ANCC IQ Domain 5 Ethical and Legal Principles (72 questions with rationales)

ANCC IQ Domain 5: Ethical and Legal Principles (72 questions with rationales) You have students from local psychiatric nurse practitioner programs follow you in your clinical practice to show them what you do as a Psychiatric Nurse Practitioner. This is called being a: a. Preceptor b. Mentor c. Professor d. Teacher A A Psychiatric Mental Health Nurse Practitioner providing psychiatric consultation makes a home visit after the police found an 86-year-old widow wandering the streets at 4AM after emergency call from her daughter. The woman has been living with her daughter for the past ten years, after her husband died. Her daughter is a 66-year-old, single, retired schoolteacher, appears thin, exhausted, and reports little sleep for past two years trying to care for her mother. The daughter reports that her mother becomes increasingly confused every evening and wanders the house unable to sleep at night. The daughter is unable to leave her mother alone for even a short period of time because unsupervised her mother will turn on the gas stove burner, leave it unattended, and she escapes the house at every chance to wander the neighborhood. Her mother is socially pleasant, disoriented to time and place, and does not recognize her daughter. Her mother thinks that the daughter is a housekeeper intent on stealing her money and possessions, which is upsetting to the daughter. What is the most important in determining the level of care needed for this elderly client? A. Appraisal of daughter's health and her ability and willingness to continue caring for mother in home. B. Modification of environment such as bright lights in evening, identification bracelet, and safety lock on stove. C. Trial of low-dose atypical antipsychotic to reduce paranoid ideation, help sleep, and decrease wandering. D. Linkage with home health aide 4 to 6 hours, three times per week, and community resources for respite care. A As a psychiatric nurse practitioner, you evaluate your patients for health concerns and beyond, in a holistic manner. your current patient has a blood sugar of 186 and a hemoglobin A1C of 6.7. You refer this patient to an internal medicine practitioner with whom you frequently share patients. You have just violated: A. The DATA Act B. The Adams Act C. No statute D. The Stark law C Which of the following is not insured by the Universal Bill of Rights for Mental Health Patients? A. The right to refuse a particular mode of treatment regardless of informed, voluntary, written consent, or situation. B. The right to freedom from restraint or seclusion, other than as a mode of treatment during an emergency situation. C. The right to be given a reasonable explanation of one's general mental and physical condition, the objectives of treatment, and the possible adverse effects of recommended treatment. D. The right to ongoing participation in the planning of mental health services provided in a manner appropriate to a person's capabilities. A During an outpatient medication evaluation a depressed client reports persistent anger toward his former boss after losing his job due to arguments and assaultive behavior toward co-workers. The client has been waiting outside the plant in the afternoon, watching for the boss to leave to confront him regarding his terminated employment. What responsibility does the PMHNP have in this situation? A. Contact the client's boss to notify him of potential harm. B. Ask the client to sign a "no harm to others" agreement and document in chart. C. Consult state board of nursing regarding state law requirements on reporting potential harm. D. Advise the client to stop going to the plan and avoid any contact with his former boss. C Your patient is a 32-year-old who is diagnosed with major depressionrecurrent, insomnia, and chronic lower back pain. The patient has seen you for three medication management sessions over the last two months. During the fourth medication management session, the patient states that money is tight and an appointment is required with the general practice (GP) physician every time a refill of the Hydrocodone (pain medication) is needed. The patient asks you to refill the Hydrocodone to save the cost of another medical visit. you: A. State that you certification is for psychiatric care only and refer him back to his GP. B. State that you are willing to discuss alternative medications to manage his pain. C. State that you can refill this prescription just once. D. State that you would be willing to call his GP to discuss the issues and help him out. A You are a nurse practitioner (NP) who performs psychotherapy. your patient is distraught, and you call in the NP who is performing the medication management to sit in and discuss and determine if an emergency medication evaluation is needed. After the discussion of medication changes that will take place, the medication manager NP asks the crying patient if she needs a hug. The patient stands and extends her arms outward. The medication NP gives her a chaste hug and leaves the room. Is this a case of inappropriate touch or battery? A. Yes. This is inappropriate, as you never touch a patient under any circumstances. B. No but, nonverbal communication methods are not sufficient for ensuring agreement to hug a patient. C. Yes. This is a case of battery. The patient did not verbally say that it was okay to touch. D. No. This is a case where there was a question asked, nonverbal consent was given, and the NP gave the patient a hug to help the patient cope.D A social worker concerned about a Nigerian refugee who seems to be suffering from severe post-traumatic stress disorder since arriving in U.S. three months ago referred this man to an African American female Psychiatric-Mental