Mental Health Varcarolis Ch. 9: Legal and Ethical Issues
Which is the most important reason for psychiatric nurses to understand law, legislation, and legal
processes that relate to professional nursing practice? Correct Answer: Because doing so gives the
nurse the ability to provide quality care that will safeguard the rights and safety of clients.
Explanation:
Nurses practice under the Code of Ethics and the Scope of Practice. Nurses must learn to value, respect,
and develop knowledge about laws, legislation, and the legal processes that regulate, impede, and
facilitate professional nursing practice.
While performing the admission assessment of a new client, the nurse observed that the client brought
a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or
remove the medication from the room. Subsequently, the client experienced a serious adverse drug
reaction as a result of the interaction between this drug and one of the drugs that the client was
prescribed in the hospital. This nurse may be guilty of what? Correct Answer: Malpractice
Explanation:
The four elements of nursing malpractice are evident in this scenario. Assault is an act that puts another
person in apprehension of being touched (or of bodily harm without consent), and failure of duty to
warn surrounds a client's threat to harm another person. Incompetence, in the legal sense, surrounds a
client's right to autonomy.
A psychiatric nursing class is discussing current trends in mental health care. A student voices the
opinion that there should be equitable access to mental health care and resources for those who live in
rural areas, for those without health insurance, and for those with very little income. The student
nurse's opinion most closely reflects which ethical principle? Correct Answer: justice
Explanation:
Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue
when some portion of a population does not have access to health care. Nonmaleficence is the duty to
cause no harm, both individually and for all. Paternalism is the belief that knowledge and education
authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth.
A nursing student is initiating a relationship with an assigned client. After meeting and spending
approximately 20 minutes talking with the client, the student makes arrangements to visit again after
lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of
clients to play volleyball. The student starts to go with them but then remembers the promise to meet
with the client. The student decides to forgo volleyball and talk with the client. The student's decision
reflects which ethical principle? Correct Answer: fidelity
Explanation:
Fidelity is faithfulness to obligations and duties. It is keeping promises. Fidelity is important in
establishing trusting relationships. With autonomy, each person has the fundamental right of self-
determination. According to the principle of beneficence, a health care provider uses knowledge of
science and incorporates the art of caring to develop an environment in which individuals achieve their
maximal health care potential. Veracity is the duty to tell the truth.
,Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then
supports him or her in whatever decision he or she makes? Correct Answer: Advocate
Explanation:
In the advocate role, the nurse informs the client and then supports him or her in whatever decision he
or she makes. The primary caregiving role in mental health settings is the implementation of the
therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the
client about the medication regimen. In the role of the parent surrogate, the nurse may be tempted to
assume a parental role.
A psychiatric-mental health nurse is practicing at the advanced level. Which function would this nurse be
able to perform based on the nurse's advanced level of preparation? Correct Answer: Psychotherapy
Explanation:
Although the advanced level psychiatric-mental health nurse would be able to perform the functions of
health promotion, counseling, and intake screening, because of the nurse's advanced level of
preparation, the nurse would be able to perform psychotherapy. Health promotion, counseling, and
intake screening are basic-level functions in the practice area of psychiatric-mental health nursing.
A client with depression tells the nurse, "I want to stop taking my antidepressant medication because I
don't like taking medications." The nurse discusses the benefits of adhering to the medication plan and
strongly urges the client to use the medication. The nurse interprets the client's statement as reflecting
which ethical principle? Correct Answer: autonomy
Explanation:
Autonomy reflects the fundamental right of all persons for self-determination, to make independently
make choices. Autonomy is reflected by the client's statement to stop taking the medication. The nurse's
urging the client to continue to use the medication because of the medication's benefits reflects the
principle of beneficence, that is, the nurse is using scientific knowledge and incorporating that
knowledge to promote the client's maximum health potential. In this case, the medication would help to
control the client's depressive symptoms. Justice reflects the duty to treat all fairly; paternalism is the
belief that knowledge and education authorize professionals to make decisions for the good of the
client.
The client is brought to the hospital in a coma. The nurse understands that when a person is
incapacitated, the document used to dictate the patient's written instructions for health care is called:
Correct Answer: advance directive
Explanation:
Advance care directives are written instructions for health care when individuals are incapacitated.
Informed consent, durable power of attorney, and patient rights are not instructions for health care
when individuals are incapacitated. A durable power of attorney means that the advance care directives
stays in effect if you become incapacitated and unable to handle matters on your own. Informed
consent is the permission granted in the knowledge of the possible consequences, typically that which is
given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.
Patient rights are those basic rule of conduct between patients and medical caregivers as well as the
institutions and people that support them.
