Chapter 06: Legal and Ethical Considerations |Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. Which action by a psychiatric nurse best applies the ethical principle of autonomy? a. Exploring alternative solutions with the patient, who then makes a choice. b. Suggesting that two patients who were fighting be restricted to the unit. c. Intervening when a self-mutilating patient attempts to harm self. d. Staying with a patient demonstrating a high level of anxiety. ANS: A Autonomy is the right to self-determination, that is, to make one‘s own decisions. By exploring alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. The distracters demonstrate beneficence, fidelity, and justice. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-3, 4 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 2. A nurse finds a psychiatric advance directive in the medical record of a patient currently experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should a. review the directive with the patient to ensure it is current. b. ensure that the directive is respected in treatment planning. c. consider the directive only if there is a cardiac or respiratory arrest. d. encourage the patient to revise the directive in light of the current health problem. ANS: B The nurse has an obligation to honor the right to self-determination. An advanced psychiatric directive supports that goal. Since the patient is currently psychotic, the terms of the directive now apply. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 6-16 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 3. Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion a. reinforces the autonomy of the two patients. b. violates the civil rights of both patients. c. represents the intentional tort of battery. d. correctly places emphasis on safety. ANS: B Patients have a right to treatment in the least restrictive setting. Safety is important, but less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion violates the patient‘s autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 6-16 to 18, 53 (Table 6-3) TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 4. In a team meeting a nurse says, ―I‘m concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self- mutilating patient requires one-on-one supervision.‖ Which ethical principle most clearly applies to this situation? a. Beneficence b. Autonomy c. Fidelity d. Justice ANS: D The nurse is concerned about justice, that is, fair distribution of care, which includes treatment with the least restrictive methods for both patients. Beneficence means promoting the good of others. Autonomy is the right to make one‘s own decisions. Fidelity is the observance of loyalty and commitment to the patient. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 6-3 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 5. Select the example of a tort. a. The plan of care for a patient is not completed within 24 hours of the patient‘s admission. b. A nurse gives a prn dose of an antipsychotic drug to an agitated patient because the unit is short-staffed. c. An advanced practice nurse recommends hospitalization for a patient who is dangerous to self and others.