Test Bank - Varcarolis\' Foundations of
Psychiatric Mental Health Nursing
(8th Edition) {Chapters 06-10}
C HAPTER 06: L EGAL AND E THICAL
C ONSIDERATIONS
MULTIPLE CHOICE
1. Insurance will not pay for continued private hospitalization of a mentall y
ill patient. The family considers transferring the patient to a public
hospital but expresses concern that the patient will not get any treatment
if transferred. Select the nurses most helpful repl y.
a. By law, treatment must be provided. Hospitalization without
treatment violates patients ri ghts.
b. All patients in public hospitals have the right to choose both a
primary therapist and a primary nurse.
c. You have a justifiable concern because the right to treatment
extends onl y to provision of food, shelter, and safet y.
d. Much will depend on other pa tients, because the right to treatment
for a psychotic patient takes precedence over the right to treatment
of a patient who is stable.
ANS: A
The right to medical and psychiatric treatment was conferred on all
patients hospitalized in public mental hosp itals with the enactment of
the federal Hospitalization of Mentall y Il l Act in 1964.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 94 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
,2. Which individual with mental illness may need emergency or involuntary
admission? The individual who:
a. resumes using heroin while still taking naltrexone (ReVia).
b. reports hearing angels playing harps during thunderstorms.
c. does not keep an outpatient appointment with th e mental health
nurse.
d. throws a heavy plate at a waiter at the direction of command
hallucinations.
ANS: D
Throwing a heavy plate is likel y to harm the waiter and is evidence of
dangerousness to others. This behavior meets the criteria for
emergency or involuntary hospitalization for mental illness. The
behaviors in the other options evidence mental illness but not
dangerousness. See related audience response question.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 93
TOP: Nursing Process: Impl ementation MSC: Client
Needs: Safe, Effective Care Environment
3. A patient in alcohol rehabilitation reveals to the nurse, I feel terrible guilt
for sexuall y abusing my 6 -year- old before I was admitted. Select the
nurses most important action.
a. Anonymousl y report the abuse by phone to the local child protection
agency.
b. Repl y, Im glad you feel comfortable talking to me about it.
c. File a written report with the agencys ethics committee.
d. Respect nurse-patient relationship confidentialit y.
ANS: A
Laws regardin g child abuse reporting discovered by a professional
during the suspected abusers alcohol or drug treatment differ by state.
Federal law supersedes state law and prohibits disclosure without a
court order except in instances in which the report can be made
anonymousl y or without identifying the abuser as a patient in an
alcohol or drug treatment facilit y.
, PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 99 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
4. A famil y member of a patient with delusions of persecution asks the
nurse, Are there any circumstances under which the treatment team is
justified in violating a patients right to confidentialit y? The nurse should
repl y that confidentialit y may be breached:
a. under no circumstances.
b. at the discretion of the psychiatrist.
c. when questions are asked by law enforcement.
d. if the patient threatens the life of another person.
ANS: D
The dut y to warn a person whose life has been threatened by a
ps ychiatric patient overrides the patients right to confidentiality. The
right to confidentiality is not suspended at the discretion of the
therapist or for legal investigations.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 99 TOP: Nursing Process: Impleme ntation
MSC: Client Needs: Safe, Effective Care Environment
5. A new antidepressant is prescribed for an elderl y patient with major
depression, but the dose is more than the usual geriatric dose. The nurse
should:
a. consult a reliable drug reference.
b. teach the patient about possible side effects and adverse effects.
c. withhold the medication and confer with the health care provider.
d. encourage the patient to increase oral fluids to reduce drug
concentration.
ANS: C
, The dose of antidepressants for elderl y patien ts is often less than the
usual adult dose. The nurse should withhold the medication and consult
the health care provider who wrote the order. The nurses dut y is to
practice according to professional standards as well as intervene and
protect the patient.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 101 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
6. A patient diagnosed with schizophrenia believes a local minister stirred
evil spirits. The patient thre atens to bomb a local church. The psychiatrist
notifies the minister. Select the answer with the correct rationale. The
ps ychiatrist:
a. released information without proper authorization.
b. demonstrated the duty to warn and protect.
c. violated the patients confid entialit y.
d. avoided charges of malpractice.
ANS: B
It is the health care professionals dut y to warn or notify an intended
victim after a threat of harm has been made. Informing a potential
victim of a threat is a legal responsibilit y of the health care
professional. It is not a violation of confidentialit y.
PTS: 1 DIF: Cognitive Level: Un derstand (Comprehension)
REF: 101 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
7. A patient with psychosis became aggressive, struck another patient, and
required seclusion. Select the best documentation.
a. Patient struck another patient who attempted to leave day room to
go to bathroom. Seclusion necessary at 1415. Plan: Maintain
seclusion for 8 hours and keep these two patients away from each
other for 24 hours.
