Chapter 9 - Legal and Ethical Issues:
Test Bank for Psychiatric-Mental Health Nursing, 8th Edition
1. A client made threats to harm his parents if they come too close to him. The
parents called 911, and the client is now held involuntarily for a psychiatric
evaluation. During this time of involuntary admission, the client retains all client
rights except for which of the following?
A) Confidentiality
B) Right to freedom
C) Periodic treatment review
D) Choice of providers
Answer: B
Explanation: Involuntary hospitalization, or civil commitment, specifically curtails the
client's right to liberty and freedom, meaning they cannot leave the hospital at will. All other
client rights, including confidentiality, periodic treatment review, and choice of providers,
remain intact.
2. Which of the following would be circumstances when a client could be subjected
to involuntary hospitalization? Select all that apply.
A) When a client states that he or she intends to commit suicide and is making plans
to do so.
B) When a client does not bathe regularly or change clothes often.
C) When a client states that he or she intends to harm others by a deliberate act.
D) When a client who has diabetes refuses to follow the prescribed diet.
E) When a client is unable to control his or her rage and is assaulting everyone around
him or her.
Answer: A, C, E
Explanation: Involuntary hospitalization is justified when a client poses a danger to
themselves (suicidal intent with a plan) or others (threatening or assaultive behavior). Poor
hygiene and nonadherence to a medical diet do not constitute imminent danger warranting
involuntary commitment.
3. A client who has depression is admitted to treatment on a voluntary basis. While
in the hospital, the client makes several comments about wanting to "end it all."
The client decides one day to leave against medical advice. Which of the
following would be the most appropriate action by the nursing staff?
A) Calling security and asking them to detain the client
, B) Allowing the client to leave with community resources for follow-up care
C) Contacting the psychiatrist for initiation of commitment proceedings
D) Contacting the client's family to request they convince the client to stay
Answer: C
Explanation: If a voluntary client who is dangerous to themselves or others requests
discharge, the psychiatrist can initiate civil commitment proceedings to legally detain the
client for evaluation until a hearing determines the need for continued hospitalization.
4. Which of the following clients would most likely be mandated outpatient
treatment?
A) A client who is addicted to alcohol who has two DUI offenses
B) A client with schizophrenia who lives in a single family home with siblings
C) A client with bipolar disorder who has quit three jobs in the last 6 months
D) A homeless client who has been arrested for petty theft of groceries from a
convenience store.
Answer: A
Explanation: Mandatory outpatient treatment is often court-ordered for individuals with
severe, persistent mental illness who have repeated contacts with the legal system, such as
multiple DUI offenses, especially when voluntary treatment compliance has been
unsuccessful.
5. Under which conditions would it be in the client's best interest for the court to
appoint a conservator, or legal guardian? Select all that apply.
A) Gravely disabled
B) Mentally incompetent
C) Noncompliant
D) Unable to provide basic needs when resources exist
E) Act only on his or her own interests
Answer: A, B, D
Explanation: A conservator or legal guardian is appointed for individuals who are gravely
disabled, found mentally incompetent, or unable to provide for their basic needs (food,
clothing, shelter) even when resources are available. Noncompliance or self-interest alone are
not sufficient grounds.
6. An adolescent on the unit is argumentative with staff and peers. The nurse tells
the adolescent, "Arguing is not allowed. One more word and you will have to
stay in your room the rest of the day." The nurse's directive is
, A) inappropriate; room restriction is not treatment in the least restrictive environment.
B) inappropriate; the adolescent should be offered a sedative before room restriction.
C) appropriate; room restriction is an effective behavior modification technique.
D) appropriate; the adolescent should not have conflicts with others.
Answer: A
Explanation: Clients have the right to treatment in the least restrictive environment. Room
restriction should not be used as a first-line intervention; verbal and behavioral techniques
should be attempted first. Sedation is not an appropriate alternative to de-escalation.
7. The nurse on an addictive disorders unit receives a phone call inquiring about
the status of a client. The caller is not on the client's allowed contact list. Which
of the following is the appropriate response by the nurse to the caller?
A) "I cannot confirm or deny the existence of any client here."
B) "You will need to be placed on the client's contact list before I can discuss any
information with you."
C) "The person you are asking for is not a client here."
D) "Hold 1 minute while I get the client for you."
Answer: A
Explanation: HIPAA regulations require protecting client confidentiality. The nurse should
not confirm or deny a client's presence, as doing so would disclose protected health
information.
