Foundations of Mental Health Care 5th Edition By Michelle Morrison – Valfre -Test Bank
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Sample
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Chapter 3: Ethical and Legal Issues
Test Bank
MULTIPLE CHOICE
1. A
male teenage client tells the nurse that his friends like to drink alcohol
occasionally to get drunk. The client’s friends see nothing wrong with their
drinking habits. The client states that he was taught by his parents and agrees
that underage drinking is not acceptable. Also, he has never seen his parents
drunk; therefore, he refuses to drink with his friends. Which mode of
transmission best describes how this client’s particular value was formed?
|
a. |
Moralizing |
|
b. |
Modeling |
|
c. |
Reward-punishment |
|
d. |
Laissez-faire |
ANS: B
Modeling best describes how the teenage client developed this
value because his parents not only discussed this issue but behaved in a way
for the teen to copy. Moralizing sets standards of right and wrong with no
choices allowed; the reward-punishment model reward valued behavior and punishes
undesired behavior; and the laissez-faire model imposes no restriction or
direction on choices.
DIF: Cognitive Level:
Application
REF: p.
21
OBJ: 1
TOP: Acquiring Values
KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
2. A
female client becomes combative when the nurse attempts to administer routine
medications. The nurse would like to ignore the client but chooses to talk with
the client to calm her. The nurse is successful in calming the client, and the
client takes her medications. What process best describes how the nurse decided
on the course of action taken?
|
a. |
Values clarification |
|
b. |
Nurse’s rights |
|
c. |
Beliefs |
|
d. |
Morals |
ANS: A
Values clarification consists of the steps of choosing, prizing,
and acting. This most accurately describes how the nurse made the proper
decision. The nurse chose the best action, reaffirmed the choice, and then enacted
the choice. The nurse’s rights were not violated, and beliefs and morals do not
describe the entire decision-making process that occurred.
DIF: Cognitive Level:
Application
REF: p.
21
OBJ: 1
TOP: Values Clarification
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
3. Twenty-three
states have enacted mental health parity laws. The most accurate description of
these laws is that they require insurance companies to include coverage for:
|
a. |
Mental illness |
|
b. |
Substance abuse treatment |
|
c. |
Mental illness that is
equal to coverage for physical illness |
|
d. |
Outpatient therapy for
individuals with substance abuse |
ANS: C
The mental health parity laws require insurance companies to
include coverage for mental illness that is equal to coverage for physical
illness. Only nine states include treatment for substance abuse in their parity
laws.
DIF: Cognitive Level:
Knowledge
REF: p.
22
OBJ: 2
TOP: Client
Rights
KEY: Nursing Process Step: Assessment
MSC: Client Needs: Safe and Effective Care Environment
4. The
client is feeling very anxious and has requested that a p.r.n. antianxiety
medication be ordered. The nurse informs the client that the medication can be
administered only every 4 hours and was given 3 hours ago. The nurse promises
to give the client the medication as soon as it is due, but the nurse goes to
lunch 1 hour later without giving the client the medication. Which ethical
principle did the nurse violate?
|
a. |
Fidelity |
|
b. |
Veracity |
|
c. |
Confidentiality |
|
d. |
Justice |
ANS: A
Fidelity refers to the obligation to keep one’s word. The nurse
violated this principle in this situation, which leads to mistrust from the
client. Veracity is the duty to tell the truth, confidentiality is the duty of
keeping the client’s information private, and justice indicates that all
clients must be treated fairly, equally, and respectfully.
DIF: Cognitive Level:
Application
REF: p.
23
OBJ: 3
TOP: Ethical
Principles
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
5. A
male client is seeking help in a mental health clinic for anger management
problems. He voices that he is fearful that his wife may divorce him because of
his anger problem, and he is willing to do “whatever it takes” to control his
anger. Later in the week, the client’s wife also seeks assistance because she
is going to divorce her husband. The nurse who is caring for both of these
clients tries to decide the correct action to take. The nurse is experiencing:
|
a. |
A moral dilemma |
|
b. |
Value clarification |
|
c. |
An ethical conflict (or
dilemma) |
|
d. |
A breach of confidentiality |
ANS: C
This is an example of an ethical conflict or ethical dilemma.
The nurse wants to help both clients but must maintain confidentiality for
each. Use of guidelines for ethical decision making can assist the nurse in
making an ethical decision. A moral dilemma is simply a dilemma associated with
making a decision between right and wrong. Value clarification is a process
that helps to identify an individual’s values.
