Mental Health Nursing: Ethical Dilemmas and Decision Making, Exams of Psychology

Download Mental Health Nursing: Ethical Dilemmas and Decision Making and more Exams Psychology in PDF only on Docsity! Unit II Mental Health Test Bank Questions And Answers 5.1. In response to a students question regarding choosing a psychiatric specialty, a charge nurse states, Mentally ill clients need special care. If I were in that position, I'd want a caring nurse also. From which ethical framework is the charge nurse operating? A. Kantianism B. Christian ethics C. Ethical egoism D. Utilitarianism - ANSWER: B RATIONALE: The charge nurse is operating from a Christian ethics framework. A basic principle in Christian ethics is to do unto others as you would have them do unto you. Kantianism states that decisions should be based on moral law and that actions are bound by a sense of moral duty. Utilitarianism holds that decisions should be made with a focus on the end result being happiness. Ethical egoism promotes the idea that what is right is good for the individual. 5.2. During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework? A. I would want to be treated in a caring manner if I were mentally ill. B. This job will pay the bills, and the workload is light enough for me. C. I will be happy caring for the mentally ill. Working in Med/Surg kills my back. Unit II Mental Health Test Bank Questions And Answers D. It is my duty in life to be a psychiatric nurse. It is the right thing to do. - ANSWER: B RATIONALE: The applicants comment reflects an ethical egoism framework. This framework promotes the idea that decisions are based on what is good for the individual and may not take the needs of others into account. 5.3. Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurses coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworkers lack of involvement? A. Taking no action is still considered an action by the coworker. B. Taking no action releases the coworker from ethical responsibility. C. Taking no action is advised when potential adverse consequences are foreseen. D. Taking no action is acceptable, because the coworker is only a bystander. - ANSWER: A RATIONALE: The coworkers lack of involvement can be interpreted as an action taken. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. Although the coworker may be struggling with ethical decision making, he or she has witnessed another nurse dispensing medication outside Unit II Mental Health Test Bank Questions And Answers 5.7. Which statement should a nurse identify as correct regarding a clients right to refuse treatment? A. Clients can refuse pharmacological but not psychological treatment. B. Clients can refuse any treatment at any time. C. Clients can refuse only electroconvulsive therapy (ECT). D. Professionals can override treatment refusal if the client is actively suicidal or homicidal. - ANSWER: D RATIONALE: The nurse should understand that health-care professionals can override treatment refusal when a client is actively suicidal or homicidal. A suicidal or homicidal client who refuses treatment may be a danger to self or others. This situation should be treated as an emergency, and treatment may be performed without informed consent. 5.8. Which client should a nurse identify as a potential candidate for involuntarily commitment? A. A client living under a bridge in a cardboard box B. A client threatening to commit suicide C. A client who never bathes and wears a wool hat in the summer D. A client who eats waste out of a garbage can - ANSWER: B Unit II Mental Health Test Bank Questions And Answers RATIONALE: The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatments is a danger to self and requires emergency treatment. 5.9. A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the clients wishes? A. When the client makes inappropriate sexual innuendos to a staff member B. When the client constantly demands inappropriate attention from the nurse C. When the client physically attacks another client after being confronted in group therapy D. When the client refuses to bathe or perform hygienic activities - ANSWER: C RATIONALE: The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making rational choices. The clients refusal to accept treatment can be challenged because the client is endangering the safety of others. Unit II Mental Health Test Bank Questions And Answers 5.10. A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? A. Refusing to give any information to the caller, citing rules of confidentiality B. Refusing to give any information to the caller by hanging up C. Affirming that the person has been seen at the facility but providing no further information D. Suggesting that the caller speak to the clients therapist - ANSWER: A RATIONALE: The most appropriate action by the nurse is to refuse to give any information to the caller. Admission to the facility would be considered protected health information (PHI) and should not be disclosed by the nurse without prior client consent. 5.11. A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? A. Autonomy B. Beneficence C. Nonmaleficence D. Justice - ANSWER: A Unit II Mental Health Test Bank Questions And Answers day. This indicates that this client is disoriented and may not be competent to make informed choices. 