatric/mental
health nursing.
Page: 41
Heading: Core Concepts
Integrated Processes: Teaching and Learning
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Ethics
Difficulty: Easy
Feedback: A right is
a valid, legally recognized claim or entitlement, encompassing both freedom
from government interference or discriminatory treatment and an entitlement to
a benefit or a service. A right is
absolute when there is no restriction whatsoever on the individual’s
entitlement.
PTS:
1
CON: Ethics
21. ANS:
ethics
Chapter: Chapter 3, Ethical and Legal Issues
Objective: Differentiate among ethics, morals, values, and rights.
Page: 41
Heading: Core Concepts
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Ethics
Difficulty: Easy
Feedback: Ethics is a branch of philosophy that deals with
systematic approaches to distinguishing right from wrong behavior. Bioethics is the
term applied to these principles when they refer to concepts within the scope
of medicine, nursing, and allied health.
PTS:
1
CON: Ethics
Chapter 4: Psychopharmacology
Multiple Choice
Identify the choice that best completes the statement or answers
the question.
____ 1. When used in combination
with anxiolytic medication, alcohol leads to _____________ effects, and
caffeine leads to _______________ effects.
|
1. |
increased; increased |
|
2. |
increased; decreased |
|
3. |
decreased; decreased |
|
4. |
decreased; increased |
____ 2. A client was recently
admitted to the inpatient unit after a suicide attempt. He has been placed on a
tricyclic antidepressant. In terms of medication, what steps should be taken to
maintain the client’s safety when he is discharged?
|
1. |
Provide a 6-month supply to
ensure long-term compliance. |
|
2. |
Provide a 1-week supply of
medication, with refills authorized only after he visits his provider. |
|
3. |
Encourage him to increase
fluid intake to counteract the common side effect of diarrhea. |
|
4. |
Educate him not to eat
foods that contain tyramine. |
____ 3. A client was recently
admitted to the inpatient unit after a suicide attempt and is prescribed a
selective serotonin reuptake inhibitor (SSRI). The nurse teaches the client
about serotonin syndrome. Which of the following is a symptom of serotonin
syndrome?
|
1. |
Change in mental status |
|
2. |
Myoclonus |
|
3. |
Blood pressure lability |
|
4. |
Priapism |
____ 4. A client was recently
admitted to the inpatient unit after a suicide attempt and has not responded to
SSRIs or tricyclic antidepressants. The client asks the nurse, “I heard about
monoamine oxidase inhibitors (MAOIs). Why can’t they be added to what I am on
now? Wouldn’t adding one help?” Which is the appropriate nursing response?
|
1. |
“Electroconvulsive therapy
is your best option at this point.” |
|
2. |
“Combined use can lead to a
life-threatening condition called hypertensive crisis.” |
|
3. |
“There is no reason why an
MAOI couldn’t be added to your therapy.” |
|
4. |
“They can’t be used
together because their mechanisms of action are very different.” |
____ 5. A client began taking
lithium for the treatment of bipolar disorder approximately 1 month ago and
asks why he has gained 12 lbs. since then. Which is the appropriate nursing
response?
|
1. |
“I’m surprised you have
gained; weight loss is the typical pattern when taking lithium.” |
|
2. |
“Your weight gain is more
likely related to food intake than medication.” |
|
3. |
“Weight gain is a common,
but troubling side effect. Let’s talk about some strategies for safely
improving your nutrition and exercise habits.” |
|
4. |
“There’s not much you can
do about the weight gain. It’s better than being emotionally unstable,
though.” |
____ 6. The nurse is assessing a
client who has a diagnosis of schizophrenia and takes an antipsychotic agent
daily. Which finding requires further nursing assessment?
|
1. |
Respirations of 22
beats/minute |
|
2. |
Weight gain of 8 lbs. in 2
months |
|
3. |
Temperature of 101oF |
|
4. |
Excess salivation |
____ 7. An aging client with
chronic schizophrenia takes a beta-adrenergic blocking agent (propranolol) for
hypertension and an antipsychotic. Given the combined side effects of these
drugs, what teaching should the nurse provide?
|
1. |
“Make sure you concentrate
on taking slow, deep, cleansing breaths.” |
|
2. |
“Watch your diet and try to
engage in some regular physical activity.” |
|
3. |
“Rise slowly when you
change position from lying to sitting or sitting to standing.” |
|
4. |
“Wear sunscreen and try to
avoid midday sun exposure.” |
____ 8. A client with depression
and substance abuse has an interrupted sleep pattern. She demands that her
psychiatrist prescribe her a sedative. What teaching would the nurse provide
about the rationale for the use of nonpharmacological interventions instead?