DIF: Cognitive Level:
Application
REF: p.
23
OBJ: 3
TOP: Ethical
Conflict
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
6. The
psychiatrist asks the nurse to perform a procedure that she is not familiar
with, and the nurse is unsure whether this is something within the scope of
practice. Where can the nurse find the answer to her question?
|
a. |
National nurse practice act |
|
b. |
State nurse practice act |
|
c. |
Regional nurse practice act |
|
d. |
Community nurse practice
act |
ANS: B
Each state’s board of nursing determines the scope of practice
in that state through a series of regulations that are called nurse practice
acts. It is the nurse’s responsibility to know his or her scope of practice.
The other options do not exist.
DIF: Cognitive Level:
Comprehension REF: p.
25
OBJ: 4
TOP: Legal Concepts in Health
Care KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
7. An
order written by a physician is reviewed by the nursing staff, and no one is
familiar with the treatment instructions. A nurse who was recently hired knows
that this treatment is covered by the state’s nurse practice act. What is the
nurse’s best course of action?
|
a. |
Call the physician to ask
for clarification. |
|
b. |
Check the state’s nurse
practice act again. |
|
c. |
Contact the nursing
supervisor for approval to carry out the treatment. |
|
d. |
Refer to the facility’s
policy and procedure to determine the course of action. |
ANS: D
Because this treatment is covered under the state nurse practice
act, the next step is to refer to the facility’s policy and procedure manual to
determine whether the ordered treatment is allowed by the facility. Calling the
physician is not necessary because there was no question about how the order
was written, and the state’s nurse practice act has already been checked.
Contacting the nursing supervisor would be acceptable only after the facility’s
policy has been checked.
DIF: Cognitive Level: Application
REF: p.
23
OBJ: 4
TOP: Legal Concepts in Health
Care KEY: Nursing Process Step:
Intervention
MSC: Client Needs: Safe and Effective Care Environment
8. Standards
of nursing practice for mental health can best be described as helping to
ensure:
|
a. |
That certain clients
receive care |
|
b. |
Quality and effectiveness
of care |
|
c. |
Proper documentation |
|
d. |
Proper medication
administration |
ANS: B
Most health care disciplines have standards of practice documented
as guidelines with measurable criteria that can be used to evaluate the quality
and effectiveness of care provided. All clients have the right to receive care,
so standards of nursing practice would not address who receives care. Although
proper documentation and proper medication administration might be part of the
evaluation process, they do not provide complete evaluation of quality and
effectiveness of care.
DIF: Cognitive Level:
Comprehension REF: p.
25
OBJ: 4
TOP: Legal Concepts in Health
Care KEY: Nursing Process Step:
Evaluation
MSC: Client Needs: Safe and Effective Care Environment
9. If a
client is involuntarily committed to a mental health care facility
indefinitely, the law requires that the case must be reviewed every _____
months.
|
a. |
3 |
|
b. |
6 |
|
c. |
12 |
|
d. |
15 |
ANS: C
Although the case is being reviewed constantly by the mental
health care team, the court must review the indefinite commitment on a yearly
basis.
DIF: Cognitive Level: Knowledge
REF: p.
26
OBJ: 5
TOP: Adult Psychiatric
Admissions KEY: Nursing
Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
10. A
male client is being argumentative during a group therapy session. The male
psychiatric technician warns the client that if he does not cooperate with the
nurse, he will physically restrain him and take the client to his room for the
remainder of the day. For which action could the technician be held liable?
|
a. |
Assault |
|
b. |
Battery |
|
c. |
Privacy |
|
d. |
Fraud |
ANS: A
The technician is engaging in assault, which is any act that
threatens a client. Battery of a client occurs when any physical act of
touching occurs without the client’s permission. Privacy refers to issues
related to the body and confidentiality, and fraud is giving false information.
DIF: Cognitive Level:
Application
REF: p.
26
OBJ: 6
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
11. Which
of the following circumstances, when it occurs on an inpatient mental health
unit, would be considered false imprisonment?
|
a. |
An alert and oriented
client is confined to his room after being loud and argumentative with
another client in the recreation area. |
|
b. |
Restraints are placed on a
client who has been admitted in a lethargic state because of misuse of
medications and who has fallen three times since admission. |
|
c. |
A client is housed in a
private room with visual monitors after attempting suicide at home on the
previous day. |
|
d. |
An alert and oriented
client who was admitted for a 72-hour involuntary commitment is prevented
from leaving the facility 2 days after admission. |
ANS: A
The client cannot be confined to his room if he did not pose a
threat to himself or others, or if no contract was made with the client
regarding consequences for inappropriate behavior. All of the other options are
appropriate because they follow guidelines for client safety.