, The client has not been on speaking terms with the client's parents for several years. The parents have
expressed a desire to reunite with the client. At first, the client agreed to a family meeting, and then
decided not to meet with the parents. The nurse has encouraged the client to attend the family meeting
knowing that the family's support would be valuable. What ethical principles are in conflict in this
situation? Correct Answer: autonomy and beneficence
Explanation:
According to the principle of autonomy, each person has the fundamental right of self-determination.
According to the principle of beneficence, the health care provider uses knowledge of science and
incorporates the art of caring to develop an environment in which individuals achieve their maximal
health care potential. The client has the right to decide whether to go to a family meeting or not, and
the nurse urges the client to go to the meeting because the nurse knows that the family will be a great
support to the client. The ethical principles that are not in conflict in this situation are justice and
beneficence, non-maleficence and autonomy, and veracity and fidelity.
A client with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the way it
makes me feel, I feel like I'm under water when I take it." The nurse explains, "schizophrenia is caused
by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. Your
symptoms will get better if you take the medication." This conversation reflects conflict between which
ethical principles? Correct Answer: autonomy and beneficence
Explanation:
According to the principle of autonomy, each person has the fundamental right of self-determination.
According to the principle of beneficence, the health care provider uses knowledge of science and
incorporates the art of caring to develop an environment in which individuals achieve their maximal
health care potential. The client has the right to decide whether or not to take the medication. The
nurse knows that the medication will help the chemical imbalance and thus help with the manifestations
of schizophrenia. There is no conflict between the ethical principles of Justice and nonmaleficence,
autonomy and justice, and fidelity and veracity.
A nurse sitting with a client in a therapy session with the psychotherapist hears the client state, "I have
had it with this marriage. I'm telling you, and not that I ever would do it, but I feel like hiring a hit man to
kill my spouse!" Which action is the nurse obligated to take? Correct Answer: Warn the client's spouse,
based on the Tarasoff rule.
Explanation:
Mental health clinicians have a duty to warn identifiable third parties of threats made by clients even if
the threats were discussed during a therapeutic session otherwise protected by client-therapist
privilege.
A physician would like to include a client with schizophrenia in a research study testing a new
medication. The nurse's obligation is to do what? Correct Answer: Assess the client's legal capacity
when that client is asked to give consent.
Explanation:
The nurse serves as the client's advocate, the team's colleague, and the facility's excellent employee by
continually evaluating the client's ability to give informed consent and his or her willingness to
Which is the most important reason for psychiatric nurses to understand law, legislation, and legal
processes that relate to professional nursing practice? Correct Answer: Because doing so gives the
nurse the ability to provide quality care that will safeguard the rights and safety of clients.
Explanation:
Nurses practice under the Code of Ethics and the Scope of Practice. Nurses must learn to value, respect,
and develop knowledge about laws, legislation, and the legal processes that regulate, impede, and
facilitate professional nursing practice.
While performing the admission assessment of a new client, the nurse observed that the client brought
a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or
remove the medication from the room. Subsequently, the client experienced a serious adverse drug
reaction as a result of the interaction between this drug and one of the drugs that the client was
prescribed in the hospital. This nurse may be guilty of what? Correct Answer: Malpractice
Explanation:
The four elements of nursing malpractice are evident in this scenario. Assault is an act that puts another
person in apprehension of being touched (or of bodily harm without consent), and failure of duty to
warn surrounds a client's threat to harm another person. Incompetence, in the legal sense, surrounds a
client's right to autonomy.
A psychiatric nursing class is discussing current trends in mental health care. A student voices the
opinion that there should be equitable access to mental health care and resources for those who live in
rural areas, for those without health insurance, and for those with very little income. The student
nurse's opinion most closely reflects which ethical principle? Correct Answer: justice
Explanation:
Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue
when some portion of a population does not have access to health care. Nonmaleficence is the duty to
cause no harm, both individually and for all. Paternalism is the belief that knowledge and education
authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth.
A nursing student is initiating a relationship with an assigned client. After meeting and spending
approximately 20 minutes talking with the client, the student makes arrangements to visit again after
lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of
clients to play volleyball. The student starts to go with them but then remembers the promise to meet
with the client. The student decides to forgo volleyball and talk with the client. The student's decision
reflects which ethical principle? Correct Answer: fidelity
Explanation:
Fidelity is faithfulness to obligations and duties. It is keeping promises. Fidelity is important in
establishing trusting relationships. With autonomy, each person has the fundamental right of self-
determination. According to the principle of beneficence, a health care provider uses knowledge of
science and incorporates the art of caring to develop an environment in which individuals achieve their
maximal health care potential. Veracity is the duty to tell the truth.
,Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then
supports him or her in whatever decision he or she makes? Correct Answer: Advocate
Explanation:
In the advocate role, the nurse informs the client and then supports him or her in whatever decision he
or she makes. The primary caregiving role in mental health settings is the implementation of the
therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the
client about the medication regimen. In the role of the parent surrogate, the nurse may be tempted to
assume a parental role.
A psychiatric-mental health nurse is practicing at the advanced level. Which function would this nurse be
able to perform based on the nurse's advanced level of preparation? Correct Answer: Psychotherapy
Explanation:
Although the advanced level psychiatric-mental health nurse would be able to perform the functions of
health promotion, counseling, and intake screening, because of the nurse's advanced level of
preparation, the nurse would be able to perform psychotherapy. Health promotion, counseling, and
intake screening are basic-level functions in the practice area of psychiatric-mental health nursing.
A client with depression tells the nurse, "I want to stop taking my antidepressant medication because I
don't like taking medications." The nurse discusses the benefits of adhering to the medication plan and
strongly urges the client to use the medication. The nurse interprets the client's statement as reflecting
which ethical principle? Correct Answer: autonomy
Explanation:
Autonomy reflects the fundamental right of all persons for self-determination, to make independently
make choices. Autonomy is reflected by the client's statement to stop taking the medication. The nurse's
urging the client to continue to use the medication because of the medication's benefits reflects the
principle of beneficence, that is, the nurse is using scientific knowledge and incorporating that
knowledge to promote the client's maximum health potential. In this case, the medication would help to
control the client's depressive symptoms. Justice reflects the duty to treat all fairly; paternalism is the
belief that knowledge and education authorize professionals to make decisions for the good of the
client.
The client is brought to the hospital in a coma. The nurse understands that when a person is
incapacitated, the document used to dictate the patient's written instructions for health care is called:
Correct Answer: advance directive
Explanation:
Advance care directives are written instructions for health care when individuals are incapacitated.
Informed consent, durable power of attorney, and patient rights are not instructions for health care
when individuals are incapacitated. A durable power of attorney means that the advance care directives
stays in effect if you become incapacitated and unable to handle matters on your own. Informed
consent is the permission granted in the knowledge of the possible consequences, typically that which is
given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.
Patient rights are those basic rule of conduct between patients and medical caregivers as well as the
institutions and people that support them.
, The client has not been on speaking terms with the client's parents for several years. The parents have
expressed a desire to reunite with the client. At first, the client agreed to a family meeting, and then
decided not to meet with the parents. The nurse has encouraged the client to attend the family meeting
knowing that the family's support would be valuable. What ethical principles are in conflict in this
situation? Correct Answer: autonomy and beneficence
Explanation:
According to the principle of autonomy, each person has the fundamental right of self-determination.
According to the principle of beneficence, the health care provider uses knowledge of science and
incorporates the art of caring to develop an environment in which individuals achieve their maximal
health care potential. The client has the right to decide whether to go to a family meeting or not, and
the nurse urges the client to go to the meeting because the nurse knows that the family will be a great
support to the client. The ethical principles that are not in conflict in this situation are justice and
beneficence, non-maleficence and autonomy, and veracity and fidelity.
A client with schizophrenia is refusing antipsychotic medication. The client states, "I don't like the way it
makes me feel, I feel like I'm under water when I take it." The nurse explains, "schizophrenia is caused
by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. Your
symptoms will get better if you take the medication." This conversation reflects conflict between which
ethical principles? Correct Answer: autonomy and beneficence
Explanation:
According to the principle of autonomy, each person has the fundamental right of self-determination.
According to the principle of beneficence, the health care provider uses knowledge of science and
incorporates the art of caring to develop an environment in which individuals achieve their maximal
health care potential. The client has the right to decide whether or not to take the medication. The
nurse knows that the medication will help the chemical imbalance and thus help with the manifestations
of schizophrenia. There is no conflict between the ethical principles of Justice and nonmaleficence,
autonomy and justice, and fidelity and veracity.
A nurse sitting with a client in a therapy session with the psychotherapist hears the client state, "I have
had it with this marriage. I'm telling you, and not that I ever would do it, but I feel like hiring a hit man to
kill my spouse!" Which action is the nurse obligated to take? Correct Answer: Warn the client's spouse,
based on the Tarasoff rule.
Explanation:
Mental health clinicians have a duty to warn identifiable third parties of threats made by clients even if
the threats were discussed during a therapeutic session otherwise protected by client-therapist
privilege.
A physician would like to include a client with schizophrenia in a research study testing a new
medication. The nurse's obligation is to do what? Correct Answer: Assess the client's legal capacity
when that client is asked to give consent.
Explanation:
The nurse serves as the client's advocate, the team's colleague, and the facility's excellent employee by
continually evaluating the client's ability to give informed consent and his or her willingness to