Psychiatric Mental Health Nursing
(8th Edition) {Chapters 06-10}
C HAPTER 06: L EGAL AND E THICAL
C ONSIDERATIONS
MULTIPLE CHOICE
1. Insurance will not pay for continued private hospitalization of a mentall y
ill patient. The family considers transferring the patient to a public
hospital but expresses concern that the patient will not get any treatment
if transferred. Select the nurses most helpful repl y.
a. By law, treatment must be provided. Hospitalization without
treatment violates patients ri ghts.
b. All patients in public hospitals have the right to choose both a
primary therapist and a primary nurse.
c. You have a justifiable concern because the right to treatment
extends onl y to provision of food, shelter, and safet y.
d. Much will depend on other pa tients, because the right to treatment
for a psychotic patient takes precedence over the right to treatment
of a patient who is stable.
ANS: A
The right to medical and psychiatric treatment was conferred on all
patients hospitalized in public mental hosp itals with the enactment of
the federal Hospitalization of Mentall y Il l Act in 1964.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 94 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
,2. Which individual with mental illness may need emergency or involuntary
admission? The individual who:
a. resumes using heroin while still taking naltrexone (ReVia).
b. reports hearing angels playing harps during thunderstorms.
c. does not keep an outpatient appointment with th e mental health
nurse.
d. throws a heavy plate at a waiter at the direction of command
hallucinations.
ANS: D
Throwing a heavy plate is likel y to harm the waiter and is evidence of
dangerousness to others. This behavior meets the criteria for
emergency or involuntary hospitalization for mental illness. The
behaviors in the other options evidence mental illness but not
dangerousness. See related audience response question.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 93
TOP: Nursing Process: Impl ementation MSC: Client
Needs: Safe, Effective Care Environment
3. A patient in alcohol rehabilitation reveals to the nurse, I feel terrible guilt
for sexuall y abusing my 6 -year- old before I was admitted. Select the
nurses most important action.
a. Anonymousl y report the abuse by phone to the local child protection
agency.
b. Repl y, Im glad you feel comfortable talking to me about it.
c. File a written report with the agencys ethics committee.
d. Respect nurse-patient relationship confidentialit y.
ANS: A
Laws regardin g child abuse reporting discovered by a professional
during the suspected abusers alcohol or drug treatment differ by state.
Federal law supersedes state law and prohibits disclosure without a
court order except in instances in which the report can be made
anonymousl y or without identifying the abuser as a patient in an
alcohol or drug treatment facilit y.
, PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 99 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
4. A famil y member of a patient with delusions of persecution asks the
nurse, Are there any circumstances under which the treatment team is
justified in violating a patients right to confidentialit y? The nurse should
repl y that confidentialit y may be breached:
a. under no circumstances.
b. at the discretion of the psychiatrist.
c. when questions are asked by law enforcement.
d. if the patient threatens the life of another person.
ANS: D
The dut y to warn a person whose life has been threatened by a
ps ychiatric patient overrides the patients right to confidentiality. The
right to confidentiality is not suspended at the discretion of the
therapist or for legal investigations.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 99 TOP: Nursing Process: Impleme ntation
MSC: Client Needs: Safe, Effective Care Environment
5. A new antidepressant is prescribed for an elderl y patient with major
depression, but the dose is more than the usual geriatric dose. The nurse
should:
a. consult a reliable drug reference.
b. teach the patient about possible side effects and adverse effects.
c. withhold the medication and confer with the health care provider.
d. encourage the patient to increase oral fluids to reduce drug
concentration.
ANS: C
, The dose of antidepressants for elderl y patien ts is often less than the
usual adult dose. The nurse should withhold the medication and consult
the health care provider who wrote the order. The nurses dut y is to
practice according to professional standards as well as intervene and
protect the patient.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 101 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
6. A patient diagnosed with schizophrenia believes a local minister stirred
evil spirits. The patient thre atens to bomb a local church. The psychiatrist
notifies the minister. Select the answer with the correct rationale. The
ps ychiatrist:
a. released information without proper authorization.
b. demonstrated the duty to warn and protect.
c. violated the patients confid entialit y.
d. avoided charges of malpractice.
ANS: B
It is the health care professionals dut y to warn or notify an intended
victim after a threat of harm has been made. Informing a potential
victim of a threat is a legal responsibilit y of the health care
professional. It is not a violation of confidentialit y.
PTS: 1 DIF: Cognitive Level: Un derstand (Comprehension)
REF: 101 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
7. A patient with psychosis became aggressive, struck another patient, and
required seclusion. Select the best documentation.
a. Patient struck another patient who attempted to leave day room to
go to bathroom. Seclusion necessary at 1415. Plan: Maintain
seclusion for 8 hours and keep these two patients away from each
other for 24 hours.