DIF: Cognitive Level:
Analysis
REF: p.
27
OBJ: 6
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
12. The
nurse often assists in the process of obtaining informed consent from the
client for treatment and/or procedures. Who has the responsibility of providing
information to the client so he can give informed consent?
|
a. |
Social worker |
|
b. |
Nurse |
|
c. |
Physician |
|
d. |
Facility’s legal
representative |
ANS: C
The physician is responsible for providing the client with the
information necessary to give informed consent, including expectations and
risks involved. The nurse can assist by obtaining the written documentation
necessary for informed consent.
DIF: Cognitive Level:
Knowledge
REF: p.
27
OBJ: 8
TOP: Care Providers’
Responsibilities KEY: Nursing Process Step:
Intervention
MSC: Client Needs: Safe and Effective Care Environment
13. An
important responsibility of the nurse in a mental health facility is to ensure
that clients do not __________ from the facility without a discharge order, by
carefully supervising and accurately documenting client behaviors and
therapeutic actions.
|
a. |
Escape |
|
b. |
Abandon |
|
c. |
Flee |
|
d. |
Elope |
ANS: D
The appropriate terminology for when a client runs away from a
facility without a discharge order is elopement. In the event of elopement, the
caregiver can be held liable if a client becomes injured.
DIF: Cognitive Level:
Knowledge
REF: p.
28
OBJ: 8
TOP: Care Providers’
Responsibilities KEY: Nursing Process Step:
Intervention
MSC: Client Needs: Safe and Effective Care Environment
14. If a
female client tells the nurse of extensive plans she has to harm the girlfriend
of her ex-husband, what is the nurse’s best action?
|
a. |
Try to talk with the client
to convince her not to harm the girlfriend. |
|
b. |
Have the client sign a
contract with you stating that she will not harm the girlfriend. |
|
c. |
Inform the ex-husband of
the intentions of the client. |
|
d. |
Inform the girlfriend of
the intentions of the client. |
ANS: D
Health care providers have a duty to warn others when serious
harm may occur as the result of actions taken by the client. This does not
breach confidentiality because providers have an obligation to protect the
public as well as the client. In addition to warning the client, the nurse
should inform the client’s physician and the nursing supervisor and must
document the situation and actions taken. The other options are not adequate to
meet the duty to warn or to prevent harm to the girlfriend.
DIF: Cognitive Level:
Application
REF: p. 28
OBJ: 8
TOP: Care Providers’
Responsibilities KEY: Nursing Process Step:
Intervention
MSC: Client Needs: Safe and Effective Care Environment
15. A
female client asks the nurse if the medication risperidone (Risperdal), an antipsychotic
medication for schizophrenia, has any side effects. Which response by the nurse
would violate the ethical concept of veracity?
|
a. |
“I am not sure, but I will
find out.” |
|
b. |
“Risperdal has no
documented side effects.” |
|
c. |
“Risperdal does have some
side effects.” |
|
d. |
“Let’s talk to your
physician about potential side effects.” |
ANS: B
The ethical concept of veracity refers to the duty of being
truthful with the client, within the scope of one’s practice. Stating that the
drug has no side effects is not a truthful statement because the medication
does have side effects.
DIF: Cognitive Level:
Application
REF: p.
23
OBJ: 3
TOP: Ethical
Principles
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
16. The
charge nurse on a busy inpatient psychiatric unit is concerned because a nurse
and a nursing assistant have called out for the shift. Upon calling the nursing
office, the charge nurse is informed that there is no one to replace them. In
addition, the emergency call button at the nurse’s station is malfunctioning.
This charge nurse sees this as a violation of:
|
a. |
Legal rights |
|
b. |
The patient bill of rights |
|
c. |
Care provider rights |
|
d. |
Ethical principles |
ANS: C
Care provider rights provide for respect, safety, and competent
assistance. Patient’s Bill of Rights deals with provision for client rights.
Legal rights are not impacted and although ethical principles serve as behavior
guidelines, it is not the most appropriate response in this case.
DIF: Cognitive Level:
Application
REF: p.