Health Nurse Practitioner in the community mental health center. The PMHNP builds rapport by exploring the values, beliefs, life experiences, and accepted behaviors of this young Nigerian man as she seeks to understand the context of his transition to the U.S. before making any diagnosis or proposed intervention. The PMHNP is striving to provide what type of mental health care? a. Alternative care b. Individualized care c. Culturally competent care Culture specific car C You are a psychiatric nurse practitioner (NP) and have many patients with comorbid medical and mental health issues. As a part of your continuous quality improvement (CQI) process, you might best serve your practice by: a. Develop a journal group with a general practice colleague to read the latest articles on self-care for advanced practice nurses. b. Subscribe to Medscape and read it daily to see about new medications being developed for personality disorders. c. Developing a peer review process of your charts with a general practice colleague. d. Subscribe to Medscape Psychiatry and read it critically noting studies that apply to your patient's access to care issues. C The Nurse Practitioner (NP) attends a local meeting where allocation of resources for healthcare will be discussed. One of the stakeholders has a pamphlet that describes the types of healthcare providers available to help persons in need of health care. The NP notices that Nurse Practitioners are labeled as "Paraprofessionals". In the meeting, the NP asks the organization responsible for the pamphlet why they have identified the Nurse Practitioners as paraprofessionals when a Nurse Practitioner is by law working as 85-90% of the same capacity as a Medical Doctor. The NP goes on the explain what a Nurse Practitioner does in various areas of practice. This is an example of: a. Promoting nurse practitioners in the community b. Public education on the NP scope and standards of practice c. Correcting misinformation that deliberately misleads the public d. Advocating for the role and value of the Nurse Practitioner D As a nurse practitioner (NP), you teach your patients that mental illness is no different from any other physical illness that a person suffers. In classes for the community, you emphasize that everybody has a brain and it is another organ in the body. You remind the audience that illness in the brain is no different from illness in the heart, lungs, or liver. This is an example of: a. Reducing Stigma b. Cross education c. Holistic Dynamism d. Integrated health A The Veterans Health Administration (VHA) is asking to let its advanced practice registered nurses (APRNs) work independently, even in states that normally require physician oversight. You begin a writing campaign within your state nursing association and American Psychiatric Nurses Association to convince your state's congressman and senators to vote for the bills associated with this legislation. You are: a. Advocating for the total removal of physician supervision of Nurse Practitioners (NP). b. Advocating for the role and value of Nurse Practitioners (NP). c. Advocating for the healthcare of the nation's veterans. d. Advocating for the Nurse Practitioners (NP) to practice to the full extent of their education and training. D Which of the following is not associated with increased validity in a clinical research trial? a. Outcome measure b. Sample size c. Confounder d. Randomization C A 45-year-old woman with Type I Bipolar Disorder experiencing an acute episode of depression with psychotic features requires a temporary leave of absence from the job as an administrative assistant to a school principal. The patient has signed a release of information for the PMHNP to disclose full mental health records to the principal and the human resources department to facilitate her gradual return to work. The patient fears that she will lose her job due to her psychiatric disorder. What is the most appropriate information the PMHNP can provide in this situation? a. Employers cannot discriminate against individuals with a mental health disorder, which is considered equivalent to a medical disorder by the Mental health Parity Act of 1996. b. Employers cannot discriminate against individuals with a mental health disorder, which is considered a disability covered by the Americans with Disability Act of 1990. c. Employers cannot discriminate against individuals with a mental health disorder, which is protected as a confidential health care information by the Health Insurance Portability and Accountability Act of 1996. d. Employers cannot discriminate against individuals with a mental health disorder, which is a right insured by the Universal Bill of Rights for Mental Health Patients of 1980. B You see a patient for a routine medication visit. At. The end of the session, the patient asks questions and the session. Ends. Up 50 minutes in length. You normally charge for the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-hour appointment includes a full body assessment that you did not perform. This violation is known as: a. Down-coding b. Super-coding c. Over-coding d. Up-coding D A primary care nurse practitioner consults the PMHNP for. Guidance on medication management for a family member she is prescribing medication for bipolar I disorder, because the family member does not have health insurance and cannot afford to see a mental health provider. What would be the most appropriate response by the PMHNP? a. Recommend that she not manage a family member's medication and recommend free clinic. b. Determine acuity and phase of bipolar I disorder to advise on appropriate generic medications c. Recommend free clinic and report nurse practitioner to state board of nursing for practice violation. d. Offer to see the patient pro bono and manage