University of San Francisco - NURS 320

Chapter 03: Legal Issues

Keltner: Psychiatric Nursing, 8th Edition

MULTIPLE CHOICE

1)Considering the M’Naghten Rule, what information is most important for the nurse to document when caring for a patient who will soon be tried on murder charges?

1. 1. The patient’s participation in treatment planning
   2. The patient’s comments about commission of the crime
   3. Examples of behaviors that support psychiatric diagnoses
   4. The patient’s perceptions of the need for hospitalization and treatment

2. When discussing the precedent established in Wyatt v. Stickney with nursing students, the nurse demonstrates an accurate understanding or the decision by focusing on what factor?
   1. Intellectualization of the client’s condition
   2. About the client’s rights to adequate treatment

3. A patient shouts, “I’m holding you responsible for mistreatment based on Rogers v. Orkin.” The nurse should review past care related to what focus?
   1. Loss of privileges
   2. Inability to make phone calls
   3. Medication administration
   4. Involuntary hospitalization

4. To help preserve patients’ rights to freedom from restraint and seclusion, the most important interventions that the nurse can use are based on which intervention?
   1. Therapeutic management of the patient’s needs
   2. Reality-based communication to minimize cognitive disorientation
   3. Confidentiality of all documentation associated with the patient
   4. Effective use of ancillary personnel to monitor the patient

5. A nurse finds a mental health care directive in the medical record of a patient experiencing psychosis. The directive prohibits the prescription of specific medications. Considering the patient’s impaired function, what is the nurse’s primary responsibility regarding medication administration?
   1. Ensure that the directives are respected in treatment planning.
   2. Review the directive with the patient to ensure that it is current.
   3. Alert the prescribing psychiatrist of the directive.
   4. Discuss the revision of the directive with the patient’s guardian or power of attorney.

6. A patient constantly disrupts activities on an inpatient unit. Which action would place the nurse at risk of being quality of assault?
   1. Threatening to rescind the patient’s weekend pass
   2. Placing the patient in seclusion
   3. Refusing to medicate the patient as prescribed
   4. Pushing the patient out of the day room

7. A patient tells the nurse, “When I get out, I’m going to get even with a lot of people.” With respect to the nurse’s duty to warn, what priority action should the nurse take?
   1. Discuss the consequences of such actions with the client.
   2. Notify local law enforcement officials of the threat.
   3. Warn close relatives and significant other as required by law.
   4. Document and discuss the threat with the clinical team.

8. A cognitively impaired psychiatric patient has been a court appointed guardian. What the nurse is appropriate in seeking the opinion of the guardian regarding what matter?
   1. The patient’s need for a winter coat
   2. Accompanying the patient on an outing off of facility grounds
   3. Addressing the patient’s financial issues
   4. TA change in needed treatment

9. A patient tells the nurse, “I still have suicidal thoughts, but don’t tell anyone because I am supposed to be discharged today.” Select the nurse’s best course of action.
   1. Have the patient sign a “no suicide” contract.
   2. Respect the patient’s request related to confidentiality.
   3. Inform the health care provider and other team members.
   4. Search the patient’s belongings for potentially hazardous items.

10. Which nurse is at risk of being guilty of committing a legal tort?
    1. The primary nurse who does not complete the plan of care for a patient within 24 hours of the patient’s admission.
    2. An advanced-practice nurse who recommends that a patient who is dangerous to

self and others be involuntarily hospitalized.

1. 3. A nurse who suggests that a patient’s admission status be changed from involuntary to voluntary after the patient’s hallucinations subside.
   4. A nurse who gives a PRN dose of an antipsychotic drug to a patient to prevent violent acting out because the unit is short staffed.

11. A crisis team led by a psychiatric nurse assesses a patient with a history of paranoid schizophrenia who is standing on the lawn shouting, “Don’t come near me. People are

poisoning my water.” Which statement made to the police officer accurately identifies the patient’s immediate needs?

1. 1. “We’ve identified that this patient requires immediate emergency care.”
   2. “This patient will require a hearing to implement a long-term commitment.”
   3. “Please arrange for a probable-cause hearing for this patient.”
   4. “This patient meets the criteria for short-term observation and treatment.

12. Which individual would be the most likely candidate to require at court appointed guardian?
    1. A patient diagnosed with panic attacks
    2. A patient who frequently refuses medication
    3. A patient with frequent admissions for drug abuse
    4. A patient diagnosed with chronic, paranoid schizophrenia

13. An involuntarily admitted inpatient diagnosed with paranoid schizophrenia repeatedly calls the local mayor. The patient verbally abuses the person who answers the phone as well as the mayor. Select the most appropriate initial nursing intervention to help manage this behavior.
    1. Document the behavior and inform the patient that their phone privileges could be revoked.
    2. Include the patient in a social skills building group.
    3. Suspend the patient’s phone privileges temporarily, and document the reason.
    4. Ask the patient advocate to review the limits of the patient’s rights with the patient.

14. A nurse in a community mental health center receives a call asking for information about a patient. Under which condition can the nurse release information to the caller?
    1. The caller is related to the patient.
    2. The psychiatrist approves the request.
    3. The caller is a mental health professional.
    4. The patient has given written consent for release of information.