22
OBJ: 1
TOP: Care Provider
Rights
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
17. The
nurse encounters a client crying in her room. Upon talking to the client, it is
discovered that she is upset because a new nursing assistant made her go out
for a walk with the group even though the client informed her that she waits
for her daughter to go for her walk. This is a potential violation of which
ethical principle?
|
a. |
Beneficence |
|
b. |
Autonomy |
|
c. |
Confidentiality |
|
d. |
Nonmaleficence |
ANS: B
Autonomy refers to the right of people to act for themselves and
make personal choices. The principle of beneficence refers to actively doing
good and maleficence refers to doing no harm. Confidentiality is not violated
in this situation
DIF: Cognitive Level:
Application
REF: p. 23
OBJ: 1
TOP: Ethical
Principles
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
18. A
client preparing for discharge from an inpatient unit asks a nurse which
psychiatrist she would recommend to use for follow-up as an outpatient. The
nurse responds, “There are several good physicians on your list. Make sure you
do not use Dr. Smith. I have heard some terrible things about his methods of
treatment.” This is an example of which type of potential liability?
|
a. |
Slander |
|
b. |
Invasion of privacy |
|
c. |
Assault |
|
d. |
Libel |
ANS: A
Slander is verbal defamation that is false communication and can
result in harm to the psychiatrist’s practice. Libel is written defamation and
assault is threat of bodily harm. Invasion of privacy pertains to confidential
information and is not pertinent in this case.
DIF: Cognitive Level:
Application
REF: p.
26
OBJ: 6
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
19. A
client frequently wanders around the unit, and the staff frequently needs to
reorient the client to the environment and remind her not to walk into the
rooms of other clients on the unit. Due to short staffing, the decision is made
to use a restraint device to prevent this from occurring. This action may
constitute:
|
a. |
Assault |
|
b. |
Defamation |
|
c. |
False imprisonment |
|
d. |
Negligence |
ANS: C
The application of protective devices and restraints may
constitute false imprisonment. Restraints must be used only to protect the
client, not for staff convenience. All less restrictive measures should first
be attempted and documented.
DIF: Cognitive Level: Application
REF: p.
27
OBJ: 6
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
MULTIPLE RESPONSE
20. If a
person is perceived to be a threat to himself or others, who can implement an
involuntary commitment to a mental health facility? (Select all that apply.)
|
a. |
Family members |
|
b. |
Police |
|
c. |
Physicians |
|
d. |
Social workers |
|
e. |
Representatives of a county
administrator |
ANS: B, C, E
Police, physicians, and representatives of a county
administrator are the only individuals who can implement an involuntary
admission to a mental health facility. An involuntary admission can last from
days to years, depending on the need. A court order is necessary for extended
involuntary admissions.
DIF: Cognitive Level:
Knowledge
REF: p.
26
OBJ: 5
TOP: Adult Psychiatric
Admissions KEY: Nursing
Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
21. For a
nurse or health care provider to be found negligent, what requirements must the
provider’s misconduct meet? (Select all that apply.)
|
a. |
The provider owed a duty to
the client. |
|
b. |
The provider breached a
duty to the client. |
|
c. |
The provider had intent to
harm the client. |
|
d. |
The provider caused injury
to the client by action or inaction. |
|
e. |
The provider caused loss or
damage through his or her actions. |
ANS: A, B, D, E
These four criteria must be present for an act of a health care
provider to be considered negligent. Intent to harm would be considered a
criminal action rather than an action of negligence.
DIF: Cognitive Level:
Comprehension REF: p.
27
OBJ: 7
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
22. The
use of protective devices may be considered false imprisonment. In order to
assure the rights of the client are not violated, which practices must be
implemented when using a device? (Select all that apply.)
|
a. |
A written medical order
must be on the medical record. |
|
b. |
Client must be confined to
bed. |
|
c. |
Restraints must be removed
and limb exercised every 2 hours. |
|
d. |
Implement use of restraints
in the event of short staffing as a preventive measure. |
|
e. |
Client must be assessed and
monitored every 15 minutes. |
ANS: A, C, E
Restraints must be used only to protect the client, not for
staff convenience. All less restrictive measures should first be attempted and
documented. A written medical order for restraints must be on file in the
client’s chart. Once restraints have been applied, the caregivers have an
increased obligation to observe, assess, and monitor the client every 15 minutes.
The restraints must be removed, one limb at a time, and the limb exercised
every 2 hours. All observations and actions must be documented. Restraints are
removed as soon as the client’s behavior is under control.
DIF: Cognitive Level: Application
REF: p.
