Chapter 09: Legal and Ethical Aspects in Clinical Practice ALL ANSWERS 100% CORRECT SPRING FALL-2022 LATEST SOLUTION GUARANTEED GRADE A+

1. An advanced practice nurse evaluates a patient for emergency commitment because of the likelihood the patient will do serious harm to others. Which statement best reflects the nurse’s role as patient advocate during the assessment process? a. “Tell me about any delusions you are experiencing.” b. “I understand you have had some difficulty today.” c. “Tell me why you need to threaten or hurt others around you.” d. “Threatening to hurt others will require that you be committed to the hospital.” ANS: B The advocacy role of nurses to help patients to obtain, maintain, and fully make use of mental health benefits is critical. Assessment for commitment requires data collection from the patient. This statement is the most neutral of the options given and the most open ended; therefore it will be most likely to elicit a response. It is an unfounded assumption that the patient is delusional. “Why” questions will usually elicit rationalizations from the patient. Making a statement about the resulting hospitalization is not information gathering. DIF: Cognitive Level: Application REF: Page 169 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 2. A patient was placed in restraints for 2 hours in order to help manage impulsive, destructive, unsafe behavior. Which statement made by the charge nurse during a meeting to discuss the incident shows an understanding of the need to use restraints only as a last resort? a. “How did this situation get so out of control?” b. “You all know that restraints are used only as a last resort.” c. “Can anyone tell me why restraints were used on this patient?” d. “Let’s review what exactly happened that led to the use of restrains.” ANS: D To facilitate an open, honest review of the incident that will permit learning to take place, the charge nurse must not place the staff on the defensive. Reviewing the events leading up to the patient being restrained in a nonaccusatory manner shows an understanding of proper restraint use. The other options imply the nurse manager does not believe the situation was handled in an appropriate way. DIF: Cognitive Level: Application REF: Page 173 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 3. The nurse is explaining the advantage of advanced directives to a patient diagnosed with schizophrenia. Which psychiatric outcome is a result of such preplanning? a. Allows healthcare providers to manage the patient’s mental health care b. Decreases the possibility that the patient will be committed involuntarily c. Directly impacts the type of care the patient will receive as the disease progresses d. Assures that the patient will retain continued autonomy and independence of living ANS: B The implementation of psychiatric advance directives significantly decreases involuntary commitments. Healthcare management and treatments are not affected by psychiatric advanced directives. The patient’s continued autonomy and independence is more related to the condition not the directives. DIF: Cognitive Level: Application REF: Page 170 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 4. A patient is being treated in the inpatient unit for paranoid delusions that his wife is unfaithful resulting in threats to “get her for this whenever I get out.” Which intervention to assure his wife’s safety will his primary therapist include in the discharge plan? a. Sharing the threats he has made with his wife b. Requiring mandatory day hospital attendance c. Advising the patient that he needs continued outpatient services d. Informing the patient of the consequences of harming his wife ANS: A The Tarasoff ruling established the necessity for a mental health professional treating a patient who threatens to harm another individual to warn the person against whom the threat is made. The remaining options are not directly related to affecting his wife’s safety. DIF: Cognitive Level: Application REF: Page 172 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 5. A patient who has schizoaffective disorder is being treated with lithium carbonate. He repeatedly resists his medication based on his fine hand tremors as proof of drug poisoning. Which nursing intervention addresses both the patient’s need to comply with treatment and patient rights? a. Informing staff that the patient is exhibiting manipulative behavior b. Providing the patient with effective education regarding medication side effects c. Assuring the patient the tremors are a result of the disorder, not of the medication d. Providing an assessment to determine if the patient is exhibiting paranoia as well ANS: B Although the patient has a legal right to refuse medication, medication compliance is vital to successful treatment. Patient and family medication education by nurses and a reassuring therapeutic relationship will greatly assist with medication adherence while preserving the patient’s rights. Identifying manipulative behavior or paranoia does not address compliance or patient rights. The assurance about the tremors is not true. DIF: Cognitive Level: Analysis REF: Page 174 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 6. A patient diagnosed with schizophrenia is hospitalized under an emergency commitment. Which nursing explanation is most effective when the patient asks, “Why am I being kept here?” a. “The court believed you needed mental health care.” b. “Your mental condition became unstable and you relapsed.” c. “You couldn’t stop doing things that could likely have hurt you.” d. “I’d suggest that you exercise your patient right to speak to a lawyer.” ANS: C When the effects of the patient’s mental illness result in an immediate risk of self- harm or harm to others, an emergency commitment is appropriate. While it is correct that such a commitment is court ordered and may be a result of a relapse, these options do not appropriately respond to the patient’s question. The patient does have a right to a lawyer, but this option fails to answer the patient’s question as well. DIF: Cognitive Level: Application REF: Page 170 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 7. A patient has been hospitalized and is now being mandated outpatient mental health treatment as a condition for discharge. Which intervention best addresses the nurse’s role of patient advocate when this patient resists the recommendation? a. Helping the patient identify advantages of outpatient versus inpatient therapy b. Sharing that outpatient therapy is less expensive than inpatient hospitalization c. Stressing that outpatient therapy can minimize the need for future hospitalization d. Discussing the patient’s opposition to outpatient treatment with the treatment team ANS: C The purpose of mandating outpatient mental health treatment is to break the cyclic pattern of patients who, when discharged from an inpatient treatment facility, subsequently require readmission to the acute psychiatric care setting. While the other options reflect the nurse as advocate, they do not best address this patient’s situation. DIF: Cognitive Level: Evaluation REF: Page 170 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 8. A patient admitted for treatment of symptoms related to paranoid schizophrenia refuses to sign a consent form allowing the nurse to discuss any aspect of his hospitalization with his parents. Which statement by the nurse best respects the patient’s rights while providing effective care? a. Reminding the parents that, “I can’t discuss your son even though I want to.” b. Asking the patient to, “please talk with me about why you don’t trust your parents?” Telling the patient that, “Keeping your parents uninvolved in your care is very painful for c. them.” Telling the parents that, “While I can’t discuss his care with you, you can tell me anything d. you think I need to know.” ANS: D This option provides the family the ability to communicate important medical or behavioral history to the treatment facility without the nurse releasing any information about the patient without that patient’s permission. It is inappropriate for the nurse to express such personal feelings about the patient’s wishes. Challenging the patient’s decision in these manners does not fulfill the nurse’s role as advocate. DIF: Cognitive Level: Application REF: Page 171 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 9. Electroconvulsive therapy (ECT) has been prescribed for a patient diagnosed with chronic depression. Which statement by the patient helps assure the nurse that the patient’s right to informed consent has been respected? a. “ECT treatment will cure my depression.” b. “ECT is dangerous but I’m almost out of treatments.” c. “I may not remember things that happened just before the ECT treatment.” d. “I’m likely to permanently lose memory of things like dates and numbers.” ANS: C A potential side effect is memory loss that is usually temporary but that can rarely be irreversible. It is not true that ECT either cures depression or that the treatment is considered physically dangerous. DIF: Cognitive Level: Application REF: Page 174 TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment: Management of Care, Psychological Integrity 10. A 15-year-old who shows poor impulse control and resistance to authority is prescribed outpatient therapy. The parents are insistent that the treatment include commitment to an inpatient facility. Which response by the nurse best supports the outpatient treatment modality? a. “Your child has a right to receive treatment in the least restrictive manner.” b. “Outpatient therapy is better accepted by teens that are authority resistant.” c. “This form of treatment is less expensive and usually covered by insurance.” d. “Short-term therapy like this is usually