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In response to a student's 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 - CORRECT ANSWER -ANS: B. Christian ethics
The charge nurse is operating from a Christian ethics framework. The imperative demand of Christian ethics is to treat others as moral equals by permitting them to act as we do when they occupy a position similar to ours. Kantianism states that decisions should be made based on moral law and that actions are bound by a sense of moral duty. Utilitarianism holds that decisions should be made focusing on the end result being happiness. Ethical egoism promotes the idea that what is right is good for the individual.
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."
D. "It is my duty in life to be a psychiatric nurse. It is the right thing to do." - CORRECT ANSWER -ANS: B. "This job will pay the bills, and the workload is light enough for me."
The applicant's comment reflects an ethical egoism framework. This framework promotes the idea that decisions are made based on what is good for the individual and may not take the needs of others into account.
Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworker's lack of involvement?
A. Taking no action is still considered an unethical 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. - CORRECT ANSWER -ANS: A. Taking no action is still considered an unethical action by the coworker.
The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. The coworker has a responsibility to report any observed unethical actions.
Group therapy is strongly encouraged, but not mandatory, on an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy preserve?
An involuntarily committed client is verbally abusive to the staff and repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit?
A. Verbally redirect the client, and then limit one-on-one interaction.
B. Involve the hospital's security division as soon as possible.
C. Notify the client that documenting personal staff information is against hospital policy.
D. Continue professional attempts to establish a positive working relationship with the client. - CORRECT ANSWER -ANS: D. Continue professional attempts to establish a positive working relationship with the client.
The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client. The involuntarily committed client should be respected and has the right to assert grievances if rights are infringed.
Which statement should a nurse identify as correct regarding a client's 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. - CORRECT ANSWER -ANS: D. Professionals can override treatment refusal if the client is actively suicidal or homicidal.
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.
Which client should a nurse identify as a potential candidate for involuntary 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 - CORRECT ANSWER -ANS: B. A client threatening to commit suicide.
The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatment is a danger to self and requires emergency treatment.
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 client's 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
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 - CORRECT ANSWER -ANS: A. Autonomy
The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian or representative would be asked to give consent.
An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which violation of an ethical principle should a nurse recognize in this situation?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice - CORRECT ANSWER -ANS: D. Justice
The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief.
Which situation reflects the ethical principle of veracity?
A. A nurse provides a client with outpatient resources to benefit recovery.
B. A nurse refuses to give information to a physician who is not responsible for the client's care.
C. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room.
D. A nurse treats all of the clients equally regardless of illness severity. - CORRECT ANSWER -ANS: C. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room.
The nurse who tricks a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients.
A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent?
A. The client is paranoid.
B. The client is 87 years old.
C. The client incorrectly reports his or her spouse's name, date, and time of day.
D. The client relies on his or her spouse to interpret the information. - CORRECT ANSWER -ANS: C. The client incorrectly reports his or her spouse's name, date, and time of day
C. The nurse hides the client's clothes and medicates the client to prevent elopement.
D. The nurse restrains the client without just cause and communicates this to family. - CORRECT ANSWER -ANS: B. The nurse threatens to "tie down" the client and then does so against the client's wishes.
The nurse in this situation has committed both 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.
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. - CORRECT ANSWER -ANS: D. The client is monitored by an ankle bracelet.
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.
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 client's 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 - CORRECT ANSWER -ANS: C. The Health Insurance Portability and Accountability Act
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.
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 team's 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 client's family involvement will determine if discharge is possible.
D. Hospital policies will determine treatment team actions. - CORRECT ANSWER - ANS: A. State law determines how long a psychiatric facility can hold a client.
Most states commonly cite that in an emergency a client who is dangerous to self or others may be involuntarily hospitalized.
A client is concerned that information given to the nurse remains confidential. Which is the nurse's best response?
A nursing instructor is presenting content on the provisions of the nurse practice act as it relates to their state. Which student statement indicates a need for further instruction?
A. "The nurse practice act provides a list of definitions of important terms including the definition of nursing."
B. "The nurse practice act lists education requirements for licensure and reciprocity."
C. "The nurse practice act contains detailed statements that describe the scope of practice for registered nurses (RNs)."
D. "The nurse practice act lists the general authority and powers of the state board of nursing." - CORRECT ANSWER -ANS: C. "The nurse practice act contains detailed statements that describe the scope of practice for registered nurses (RNs)."