8. Which of the following client situations most urgently requires the nurse to
break confidentiality and warn a third party?
A) An abused woman states, "I have dreams that he is dead."
B) A mother states, "Sometimes I feel like killing my kids!"
C) A paranoid woman states, "I'll get them before they get me."
D) A jealous man states, "I am getting my gun and going to shoot my wife's lover!"
Answer: D
Explanation: The duty to warn applies when a client makes a specific, imminent threat of
serious harm to an identifiable third party and has the means to carry it out. The threat in
option D meets all these criteria.
9. A 22-year-old client has been manipulative of staff and disruptive in the milieu.
Although she is not dangerous to herself or others, she has created problems on
the unit and clearly is not making progress. The nurses offer prescribed
medication, but she consistently refuses any drugs. The staff realizes that legally
, this client can
A) be coerced to accept treatment.
B) be committed by her family to receive needed treatment.
C) have her family sign permission for treatment.
D) continue to refuse treatment.
Answer: D
Explanation: A client who is not dangerous to themselves or others retains the right to refuse
treatment, even if it is medically or therapeutically indicated.
10. A client who had agreed to be hospitalized for depression problems has decided
that now she wants to leave the hospital. The mental health staff caring for her
realizes that at present she can legally
A) be discharged if evaluated through administrative hearings.
B) be retained in the hospital against her will.
C) leave the hospital after giving written notice of her intent to do so.
D) leave without discussing the situation with anyone.
Answer: C
Explanation: A voluntary client who is not dangerous to themselves or others can leave the
hospital against medical advice, typically by providing written notice of their intent to
discharge.
11. Two nurses are discussing the rights of hospitalized psychiatric clients. Which of
the following statements is an error?
A) Confidentiality allows for the disclosure of information under specific
circumstances.
B) If a committed client is also found to be incompetent, he loses his rights under the
Patient's Bill of Rights.
C) Privileged communication does not apply to medical records, and they can be used
in court.
D) Clients can never be held against their will.
Answer: B
Explanation: Being committed or declared incompetent does not negate a client's rights under
the Patient's Bill of Rights. However, a court-appointed guardian may assume certain
decision-making responsibilities.
12. When is a nurse legally obligated to breach confidentiality?
A) At any time a client is threatening
Test Bank for Psychiatric-Mental Health Nursing, 8th Edition
1. A client made threats to harm his parents if they come too close to him. The
parents called 911, and the client is now held involuntarily for a psychiatric
evaluation. During this time of involuntary admission, the client retains all client
rights except for which of the following?
A) Confidentiality
B) Right to freedom
C) Periodic treatment review
D) Choice of providers
Answer: B
Explanation: Involuntary hospitalization, or civil commitment, specifically curtails the
client's right to liberty and freedom, meaning they cannot leave the hospital at will. All other
client rights, including confidentiality, periodic treatment review, and choice of providers,
remain intact.
2. Which of the following would be circumstances when a client could be subjected
to involuntary hospitalization? Select all that apply.
A) When a client states that he or she intends to commit suicide and is making plans
to do so.
B) When a client does not bathe regularly or change clothes often.
C) When a client states that he or she intends to harm others by a deliberate act.
D) When a client who has diabetes refuses to follow the prescribed diet.
E) When a client is unable to control his or her rage and is assaulting everyone around
him or her.
Answer: A, C, E
Explanation: Involuntary hospitalization is justified when a client poses a danger to
themselves (suicidal intent with a plan) or others (threatening or assaultive behavior). Poor
hygiene and nonadherence to a medical diet do not constitute imminent danger warranting
involuntary commitment.
3. A client who has depression is admitted to treatment on a voluntary basis. While
in the hospital, the client makes several comments about wanting to "end it all."
The client decides one day to leave against medical advice. Which of the
following would be the most appropriate action by the nursing staff?
A) Calling security and asking them to detain the client
, B) Allowing the client to leave with community resources for follow-up care
C) Contacting the psychiatrist for initiation of commitment proceedings
D) Contacting the client's family to request they convince the client to stay
Answer: C
Explanation: If a voluntary client who is dangerous to themselves or others requests
discharge, the psychiatrist can initiate civil commitment proceedings to legally detain the
client for evaluation until a hearing determines the need for continued hospitalization.
4. Which of the following clients would most likely be mandated outpatient
treatment?
