Chapter 03: Legal Issues
Steele: Keltner’s Psychiatric Nursing,
MULTIPLE CHOICE
1. Considering the Tarasoff v. The Regents of the University of California, what information is
most important for the nurse to document and act upon when caring for a patient?
a. The patient‘s participation in treatment planning
b. The patient‘s comments about harming others
c. Examples of behaviors that support psychiatric diagnoses
d. The patient‘s perceptions of the need for hospitalization and treatment
ANS: B
An exception to the patient‘s right to confidentiality is the duty to warn, based on the landmark
case Tarasoff v. The Regents of the University of California. Although each of the options refers
to data that should be documented and/or acted upon, the patient‘s comments about the intent to
harm others would be of most importance related to Tarasoff v. The Regents of the University of
California.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
2. When discussing the patient rights with nursing students, the nurse demonstrates an accurate
understanding or the decision by focusing on what factor?
a. Intellectualization of the client‘s condition
b. Providing treatment in the least restrictive environment.
c. Minimizing the client‘s risk of medication related side effects
d. Risks created by a request for immediate discharge from the facility
ANS: B
, The right to self-determinism with regard to psychiatric care choices and refusal includes the
right to utilize the least restrictive environment and means of treatment. An individual has the
right to freedom from unnecessary restriction when less restrictive, appropriate interventions are
available in the community. Intellectualizing is a defense mechanism. Risks are
considered as foci related to patient safety.
DIF: Cognitive level: Evaluating TOP: Nursing process: Planning
MSC: Client Needs: Safe, Effective Care Environment
3. A voluntarily admitted patient shouts, ―What you are doing is breaking the law.‖ The nurse
should review past care related to what focus?
a. Loss of recreational privileges
b. Restriction related to visiting hours
c. Medication administration
d. Suggesting involuntary hospitalization with multidisciplinary treatment team
ANS: C
The nonviolent, voluntarily admitted patient cannot be forced to take medication. Loss of
privileges are a tool for behavioral modification when supported by appropriate institutional
policy. Visitors and visiting hours are established according to institutional policies and safety
concerns. Change in admission status is appropriately handled during multidisciplinary treatment
team meeting.
DIF: Cognitive level: Applying TOP: Nursing process: Assessment
MSC: Client Needs: Safe, Effective Care Environment
4. To help preserve patients‘ rights to freedom from restraint and seclusion, the most important
interventions that the nurse can use are based on which intervention?
a. Therapeutic management of the patient‘s needs
b. Reality-based communication to minimize cognitive disorientation
c. Confidentiality of all documentation associated with the patient
d. Effective use of ancillary personnel to monitor the patient
, ANS: A
Attention to the nurse-patient relationship, the therapeutic milieu, and principles of
pharmacologic management can reduce the need for restrictive measures. The other options are
important aspects of care but do not relate directly to the use of restraint and seclusion.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
5. A nurse finds a mental health care directive in the medical record of a patient experiencing
psychosis. The directive prohibits the prescription of specific medications. Considering the
patient‘s impaired function, what is the nurse‘s primary responsibility regarding medication
administration?
a. Ensure that the directives are respected in treatment planning.
b. Review the directive with the patient to ensure that it is current.
c. Alert the prescribing psychiatrist of the directive.
d. Discuss the revision of the directive with the patient‘s guardian or power of
attorney.
ANS: A
Steele: Keltner’s Psychiatric Nursing,
MULTIPLE CHOICE
1. Considering the Tarasoff v. The Regents of the University of California, what information is
most important for the nurse to document and act upon when caring for a patient?
a. The patient‘s participation in treatment planning
b. The patient‘s comments about harming others
c. Examples of behaviors that support psychiatric diagnoses
d. The patient‘s perceptions of the need for hospitalization and treatment
ANS: B
An exception to the patient‘s right to confidentiality is the duty to warn, based on the landmark
case Tarasoff v. The Regents of the University of California. Although each of the options refers
to data that should be documented and/or acted upon, the patient‘s comments about the intent to
harm others would be of most importance related to Tarasoff v. The Regents of the University of
California.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
2. When discussing the patient rights with nursing students, the nurse demonstrates an accurate
understanding or the decision by focusing on what factor?
a. Intellectualization of the client‘s condition
b. Providing treatment in the least restrictive environment.
c. Minimizing the client‘s risk of medication related side effects
d. Risks created by a request for immediate discharge from the facility
ANS: B
, The right to self-determinism with regard to psychiatric care choices and refusal includes the
right to utilize the least restrictive environment and means of treatment. An individual has the
right to freedom from unnecessary restriction when less restrictive, appropriate interventions are
available in the community. Intellectualizing is a defense mechanism. Risks are
considered as foci related to patient safety.
DIF: Cognitive level: Evaluating TOP: Nursing process: Planning
MSC: Client Needs: Safe, Effective Care Environment
3. A voluntarily admitted patient shouts, ―What you are doing is breaking the law.‖ The nurse
should review past care related to what focus?
a. Loss of recreational privileges
b. Restriction related to visiting hours
c. Medication administration
d. Suggesting involuntary hospitalization with multidisciplinary treatment team
ANS: C
The nonviolent, voluntarily admitted patient cannot be forced to take medication. Loss of
privileges are a tool for behavioral modification when supported by appropriate institutional
policy. Visitors and visiting hours are established according to institutional policies and safety
concerns. Change in admission status is appropriately handled during multidisciplinary treatment
team meeting.
DIF: Cognitive level: Applying TOP: Nursing process: Assessment
MSC: Client Needs: Safe, Effective Care Environment
4. To help preserve patients‘ rights to freedom from restraint and seclusion, the most important
interventions that the nurse can use are based on which intervention?
a. Therapeutic management of the patient‘s needs
b. Reality-based communication to minimize cognitive disorientation
c. Confidentiality of all documentation associated with the patient
d. Effective use of ancillary personnel to monitor the patient
, ANS: A
Attention to the nurse-patient relationship, the therapeutic milieu, and principles of
pharmacologic management can reduce the need for restrictive measures. The other options are
important aspects of care but do not relate directly to the use of restraint and seclusion.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
5. A nurse finds a mental health care directive in the medical record of a patient experiencing
psychosis. The directive prohibits the prescription of specific medications. Considering the
patient‘s impaired function, what is the nurse‘s primary responsibility regarding medication
administration?
a. Ensure that the directives are respected in treatment planning.
b. Review the directive with the patient to ensure that it is current.
c. Alert the prescribing psychiatrist of the directive.
d. Discuss the revision of the directive with the patient‘s guardian or power of
attorney.
ANS: A
