Chapter 04: Patient Rights and Legal Issues

Format: Multiple Choice

Client Needs: Safe, Effective Care Environment: Management of Care

Cognitive Level: Apply

Integrated Process: Teaching/Learning

Objective: 1

Page and Header: 30, Advance Care Directives in Mental Health

1. A nurse is explaining advance care directives, or “living wills,” to a client and the client’s spouse. Which detail would the nurse include in the description of an advance care directive?

A) The document tells what treatment is to be omitted if the client is unable to make the decision.

B) A client is required to sign the “living will” document with an attorney is present.

C) The client’s physician must act as a witness when the client signs the document.

D) An attorney draws up the papers to be given to the client and his or her family.

Page and Header: 32, Competency

2. A psychiatric–mental health nurse is providing care to a client diagnosed with depression. The nurse determines that a client is competent when the client is able to engage in what action?

A) Speak coherent English

B) Communicate his or her choice

C) Write a “living will”

D) Comply with the medical regimen

Page and Header: 33, Least Restrictive Environment

3. A client receives a court order for commitment. Which concept exemplifies a “least restrictive environment?”

A) Involuntary commitment to an outpatient community mental health center

B) Medication administration for sedation so the client cannot get out of bed

C) Placement of client in a secured padded room in response to threats of self-harm

D) Admission of client to a locked inpatient psychiatric unit

Page and Header: 36, Mandates to Inform

4. A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client’s confidentiality if the client makes which statement?

A) “I think that the federal government is spying on me.”

B) “I get really ‘turned on’ by your appearance.”

C) “That doctor I had today really made me angry.”

D) “When I get out of here, I’m going to make my neighbor sorry.”

Page and Header: 34, Voluntary and Involuntary Treatment

5. Which client would a nurse determine to be the most likely candidate for involuntary commitment?

A) A 24-year-old client who refuses to take the prescribed medication

B) An elderly client who is screaming obscenities in the street and disturbing neighbors

C) A teenager who refuses to participate in the planned therapy

D) A 45-year-old client who is homeless and has been diagnosed with a mental disorder

Page and Header: 39, Nursing Documentation

6. A nurse is providing care to a client who is hospitalized with a diagnosis of schizophrenia. Which statement would be appropriate for the nurse to include in the client’s medical record?

A) “Client states having had a good night with no issues.”

B) “Reports being unable to sleep because of voices heard throughout the night.”

C) “Had a typical night without incidence of insomnia or nightmares.”

D) “Acted crazily throughout the night; kept hearing voices and noises.”

Page and Header: 35, Privacy and Confidentiality

7. A nurse working on a psychiatric unit receives a telephone call from a client’s employer. The employer asks for a copy of the client’s latest laboratory work and psychological testing results so that the client’s medical records in employee health can be updated. Based on the nurse’s knowledge of breach of confidentiality, which response would be the appropriate?

A) “I’m sorry; we’re not allowed to give out that information about our client.”

B) “I’ll have to get the client’s signed consent before we can send that information to you.”

C) “I am unable to acknowledge whether or not your employee is a client on this unit.”

D) “Sure, give me your address, and I will see that the information is sent to you.”

Page and Header: 36, Health Insurance Portability and Accountability Act and Protection of Health Information

8. A client is going to be discharged this afternoon from the mental health unit. The client asks the nurse if a copy of the medical record could be sent to the outpatient psychologist. Which response by the nurse is appropriate?

A) “Sure, we’ll have that information sent out in today’s mail.”

B) “You will need to sign written authorization for us before we can do this.”

C) “I think it would be best if you told your psychologist everything directly.”

D) “How are you feeling about being discharged this afternoon?”

Page and Header: 40, Summary of Key Points

9. A psychiatrist recommends that a client should participate in a 3-month outpatient aftercare program after being discharged. What would protect the client’s right to request a second opinion before agreeing to this suggestion?

A) Self-determinism

B) Least restrictive environment

C) Confidentiality

D) Mandates to inform

Page and Header: 39, Nursing Documentation

10. A nurse is preparing to administer an as-needed (PRN) medication. What would the nurse need to keep in mind when documenting its administration?

A) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication the first time it is administered to a client.

B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a client.

C) It requires a separate entry that includes reason for administration, dosage, and route the first time it is administered to a client.

D) It requires a separate entry that includes reason for administration, dosage, and route every time it is administered to a client.

Page and Header: 32, Internal Rights Protection Systems

11. A group of nurses is reviewing information about internal rights protection systems. The nurses demonstrate understanding of this information when they identify which example?

A) American Hospital Association

B) American Public Health Association

C) State mental health provider

D) The Joint Commission

Page and Header: 32, Competency

12. After educating a class on competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as being evaluated?

A) Communication of choices

B) Understanding of relevant information

C) Appreciation for a situation and its consequences

D) Discussion of what is right and wrong

Page and Header: 34, Voluntary and Involuntary Treatment

13. A client is involuntarily committed without a court order. The nurse understands that the emergency, short-term hospitalization can occur for how long?

A) A maximum of 24 hours

B) 48 to 92 hours

C) 3 to 5 days

D) 1 week

Page and Header: 35, Privacy and Confidentiality

14. After teaching a group of nurses about confidentiality and privacy, the group leader determines that the teaching was successful when the group identifies which aspect as privacy?

A) Part of personal life not governed by society’s laws

B) Ethical duty for nondisclosure

C) Involvement of two individuals

D) Knowledge of treatment costs and benefits

Page and Header: 38, Legal Liability in Psychiatric Nursing Practice

15. An advance care directive is listed on a psychiatric–mental health client’s medical record. A clinician provides treatment that disregards the client’s directive. The clinician would be liable for which legal tort?