A) A client who is addicted to alcohol who has two DUI offenses
B) A client with schizophrenia who lives in a single family home with siblings
C) A client with bipolar disorder who has quit three jobs in the last 6 months
D) A homeless client who has been arrested for petty theft of groceries from a
convenience store.
Answer: A
Explanation: Mandatory outpatient treatment is often court-ordered for individuals with
severe, persistent mental illness who have repeated contacts with the legal system, such as
multiple DUI offenses, especially when voluntary treatment compliance has been
unsuccessful.
5. Under which conditions would it be in the client's best interest for the court to
appoint a conservator, or legal guardian? Select all that apply.
A) Gravely disabled
B) Mentally incompetent
C) Noncompliant
D) Unable to provide basic needs when resources exist
E) Act only on his or her own interests
Answer: A, B, D
Explanation: A conservator or legal guardian is appointed for individuals who are gravely
disabled, found mentally incompetent, or unable to provide for their basic needs (food,
clothing, shelter) even when resources are available. Noncompliance or self-interest alone are
not sufficient grounds.
6. An adolescent on the unit is argumentative with staff and peers. The nurse tells
the adolescent, "Arguing is not allowed. One more word and you will have to
stay in your room the rest of the day." The nurse's directive is
, A) inappropriate; room restriction is not treatment in the least restrictive environment.
B) inappropriate; the adolescent should be offered a sedative before room restriction.
C) appropriate; room restriction is an effective behavior modification technique.
D) appropriate; the adolescent should not have conflicts with others.
Answer: A
Explanation: Clients have the right to treatment in the least restrictive environment. Room
restriction should not be used as a first-line intervention; verbal and behavioral techniques
should be attempted first. Sedation is not an appropriate alternative to de-escalation.
7. The nurse on an addictive disorders unit receives a phone call inquiring about
the status of a client. The caller is not on the client's allowed contact list. Which
of the following is the appropriate response by the nurse to the caller?
A) "I cannot confirm or deny the existence of any client here."
B) "You will need to be placed on the client's contact list before I can discuss any
information with you."
C) "The person you are asking for is not a client here."
D) "Hold 1 minute while I get the client for you."
Answer: A
Explanation: HIPAA regulations require protecting client confidentiality. The nurse should
not confirm or deny a client's presence, as doing so would disclose protected health
information.
8. Which of the following client situations most urgently requires the nurse to
break confidentiality and warn a third party?
A) An abused woman states, "I have dreams that he is dead."
B) A mother states, "Sometimes I feel like killing my kids!"
C) A paranoid woman states, "I'll get them before they get me."
D) A jealous man states, "I am getting my gun and going to shoot my wife's lover!"
Answer: D
Explanation: The duty to warn applies when a client makes a specific, imminent threat of
serious harm to an identifiable third party and has the means to carry it out. The threat in
option D meets all these criteria.
9. A 22-year-old client has been manipulative of staff and disruptive in the milieu.
Although she is not dangerous to herself or others, she has created problems on
the unit and clearly is not making progress. The nurses offer prescribed
medication, but she consistently refuses any drugs. The staff realizes that legally
, this client can
A) be coerced to accept treatment.
B) be committed by her family to receive needed treatment.
C) have her family sign permission for treatment.
D) continue to refuse treatment.
Answer: D
Explanation: A client who is not dangerous to themselves or others retains the right to refuse
treatment, even if it is medically or therapeutically indicated.
10. A client who had agreed to be hospitalized for depression problems has decided
that now she wants to leave the hospital. The mental health staff caring for her
realizes that at present she can legally
A) be discharged if evaluated through administrative hearings.
B) be retained in the hospital against her will.
C) leave the hospital after giving written notice of her intent to do so.
D) leave without discussing the situation with anyone.
Answer: C
Explanation: A voluntary client who is not dangerous to themselves or others can leave the
hospital against medical advice, typically by providing written notice of their intent to
discharge.
11. Two nurses are discussing the rights of hospitalized psychiatric clients. Which of
the following statements is an error?
A) Confidentiality allows for the disclosure of information under specific
circumstances.
B) If a committed client is also found to be incompetent, he loses his rights under the
Patient's Bill of Rights.
C) Privileged communication does not apply to medical records, and they can be used
in court.
D) Clients can never be held against their will.
Answer: B
Explanation: Being committed or declared incompetent does not negate a client's rights under
the Patient's Bill of Rights. However, a court-appointed guardian may assume certain
decision-making responsibilities.
12. When is a nurse legally obligated to breach confidentiality?
A) At any time a client is threatening