medications. A As a psychiatric nurse practitioner, you frequently are asked to "case manage" your patients for more than psychiatric issues. Your 68-year-old patient, with Medicare is the primary insurance, states that varicose veins are an issue and that treatment is needed. You know that your sister is the best vein surgeon in your city and refer the patient too her. You have just violated: a. The Stark Law b. The Harter Act c. The Adams Act d. The DATA Act A The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which of the following? a. Mental health and substance use disorder benefits must be available through both in-network-providers and out-of-network providers by a group health plan. b. Group health plans may obtain nan exemption if they can demonstrate expected cost increase resulting from implementation of the parity provisions greater than a 5% increase in the cost under existing plan. c. Small employers who insure 50 or fewer covered lives are exempt from the provisions of this MHPPAEA law. d. Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan. D You are a Psychiatric Nurse Practitioner (NP) working in a hospital health system. The hospital administration has implemented a productivity system where all the Psychiatrists and NPs in the department of psychiatry will now have to see four patients per hour. You have informed administration that this is not a good system because many patients are in fragile mental and physical health, require case management, and need extensive care during their medication management sessions to achieve good management of their symptoms and recovery. The hospital administration has reinformed that the productivity system will stay in place and is mandatory. If it is not met, persons not meeting the quota will be penalized. You inform the administration that you cannot work under these conditions. Administration informs you that you are abandoning your patients. You: a. Make the decision to leave your position. Tell your patients the hospital is treating them poorly. b. Make the decision to stay, telling your patients the hospital is treating them poorly. c. Make the decision to leave your position, as you cannot support a system that disregards the needs of the patient. d. Make the decision to stay, as you cannot abandon your patients. C The Nurse Practitioner (NP) has a Law Bill in the State Legislature passed so that funds will be released to be used for housing the severe and persistently mentally ill. The NP contacts eight persons and ask them to telephone the State Senator who heads the Health and Human Services committee. She asks them to tell the State Senator to vote to approve the bill. The NP is acting as an: a. Advocate b. Policy maker c. Stigma Reduction Agent d. Care Provider A Your patient is receiving Medicare and Social Security Disability payments. This money helps her to pay for food, clothing, shelter, and medications. She recently began to work part-time. Her work has greatly improved her mood and self-perception. She has taken on more work. The additional income has caused her to lose her disability and Medicare funding. She is concerned that she will not be able to get her medication, pay for housing, and some of the other things she was able to afford before. How do you counsel her? a. Discuss with her your assessment that her mood has improved since working and self-supporting. Assist her to find programs that will help her to continue. b. Advise her that her counselor can help her with financial issuesprograms, services, and resources. c. Advise her to maintain her Medicare and Social Security benefits because she will always have her food, clothing, shelter, and medication support. d. Discuss with her the consequences of taking on "too much" work ad losing her disability benefits.A The Nurse Practitioner (NP) is seeing a patient for both psychiatric and chemical dependency illnesses. The patient wants the NP to send medical records to his General Practitioner. The NP tells the patient that because of Federal Law 42 CFR he must: a. Sign two separate releases of information due to the special protected nature of chemical dependency information. b. Sign on combined release that designated that he is being treated for both chemical dependency and psychiatry illnesses. c. Sign two separate releases due to the special protected nature of psychiatric information. d. Sign one combined releases that does not mention his chemical dependency illness due to its special protected nature. A Psychiatric-Mental Health Nurse Practitioners seeking admitting privileges at a community hospital with inpatient psychiatric services need to influence policymakers at which of the following levels? a. State Legislature b. County board of health c. State board of nursing d. Local hospital D Your new 30-year-old patient with Generalized Anxiety Disorder has been on Alprazolam (Xanax) 0.5 mg 1 tab PO BID prn anxiety for the past 7 years after trials of multiple SSRI's. She uses this medication about two times per week for "extreme" anxiety. Your personal bias as a careful psychiatric nurse practitioner is that benzodiazepines should only be used with other non-addictive anti-anxiety medications and internally generated copping skills to manage anxiety. In discussing the case with the patient, you recognize that she has been carefully using the Alprazolam, has tried other methods o reduce anxiety, and is working with a therapist. What will your plan of care be? a. The patient is coping well with a limited amount of Alprazolam. Reinforce safe use of benzodiazepines. Continue the medication and encourage use of more internal coping mechanisms. b. The patient may do better with increased therapy. Consult the therapist and wean her off the Alprazolam. c. The patient is using Alprazolam too