The nurse practice act contains broad, not detailed, statements that describe the scope of practice for various levels of nursing (APN, RN, LPN), not just for the RN. This student statement indicates a need for further instruction.
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 client's 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 nurse's refusal to provide care for a specific client. - CORRECT ANSWER -ANS: D. A common law would be invoked to deal with a nurse's refusal to provide care for a specific client.
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.
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
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 - CORRECT ANSWER -ANS: B. Talking to the client at brief but regular intervals while the client is restrained
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.
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
A. The client is combative and will not redirect stating, "No one can stop me from leaving." The nurse seeks the physician's order after the client is restrained.
B. The client has been consistently seeking the attention of the nurse 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.
D. A client hospitalized as an involuntary admission attempts to leave the unit. The nurse calls the security team and they prevent the client from leaving. - CORRECT ANSWER -ANS: B. The client has been consistently seeking the attention of the nurse much of the day. The nurse institutes seclusion.
False imprisonment is the deliberate and unauthorized commitment of a person within fixed limits by the use of verbal or physical means. Seclusion should only be used in an emergency situation to prevent harm after least restrictive means have been unsuccessfully attempted.
After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department by police. The client threatens suicide. Which criteria would enable a physician to consider involuntary commitment? (Select all that apply.)
A. Being dangerous to others
B. Being homeless
C. Being disruptive to the community
D. Being gravely disabled and unable to meet basic needs
E. Being suicidal - CORRECT ANSWER -ANS:
A. Being dangerous to others
D. Being gravely disabled and unable to meet basic needs
E. Being suicidal
The physician could consider involuntary commitment when a client is being dangerous to others, is gravely disabled, or is suicidal. If the client is determined to be mentally incompetent, consent should be obtained from the legal guardian or court-approved guardian or conservator. A hospital administrator may give permission for involuntary commitment when time does not permit court intervention.
- The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to:
a. Use creativity.
b. Obtain support from the 7-3 shift.
c. Use institutional research.
d. Identify the problem. - CORRECT ANSWER -ANS: D. Identify the problem.
Identification of a problem is the first step in problem solving and occurs before any other step. The most common cause for failure to resolve problems is the improper identification of the problem/issue; therefore, problem recognition and identification are considered the most vital steps.
REF: Page 109 | Page 110
TOP: AONE competency: Knowledge of the Health Care Environment
- The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would:
a. Involve the rehab staff in the decision.
REF: Page 106 | Page 107
TOP: AONE competency: Communication and Relationship-Building
4. During a fire drill, several psychiatric patients become agitated. The
nurse manager quickly assigns a staff member to each patient. This
autocratic decision style is most appropriate for:
a. Routine problems.
b. Crisis situations.
c. Managers who prefer a "telling" style.
d. Followers who cannot agree on a solution. - CORRECT ANSWER -ANS:
B. Crisis situations.
An autocratic style is appropriate when rapid decision making is
required, such as in a crisis situation.
REF: Page 103 | Page 104 TOP: AONE competency: Leadership
5. After the nurses who work on an adolescent psychiatric unit have
had a brainstorming session, they are ready to resolve the problem of
teenagers who are unmanageable. To maximize group effectiveness in
decision making and problem solving, the nurse manager has:
a. Prevented conflict.
b. Formed highly cohesive groups.
c. Used majority rule to arrive at decisions.
d. Encouraged equal participation among members. - CORRECT
ANSWER -ANS: D. Encouraged equal participation among members.
Groups are more likely to be effective if members are involved, the
group is cohesive, communication is encouraged, and members
demonstrate some understanding of the group process. The nurse
leader or manager should provide a nonthreatening and positive
environment in which group members are encouraged to participate
actively.
REF: Page 105 TOP: AONE competency: Communication and
Relationship-Building
6. To solve a problem, the nurse manager understands that the most
important problem-solving step is:
a. The implementation phase.
b. Identification of numerous solutions.
c. Accurate identification of the problem.
d. Evaluation of the effectiveness of problem resolution. - CORRECT
ANSWER -ANS: C. Accurate identification of the problem.
To proceed effectively, it is important to determine if a problem exists
and to accurately identify a problem. Failure to resolve problems is
most often linked to improper identification of the problem.