27
OBJ: 7
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Implementation
MSC: Client Needs: Safe and Effective Care Environment
COMPLETION
23. The
nurse documents on the medication administration record that a medication has
been given as ordered on a daily basis, but the medication actually has been
out of stock for a week. This nurse is guilty of __________.
ANS:
Fraud
This nurse is committing fraud by giving false information. Not
only is this illegal, but it could bring harm to the client in several ways.
DIF: Cognitive Level:
Comprehension REF: p.
26
OBJ: 6
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
24. __________
is either omitting or committing a duty that a reasonable and prudent person
would or would not do that brings harm to an individual in a health care
environment.
ANS:
Negligence, Malpractice
Malpractice, Negligence
Negligence on the part of a professional is called malpractice.
DIF: Cognitive Level:
Knowledge
REF: p.
27
OBJ: 7
TOP: Areas of Potential
Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
25. __________
describes an individual’s attitudes, beliefs, and values and helps a person
distinguish between what is considered right and wrong behavior.
ANS:
Morals
Morals are developed through learned behavior, teachings of
others, and experience.
DIF: Cognitive Level:
Knowledge
REF: p.
20
OBJ: 1
TOP: Values and
Morals
KEY: Nursing Process Step: Assessment
MSC: Client Needs: Safe and Effective Care Environment
Chapter 4: Sociocultural Issues
Test Bank
MULTIPLE CHOICE
1. An
older Asian female with a diagnosis of depression is cared for by her
granddaughter. Her granddaughter is very attentive to the client’s needs,
attends every therapy session, and is active in the planning and implementing
of the treatment plan. The granddaughter’s valuing of her grandmother is most
likely due to her:
|
a. |
Ethnicity |
|
b. |
Cultural beliefs |
|
c. |
Religion |
|
d. |
Stereotype |
ANS: B
Cultural beliefs develop over many generations and are a learned
set of values, beliefs, and behaviors. Asian cultures commonly value their
elderly family members. Ethnicity and religion do not explain the
granddaughter’s behavior in that ethnicity describes customs and socialization
patterns, and religion refers to an organized form of worship. Stereotyping is
a preconceived belief about another cultural group, so it does not apply to
this situation.
DIF: Cognitive Level:
Application
REF: p. 31
OBJ: 1
TOP: Characteristics of
Culture
KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
2. A
traditional Arab female client is brought to the emergency room by her husband.
She complains of feeling very anxious and short of breath and has chest pain.
What would likely be a hindrance to the care of this client?
|
a. |
The emergency room
physician is female. |
|
b. |
Her husband asks if he can
stay with his wife. |
|
c. |
One of the emergency room
nurses is of Arab descent. |
|
d. |
The only caregivers
available in the emergency room are male. |
ANS: D
In some traditional Arab cultures, a woman will not make eye
contact with any man except her husband and may not be touched by another man.
Having only male staff in the emergency room on this shift would block
necessary care. Arrangements would have to be made to have a female staff
member come to the emergency room to assist in client care. The other options
should not cause a problem.
DIF: Cognitive Level: Application
REF: p.
32
OBJ: 3
TOP: Characteristics of
Culture
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
3. Disease
is defined as _____ dysfunction.
|
a. |
Social |
|
b. |
Emotional |
|
c. |
Physical |
|
d. |
Intellectual |
ANS: C
Disease differs from illness in that disease is an abnormal
physical function, whereas illness refers to social, emotional, and
intellectual dysfunction. Illness is affected by culture, but disease is not.
DIF: Cognitive Level:
Knowledge
REF: p.
32
OBJ: 4
TOP: Health and Illness
Beliefs
KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Physiological Integrity
4. The
nurse is caring for a 20-year-old woman from Puerto Rico. The client speaks
English, but she is accompanied by her mother who does not. The client has a
history of mental illness, and through the interpreter, the nurse learns that
the mother, who has traditional Puerto Rican cultural beliefs, believes that
the client’s mental illness is caused by:
|
a. |
Witchcraft |
|
b. |
Stress |
|
c. |
Chemical imbalances |
|
d. |
A trance |
ANS: A
It is a common traditional Puerto Rican cultural belief that
mental illness is caused by witchcraft, magic, or evil spells, as opposed to
more traditional Western medicine, which believes that stress and chemical
imbalances play a role in mental illness. A trance is considered a state of
consciousness in some cultures.
DIF: Cognitive Level:
Comprehension REF: p.
33
OBJ: 4
TOP: Health and Illness
Beliefs
KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
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