15. A patient backs into a corner of the room and shouts at the nurse, “Stay away from me.” What is the nurse’s best initial nursing intervention in this situation?
    1. Obtain an order for seclusion.
    2. Administer a PRN antipsychotic drug.
    3. Call for assistance to physically restrain the patient.
    4. Talk to the patient in a calm, nonthreatening manner.

16. A patient was restrained after assaulting a staff member. Which nursing measure has priority?
    1. Assess the patient for comfort needs every 15 minutes.
    2. Maintain constant supervision of the patient.

1. 3. Administer a sedating medication after applying the restraints.
   4. Distract the patient at frequent intervals while restraints are in use.

17. Which patient behavior should be considered when evaluating the need for an involuntary commitment for psychiatric treatment?
    1. Noncompliant with the treatment regimen
    2. Engaging in the selling and distribution of illegal drugs
    3. Verbalizing the threat to “eliminate anyone who comes near me”
    4. Living on the streets

18. A patient who is admitted involuntarily with a diagnosis of bipolar disorder, manic phase,

refuses a prescribed dose of lithium. The nurse assembles a show of force and intimidates the patient into taking the medication. What is a likely an outcome of this action for the patient?

1. A lessening of mania
2. Grounds for a civil suit against the nurse for assault
3. Grounds to sue the hospital for false imprisonment
4. Improved nurse-patient relationship

19. To reduce the risk of a lawsuit based on false imprisonment, mental health nurses must give the highest priority to which intervention?
    1. Educating patients about unit protocols
    2. Providing adequate treatment during hospitalization

1. 3. Selecting the least restrictive treatment environment that will be effective
   4. Ensuring that patients have probable-cause hearings within 24 hours of admission

20. How many violations of Medicare and Medicaid guidelines are evident in this documentation? Patient assaulted nurse in hall at 1730. Staff provided verbal intervention, but patient continued to strike out. Patient placed in seclusion at 1745. Observation instituted at hourly intervals. Order received from physician at 1930. Patient sleeping soundly at 2100. Patient released from seclusion at 2230 and returned to own room.
    1. Two
    2. Three
    3. Four
    4. Five

21. A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate to a patient diagnosed with schizophrenia. As the nurse swabs the site, the patient shouts, “Stop, stop. I don’t want to take that medicine anymore. I hate the side effects.” What action should the nurse take?
    1. Stop the medication administration procedure and say to the patient, “Tell me more about the side effects you’ve been having.”
    2. Proceed with the injection but explain to the patient that there are medications that may help reduce the unpleasant side effects.
    3. Say to the patient, “Since I’ve already drawn the medication in the syringe, I’m required to give it, but let’s talk to the doctor about delaying next month’s dose.”
    4. Notify other staff to report to the room for a show of force, and proceed with the injection, using restraint if necessary.

22. A nurse engaging in which behavior demonstrates a need for addition education regarding the release of patient information without expressed written consent?
    1. Providing the estimated date of discharge to the patient’s employer
    2. Documenting the patient’s daily behaviors during hospitalization
    3. Discussing the patient’s history with other team members during care planning
    4. Documenting in the medical record the date and circumstances information was released to the court system

23. An adolescent hospitalized after a violent physical outburst tells the nurse, “I’m going to kill my parents, but you can’t tell them.” Select the nurse’s initial response.
    1. “You’re right. Federal law requires me to keep information private.”
    2. “Those kinds of threats will make your hospitalization last much longer.”
    3. “You really should share this thought with your psychiatrist.”
    4. “I am required to talk to the treatment team about your threats.”

24. A patient’s insurance will not pay for continuing hospitalization at a private facility, so the family considers transferring the patient to a public psychiatric hospital. They express concern that the patient will “never get any treatment.” Select the nurse’s most helpful reply to their concern.
    1. “Under the law, treatment must be provided. Hospitalization without treatment violates patients’ rights.”

1. 2. “That’s a justifiable concern, because the right to treatment extends only to provision of food, shelter, and safety.”
   3. “Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable.”
   4. “All patients in public hospitals have the right to choose both a primary therapist and a primary nurse.”

25. A patient diagnosed with paranoid schizophrenia believes that evil spirits are being stirred by a local minister and verbally threatens to bomb a local church. Considering the rights of this patient, what is the initial nursing responsibility?
    1. Obtaining the patient’s permission to release this information to the police
    2. Recognizing and acting upon the duty to warn and protect
    3. Protecting the patient’s right to confidentiality
    4. Reviewing the criteria associated with malpractice so as to avoid committing this tort

MULTIPLE RESPONSE

1. Which interventions should the nurse apply to the care plan of a patient requiring involuntary secluded? (Select all that apply.)
   1. Seclusion instituted when all less restrictive interventions are ineffective in managing behavior
   2. Written medical order to be obtained within 2 hours of implementation of intervention
   3. Patient to be debriefed when seclusion is discontinued
   4. Patient to be offered bathroom privileges hourly
   5. Patient evaluation every 15 minutes