5.15. A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? A. Allow the client to decline the medication and document. B. Tell the client that if the medication is refused, hospitalization will occur. C. Arrange with a relative to add medication to the clients morning orange juice. D. Call for help to hold the client down while the injection is administered. - ANSWER: A RATIONALE: It is ethically and legally appropriate for the nurse to allow the client to decline the medication and provide accurate documentation. The clients right to refuse treatment should be upheld unless the refusal puts the client or others in harms way. 5.16. Which situation exemplifies both assault and battery? A. The nurse becomes angry, calls the client offensive names, and withholds treatment. Unit II Mental Health Test Bank Questions And Answers B. The nurse threatens to tie down the client and then does so against the clients wishes. C. The nurse hides the clients clothes and medicates the client to prevent elopement. D. The nurse restrains the client without just cause and communicates this to family. - ANSWER: B RATIONALE: The nurse in this situation has committed both the acts of assault and battery. Assault refers to an action that results in fear and apprehension that the person will be touched without consent. Battery is the touching of another person without consent. 5.17. A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client? A. The client is placed in seclusion. B. The client is placed in a geriatric chair with tray. C. The client is placed in soft Posey restraints. D. The client is monitored by an ankle bracelet. - ANSWER: D RATIONALE: The least restrictive alternative for this client would be monitoring by an ankle bracelet. The client does not pose a direct dangerous threat to self or others, so neither physical restraints nor seclusion would be justified. Unit II Mental Health Test Bank Questions And Answers 5.18. A brother calls to speak to his sister who has been admitted to the psychiatric unit. The nurse connects him to the community phone and the sister is summoned. Later the nurse realizes that the brother was not on the clients approved call list. What law has the nurse broken? A. The National Alliance for the Mentally Ill Act B. The Tarasoff Ruling C. The Health Insurance Portability and Accountability Act D. The Good Samaritan Law - ANSWER: C RATIONALE: The nurse has violated the Health Insurance Portability and Accountability Act (HIPAA) by revealing that the client had been admitted to the psychiatric unit. The nurse should not have provided any information without proper consent from the client. 5.19. An inpatient client, whom the treatment team has determined to be a danger to self, gives notice of intention to leave the hospital. What information should the nurse recognize as having an impact on the treatment teams next action? A. State law determines how long a psychiatric facility can hold a client. B. Federal law determines if the client is competent. C. The clients family involvement will determine if discharge is possible. D. Hospital policies will determine treatment team actions. - ANSWER: A Unit II Mental Health Test Bank Questions And Answers LPN), not just for the RN. This student statement indicates a need for further instruction. 5.23. Which is an accurate description of a common law? A. A common law would be invoked to deal with a nurse who, without justification, threatens a client with restraints. B. A common law would be invoked to deal with a nurse who touches a client without the clients consent. C. A common law would be invoked to deal with a hospital employee who steals drugs, hospital equipment, or both. D. A common law would be invoked to deal with a nurses refusal to provide care for a specific client. - ANSWER: D RATIONALE: Common laws apply to a body of principles that evolve from court decisions resolving various controversies. Common law may vary from state to state. Assault (threats) and battery (touch) are governed by civil law. Stealing is governed by criminal law. 5.24. The experience of being physically restrained can be traumatic. Which nursing intervention would best help the client deal with this experience? A. Administering a tranquilizing medication before applying the restraints Unit II Mental Health Test Bank Questions And Answers B. Talking to the client at brief but regular intervals while the client is restrained C. Decreasing stimuli by leaving the client alone most of the time D. Checking on the client infrequently, in order to meet documentation requirements - ANSWER: B RATIONALE: Restraints are never to be used as punishment or for the convenience of the staff. Connecting with the client by maintaining communication during the period of restraint will help the client recognize this intervention as a therapeutic treatment versus a punishment. 5.25. There is one bed available on an inpatient psychiatric unit. For which client should a nurse advocate emergency commitment? A. An individual who is persistently mentally ill and evicted from an apartment B. An individual treated in the emergency department (ED) for generalized anxiety disorder C. An individual who is delusional and has a plan to kill his wife D. An individual who rates mood 4/10 and is participating in a no-harm safety plan - ANSWER: C RATIONALE: The criteria for involuntary emergency commitment include danger to self and/or others. Of the four clients considered, the Unit II Mental Health Test Bank Questions And Answers client who is delusional and has a plan to kill his wife meets this criterion as a danger to others. 5.26. What is the legal significance of a nurses action when a nurse threatens a demanding client with restraints? A. The nurse can be charged with assault. B. The nurse can be charged with negligence. C. The nurse can be charged with malpractice. D. The nurse can be charged with beneficence. - ANSWER: A RATIONALE: Assault is an act that results in a persons genuine fear and apprehension that he or she will be touched without consent. 5.27. In the situation presented, which nursing intervention constitutes false imprisonment? A. The client is combative and will not redirect, stating, No one can stop me from leaving. The nurse seeks the physicians order after the client is restrained. B. The client has been consistently seeking the attention of the nurses much of the day. The nurse institutes seclusion. C. A psychotic client, admitted in an involuntary status, runs off the psychiatric unit. The nurse runs after the client and the client agrees to return. Unit II Mental Health Test Bank Questions And Answers B. A social worker, discovering the clients income, changes the clients discharge placement. C. A psychiatrist prescribes an antipsychotic drug on the basis of observed symptoms. D. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy. - ANSWER: D RATIONALE: The basic concept of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care. 21.3. A nursing instructor is teaching about the guiding principles of the recovery model, as described by the SAMHSA. Which student statement indicates that further teaching is needed? A. Recovery occurs via many pathways. B. Recovery emerges from strong religious affiliations. C. Recovery is supported by peers and allies. D. Recovery is culturally based and influenced. - ANSWER: B RATIONALE: SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person- driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by Unit II Mental Health Test Bank Questions And Answers peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. Recovery emerges from hope, but affiliation with any particular religion would have little bearing on the recovery process. 21.4. A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to the SAMHSA, which dimension of recovery is supporting this client? A. Health B. Home C. Purpose D. Community - ANSWER: B RATIONALE: SAMHSA describes the dimension of Home as a stable and safe place to live. 21.5. A client diagnosed with obsessive-compulsive disorder states, I really think my future will improve because of my successful treatment choices. I'm going to make my life better. Which guiding principle of recovery has assisted this client? A. Recovery emerges from hope. B. Recovery is person-driven. Unit II Mental Health Test Bank Questions And Answers C. Recovery occurs via many pathways. D. Recovery is holistic. - ANSWER: A. RATIONALE: The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person- driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. This client has internalized hope. This hope is the catalyst of the recovery process. 21.6. A nurse maintains a clients confidentiality, addresses the client appropriately, and does not discriminate on the basis of gender, age, race, or religion. Which guiding principle of recovery has this nurse employed? A. Recovery is culturally based and influenced. B. Recovery is based on respect. C. Recovery involves individual, family, and community strengths and responsibility. D. Recovery is person-driven. - ANSWER: B RATIONALE: The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person- Unit II Mental Health Test Bank Questions And Answers RATIONALE: The WRAP recovery model is a step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include Step 1, Develop a Wellness Toolbox; Step 2, Daily Maintenance List; Step 3, Triggers; Step 4, Early Warning Signs; Step 5, Things Are Breaking Down or Getting Worse; and Step 6, Crisis Planning. In Step 6 (Crisis Planning), clients can no longer care for themselves, make independent decisions, or keep themselves safe. Caregivers take an active role in this step on behalf of the client and implement the plan that the client has previously developed. All other actions presented require the client to be functionally capable. 21.10. A nursing instructor is teaching about components present in the recovery process, as described by Andersen and associates, which led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed? A. A client has a better chance of recovery if he or she truly believes that recovery can occur. B. If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover. C. A client who has a positive sense of self and a positive identity is likely to recover. D. A client has a better chance of recovery if he or she has purpose and meaning in life. - ANSWER: B Unit II Mental Health Test Bank Questions And Answers RATIONALE: In examining a number of studies, Andresen and associates identified four components that were consistently evident in the recovery process. These components are hope, responsibility, self and identity, and meaning and purpose. Under responsibility, this model tasks the client, not the health-care team, with taking responsibility for his or her life and well-being. 21.11. A client states, My illness is so devastating, I feel like my life is on hold. The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates? A. Moratorium B. Awareness C. Preparation D. Rebuilding - ANSWER: A RATIONALE: Andersen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1, Moratorium; Stage 2, Awareness; Stage 3, Preparation; Stage 4, Rebuilding; and Stage 5, Growth. The moratorium stage is identified by dark despair and confusion. It is called moratorium, because it seems that life is on hold. 21.12. A client states, I have come to the conclusion that this disease has not paralyzed me. The nurse recognizes that this client is in which Unit II Mental Health Test Bank Questions And Answers stage of the Psychological Recovery Model as described by Andersen and associates? A. Moratorium B. Awareness C. Preparation D. Rebuilding - ANSWER: B RATIONALE: Andersen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1, Moratorium; Stage 2, Awareness; Stage 3, Preparation; Stage 4, Rebuilding; and Stage 5, Growth. In the awareness stage, the individual comes to a realization that a possibility for recovery exists. Andersen and associates state, It involves an awareness of a possible self other than that of sick person: a self that is capable of recovery. 21.13. A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. What should the nurse expect to find when assessing this client? A. A client feeling confident about achieving goals in life. B. A client who is aware of the need to set goals in life. C. A client who has mobilized personal and external resources. D. A client who begins to actively take control of his or her life. - ANSWER: A