CHAPTER 03: ETHICAL AND LEGAL ISSUES MORRISON-VALFRE: FOUNDATIONS OF MENTAL HEALTH CARE, 6TH EDITION|10PAGES|UPDATED&VERIFIED|GUARANTEED SUCCESS

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 rewards valued behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction or direction on choices. PTS: 1 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. PTS: 1 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: a. Include coverage for mental illness b. Include coverage for substance abuse treatment c. Include coverage for mental illness that is equal to coverage for physical illness d. Include coverage for 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. PTS: 1 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. PTS: 1 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. PTS: 1 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. PTS: 1 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’s 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. PTS: 1 DIF: Cognitive Level: Application REF: p. 25 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. PTS: 1 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: a. 3 months b. 6 months c. 12 months d. 15 months 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. PTS: 1 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