A) Assault

B) Battery

C) Medical battery

D) False imprisonment

Page and Header: 39, Nursing Documentation

16. A psychiatric–mental health nurse is documenting information in a client’s medical record. Which would be least likely to increase the nurse’s legal liability?

A) “Client reported feeling better today than yesterday.”

B) “Administered haloperidol 10 mg IM stat as ordered for agitation.”

C) “Client was talking with another staff member and started screaming.”

D) “Applied restraints to all four client’s extremities.”

Page and Header: 31, Box 4.1 Bill of Rights for Persons Receiving Mental Health Services

17. After educating a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which as a right?

A) Freedom from restraints or seclusion

B) Access to one’s own mental health records upon request

C) An individualized written treatment plan

D) Refusal of treatment during an emergency situation

Page and Header: 37, Stigma of Criminality

18. A nursing instructor is explaining to a group of nursing students that a forensic client experiences stigma associated with being mentally ill and with being a criminal. One of the students asks the instructor how the stigma associated with criminality might influence nursing care. Which response by the instructor is appropriate?

A) “Nurses may be reluctant to care for mentally ill criminals because of unrealistic fears for their own safety and that of their other clients.”

B) “Nurses may prefer to care for forensic clients because they do not believe criminals can be mentally ill.”

C) “A nurse may volunteer to work only with forensic clients because of the belief that forensic clients experience only mild mental health problems.”

D) “Nurses are generally only reluctant to care for mentally ill criminals if the crime committed was more serious, such as murder.”

Page and Header: 37, Stigma of Criminality

19. A nurse is giving a public presentation on the topic of forensic psychiatric care at a community center. The nurse explains that someone who is found to be unfit to stand trial is subsequently hospitalized in a forensic mental health facility. A member of the audience asks, “What is the purpose of the hospitalization?” Which response by the nurse is appropriate?

A) To keep the client under protective custody as long as necessary

B) To focus efforts on helping the client become fit to stand trial

C) To determine the correct diagnosis through treatment

D) To hold the client until a new trial date can be set

Page and Header: 37, Guilty but Mentally Ill

20. A psychiatric nursing instructor is trying to explain to a group of students how clients identified as guilty but mentally ill (GBMI) and not guilty by reason of insanity (NGRI) differ. Which statement is appropriate for the instructor to include in the discussion?

A) GBMI clients are treated in a hospital setting and are often discharged sooner than NGRI clients.

B) NGRI clients are treated in a correctional setting and are discharged sooner than GBMI clients.

C) GBMI clients are treated in a hospital setting and their discharge is handled through the correctional parole system.

D) NGRI clients are treated in a hospital setting and their discharge is determined by the courts.

Page and Header: 37, Fitness to Stand Trial

21. A student nurse has been asked by the psychiatric–mental health instructor to plan educational interventions for a forensic client. The client is scheduled for a court hearing. Which activity would be most important for the student nurse to include in the plan?

A) Explaining the genetic and neurologic factors associated with criminal behavior

B) Describing information about pertinent legal and court proceedings that are pending

C) Explaining how nutrition and exercise can promote physical and mental well-being

D) Providing a list of community providers that the client’s family members can contact for assistance and support

Page and Header: 37, Fitness to Stand Trial

22. A client with mental illness who has been arrested has been found unfit to stand trial, and the client is admitted to a forensic mental health facility. The nurse understands that the client can be hospitalized for up to which duration to become “fit?”

A) 3 months

B) 6 months

C) 1 year

D) 5 years

Page and Header: 37, Fitness to Stand Trial

23. The nurse is reviewing the medical record of a forensic client who has been found not guilty by reason of insanity. Which statement represents the meaning of this outcome?

A) The client knows that a wrongful act was committed.

B) The client is unable to control actions at the time of the crime.

C) The client is unable to assist in the defense.

D) The client’s mental illness is a factor in the crime.

Page and Header: 37, Fitness to Stand Trial

24. A nurse is caring for a forensic client who is unfit to stand trial. After one year of hospitalization, which intervention is next for this client?

A) The client is discharged on probation.

B) A judge reviews the facts and rules on the case.

C) A civil commitment is initiated by the hospital.

D) The client remains hospitalized for another year.

Page and Header: 30, Self-Determinism: A Fundamental Right and Need

25. A nursing instructor is preparing a class discussion on the topic of self-determinism. Which topics would the instructor expect to include? Select all that apply.

A) Personal autonomy as a key value

B) Choices based on pleasing others

C) Activities reflecting personal goals

D) Right to refuse treatment

E) Empowerment

Page and Header: 32, Competency

26. A psychiatric–mental health nurse is providing care to a client diagnosed with dementia. The client has been deemed competent. The nurse understands that the client would demonstrate which behaviors? Select all that apply.

A) Able to repeat what was heard

B) Able to say in own words what is understood about the treatment

C) Can discuss the condition but not why treatment is needed

D) Can explain the logical reason for the choice of treatment

E) Can express the outcome but not the reason for the treatment

Page and Header: 39, Nursing Documentation

27. A psychiatric–mental health nurse is providing care to a client at a community mental health center. When documenting the client’s care, which statements would be most appropriate to include? Select all that apply.

A) “Client refused to participate in group therapy session today.”

B) “Client is manipulating staff members for special treatment.”

C) “Client has no issues.”

D) “Client answers questions clearly and completely.”

E) “Client states, ‘The relaxation exercises are helping with anger.’”