|
1. |
“Sedative-hypnotics are
potentially addictive and gradually lose their effectiveness as one builds up
tolerance to them.” |
|
2. |
“Sedative-hypnotics work
best in combination with other techniques.” |
|
3. |
“Sedative-hypnotics are not
permitted for use in patients with substance abuse disorders.” |
|
4. |
“Sedative-hypnotics are not
as effective as the antidepressant medications for treating sleep
disturbances.” |
____ 9. Which statement about the
tricyclic group of antidepressant medications is accurate?
|
1. |
Strong or aged cheese
should not be eaten while taking them. |
|
2. |
Their full therapeutic
potential may not be reached until 4 weeks. |
|
3. |
They may cause hypomania or
recent memory impairment. |
|
4. |
They should not be given
with antianxiety agents. |
____ 10. A client was admitted with major
depression that was a single episode and moderate. During her stay, she was
started on Prozac (fluoxetine) at 40 mg orally every day. The nurse’s discharge
teaching should include all of the following except:
|
1. |
Continue taking Prozac as
prescribed. You will continue to see improvement over the next few weeks. |
|
2. |
Make sure that you follow
up with outpatient psychotherapy as you and the social worker have arranged. |
|
3. |
You may be able to
discontinue the medication within 6 months to 1 year, but only under a
doctor’s supervision. However, there is a chance of recurring episodes. |
|
4. |
You should avoid foods with
tyramine, including beer, beans, processed meats, and red wine. |
____ 11. In the treatment of anxiety disorders,
benzodiazepines (such as Ativan and Xanax) are indicated for_________ use and
have__________ abuse potential.
|
1. |
short-term; high |
|
2. |
long-term; high |
|
3. |
short-term; low |
|
4. |
long-term; low |
____ 12. Which medication does not require
periodic blood-level monitoring?
|
1. |
Eskalith (lithium
carbonate) |
|
2. |
Depakote (valproic acid) |
|
3. |
Clozaril (clozapine) |
|
4. |
Paxil (paroxetine) |
____ 13. As part of discharge teaching, which
guideline regarding lithium therapy will the nurse plan to include?
|
1. |
Avoid excessive use of
beverages containing caffeine. |
|
2. |
Maintain a consistent
sodium intake. |
|
3. |
Consume at least 2,500 to
3,000 mL of fluid per day. |
|
4. |
All of the above |
____ 14. A client with schizophrenia has recently
begun a new medication, clozapine (Clozaril). Which potentially fatal side
effect will the nurse teach the client about?
|
1. |
Agranulocytosis |
|
2. |
Akathisia |
|
3. |
Dystonia |
|
4. |
Akinesia |
____ 15. A client with schizophrenia has
recently begun a new medication, clozapine (Clozaril). Which signs and symptoms
of a potentially fatal side effect will the nurse teach the client about?
|
1. |
Blurring vision and
muscular weakness |
|
2. |
Sore throat, fever, and
malaise |
|
3. |
Tremor, shuffling gait, and
rigidity |
|
4. |
Fine tremor, tinnitus, and
nausea |
____ 16. A client with schizophrenia has
recently begun a new medication, clozapine (Clozaril). Which blood cell counts
would reveal a potentially fatal side effect of this medication?
|
1. |
WBCs, >3,000/mm3; granulocytes,
>2,000/mm3 |
|
2. |
WBCs, <3,000/mm3; granulocytes,
>2,000/mm3 |
|
3. |
WBCs, >3,000/mm3; granulocytes,
<2,000/mm3 |
|
4. |
WBCs, <3,000/mm3; granulocytes,
<2,000/mm3 |
____ 17. A psychiatrist prescribes a MAOI for
a client. When teaching the client about the effects of tyramine, which foods
will the nurse caution the client to avoid?
|
1. |
Pepperoni pizza and red
wine |
|
2. |
Bagels with cream cheese
and tea |
|
3. |
Apple pie and coffee |
|
4. |
Potato chips and Diet Coke |
____ 18. A client has been diagnosed with
major depression and is prescribed imipramine (Tofranil). What information
specifically related to this class of antidepressants will the nurse plan to
include in client and family education?
|
1. |
The medication may cause
dry mouth. |
|
2. |
The medication may cause
nausea. |
|
3. |
The medication should not
be discontinued abruptly. |
|
4. |
The medication may cause
photosensitivity. |
____ 19. Which information suggests that
caution is necessary in prescribing a benzodiazepine to an anxious client?
|
1. |
The client has a history of
alcohol dependence. |
|
2. |
The client has a history of
diabetes mellitus. |
|
3. |
The client has a history of
schizophrenia. |
|
4. |
The client has a history of
hypertension. |
____ 20. Which medication is most likely to be
prescribed for the extrapyramidal side effects of antipsychotic medications?
|
1. |
Diazepam (Valium) |
|
2. |
Amitriptyline (Elavil) |
|
3. |
Benztropine (Cogentin) |
|
4. |
Methylphenidate (Ritalin) |
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