often. Reinforce safe use of benzodiazepines. Help her to wean off the medication and use more internal coping mechanisms. d. The patient is coping well with the limited amount of Alprazolam, but may do better with Atenolol (Tenormin) 25 mg po QHS. Change the medication prescribed.A You notice that you have begun to care less about your patient's needs. You are tired, unhappy and unsatisfied inn your job. You talk to your office confidant, another psychiatric nurse practitioner about your feelings and concerns about how this might impact your practice. Together, you discuss your need t: a. Reduce your present workload to get more rest and practice better living, eating, exercise, and living skills. b. Avoid those things about your present employment that upset you and get involved in a yoga class. c. Leave your present employment and find a different career in nursing that fulfills you better. d. Leave your present employment in nursing and fid a different career path in something that fulfills you better.A To demonstrate her support for social justice, within her role as a Psychiatric Nurse Practitioner caring for the person who is homeless with mental illness, the psychiatric nurse practitioner (NP): a. Volunteers her clinical services at the psychiatric clinic, run by a local mission project. b. Teaches Sunday School. c. Volunteers to serve food at the local Home for Girls. d. Volunteers to walk at the March of Dimes walk each year. A Per the Health Insurance Portability and Accountability Act (HIPPA), a Nurse practitioner (NP) who is in an independent, single practitioner practice is considered a "Covered Entity" because: a. The NP transmits protected health information in electronic forms. b. May accidently release protected health information. c. Writes information and generates protected health information. d. Maintains charts with the patient information that contains protected health information. A Your patient is a 37-year-old male who you have diagnosed with major depression. He was referred to you by a Licensed Alcohol and Drug Abuse Counselor (LADAC) who has diagnosed him with Opioid Use DisorderSevere. After your evaluation of the patient, you concur with the LADAC's diagnosis and treatment with an antidepressant and inpatient chemical dependency as his best chance for recovery. You discuss treatment with the patient and tell him the rationale for your treatment choice. You discuss his failure to maintain abstinence, his health issues, the loss of friends and family, and other issues that surround using. He refuses the treatment, citing that he is able to care for himself and will continue to try on his own to maintain abstinence. He states that he cannot go through inpatient treatment but will try antidepressant medication and continue seeing his therapist on an outpatient basis. You: a. Continue to discuss the benefits of inpatient treatment and the health needs of the patient until he accepts the recommendation. b. Dismiss the patient from your service. c. Contact the LADAC counselor to manage the patient to place him in protective custody. d. Accept his right to determine his own treatment path. D A newly graduated Nurse Practitioner (NP) wants to open a private psychiatric practice in her hometown. She wants to find out about the laws that cover her responsibility and legal liability that this practice will encounter for her as an independent psychiatric nurse practitioner. Her best source of information is: a. Local Psychiatric Nurse Practitioners in practice. b. The American Academy of Nurse Practitioners. c. The State Statutes on Nursing or Advanced Nursing practice. d. Her City Statutes. C A colleague emails on the company computer system regarding complaints about another coworker. In the message, the colleague makes several disparaging remarks about the other coworker and the difficulty of working with her. You reply: a. She is just not doing things the way we were taught. She can't help it if she is not us, but she could try harder! b. Really, I cannot believe that you get so upset over that little stuff. Help her understand where she is making a mistake and teach her how to do things correctly. c. I understand your feelings, just put up with it. You are going to another shift in one month and will leave the problem behind. d. Did you talk with her about the issue you have with her? Saying things about your co-worker will not resolve the problem or make it better. D The core values that underline advanced practice nursing and culturally competent care include: a. Care, advocacy, respect b. Autonomy, respect, collaboration c. Respect, advocacy, partnership d. Care, respect, collaboration C The Nurse practitioner (NP) is seeing a 72-year-old male for depression management. Upon assessment, the patient is alert, oriented, and nonsuicidal or homicidal. The patient is able to manage his activities of daily living. The NP witnesses the man's wife verbally abusing him on several occasions. The NP has verbal reports from staff nurses and their nursing notes that the man has come into the unit with bruising and contusions inconsistent with his affluent lifestyle and physical health condition. When the NP speaks to the man about the physical and verbal abuse, he tells her that it is occurring. He also tells her that he does not want to do anything about the situation. He tells her specifically that he does not want her to contact any authorities about the situation. a. She is required to contact Adult protective Services or similar services in the local community to investigate the senior citizen's safety. b. Take pictures of the brises and contusions and save them to the patient's record. c. Arrange to remove the patient to a safer environment. d. The NP must do as the patient requests as long as he is competent. D