Chapter 9: Legal and Ethical Issues
A voluntary client in a mental health unit signs a written request for discharge. The treatment team determines the client is still a danger to themselves. What is the most appropriate legal action for the psychiatrist to take?
A. Refuse to let the client leave and locked the unit door.
B. File for a civil commitment to detain the client until a hearing occurs.
C. Inform the client they are being discharged against medical advice (AMA).
D. Restrain the client immediately to prevent them from leaving.
B. If a voluntary client is dangerous and requests discharge, the psychiatrist can initiate civil commitment to ensure safety until a legal hearing.
A nurse is caring for a client who is becoming increasingly irritable and begins pacing the hallway. Which of the following actions should the nurse take first?
A. Obtain a "show of force" by gathering four to six staff members.
B. Direct the client to take a time-out in their room immediately.
C. Approach the client in a nonthreatening, calm manner to convey empathy.
D. Administer a PRN dose of intramuscular haloperidol.
C. During the triggering phase, the nurse should approach the client calmly and nonthreateningly to de-escalate the situation and encourage verbal expression of feelings.
A nurse in the emergency department is assessing a female client who has several bruises at various stages of healing. Which action should the nurse take first?
A. Document the physical findings and report them to the police.
B. Ask the client's partner to step out of the room before continuing the interview.
C. Inform the client about local shelters and legal services.
D. Ask the client if she would like to file a restraining order.
Answer: B
Rationale: Nurses should ask questions about abuse when the client is alone to ensure safety and provide an opportunity for the client to speak freely. Identifying abuse is a top priority, and the nurse must be skilled in asking appropriate questions once the client is in a private space.
A client who was a first responder during a major natural disaster is being screened for posttraumatic stress disorder (PTSD). Which finding should the nurse identify as a symptom of hyperarousal?
A. Feeling "dead inside" or emotionally numb.
B. Avoiding the location where the disaster occurred.
C. Recurrent nightmares regarding the event.
D. Persistent irritability and angry outbursts.
D. Hyperarousal symptoms include insomnia, hypervigilance, irritability, or angry outbursts. Option A is numbing; B is avoidance; C is reexperiencing.
A nurse is assessing a client in the emergency department who is pacing, has a heart rate of 120 bpm, and is complaining of feeling like "something is definitely wrong." The client can follow instructions but is having difficulty concentrating. The nurse should document the client's anxiety at which level?
A. Mild
B. Moderate
C. Severe
D. Panic
B. Moderate anxiety is characterized by the feeling that something is wrong, nervousness, and difficulty concentrating independently, though the person can still be redirected and process information.
A nurse is caring for a client who is being held in mechanical restraints due to aggressive behavior. Which action by the nurse is a requirement for maintaining safe and legal standards of care?
A. Ensure a face-to-face evaluation by a licensed practitioner occurs every 24 hours.
B. Monitor the client via audio and video equipment only after the first hour.
C. Provide a one-to-one staff monitor for the duration of the restraint period.
D. Free all four limbs every 2 hours for movement and exercise.
C. Standards of care require continuous one-to-one monitoring for the duration of physical/mechanical restraint.
Which statement by a client demonstrates the effective use of assertive communication for anger management?
A. "You always change the schedule without asking me, and it's unfair."
B. "I feel angry when you interrupt me during group therapy."
C. "I’m going to go hit the punching bag until I feel better."
D. "It’s fine that you’re late; I didn’t really need to start on time anyway."
B. Assertive communication uses "I" statements that express specific feelings related to a situation, such as "I feel angry when you interrupt me".
Which statement by a nurse demonstrates a correct understanding of the relationship between alcohol use and domestic violence?
A. "Alcohol use is the primary cause of abusive behavior in families."
B. "Most people who experience intimate violence report that alcohol was not involved."
C. "Alcohol may diminish inhibitions, making violent behavior more intense or frequent."
D. "Arresting an abusive partner for public intoxication will stop future domestic violence."
Answer: C
Rationale: Researchers believe alcohol may diminish inhibitions and increase the frequency or intensity of violence, though it is not a direct cause-and-effect relationship. Most people who have experienced intimate violence report that alcohol was involved in the incident.
A nurse is caring for a client who survived a physical assault 2 weeks ago. The client reports feeling "on edge," has difficulty sleeping, and experiences intrusive memories of the event. The nurse should recognize these symptoms are characteristic of which disorder?
A. Posttraumatic stress disorder (PTSD)
B. Acute stress disorder
C. Adjustment disorder
D. Dissociative amnesia
B. Acute stress disorder occurs 3 days to 4 weeks after trauma. PTSD is diagnosed only after symptoms persist for 3 months or more.
A client experiencing a panic attack is shouting "I can't breathe! I'm dying!" What is the priority nursing intervention?
A. Teach the client how to use progressive muscle relaxation.
B. Ask the client to explain what triggered the episode.
C. Remain with the client and provide a safe, quiet environment.
D. Administer a PRN dose of an SSRI antidepressant.
C. During panic-level anxiety, safety is the primary concern. The nurse must remain with the client, provide a nonstimulating environment, and offer comfort, as the client cannot process complex information.
Which situation describes the legal concept of "duty to warn" based on the Tarasoff decision?
A. A client tells the nurse they are feeling "very angry" at their boss.
B. A client with paranoia says, "I’m going to get them before they get me".
C. A client states they intend to kill their spouse upon discharge.
D. A client refuses to take their medication while in the community.
C. The duty to warn applies when a client makes a serious threat toward an identifiable person. Vague threats do not meet the criteria.
A nurse is assessing a client for a history of aggressive behavior. Which factor is the best predictor of a client's future aggression?
A. A diagnosis of clinical depression with somatic complaints.
B. Being a member of a culture that views anger as rude.
C. A history of previous violent or aggressive behavior.
D. A lack of physical space or privacy on the unit.
C. A history of violent or aggressive behavior is identified as one of the best predictors of future aggression.
A nurse is caring for an older adult client and suspects physical neglect. Which assessment finding most strongly supports this suspicion?
A. The client refuses to pay for a new television they can easily afford.
B. The client has invested a large sum of money in a charity the family dislikes.
C. The client is hesitant to talk openly and appears fearful or withdrawn.
D. The client presents with a pervasive smell of urine, rashes, and untreated pressure sores.
Answer: D
Rationale: Signs of physical neglect in older adults include a pervasive smell of urine or feces, rashes, sores, and inadequate clothing. While being fearful or withdrawn can indicate emotional abuse, the physical signs of poor hygiene and untreated sores are direct indicators of physical neglect.
When assessing a client during a flashback, which of the following clinical manifestations should the nurse expect to observe?
A. The client becomes highly talkative and relates the event in detail.
B. The client appears terrified and may attempt to hide or run away.
C. The client expresses intense guilt about surviving the event.
D. The client demonstrates a sudden increase in self-esteem.
B. During a flashback, the client is reexperiencing the trauma and may appear terrified, scream, or try to escape the "threat."
Which statement by a client with agoraphobia demonstrates an understanding of "secondary gain"?
A. "I stay inside because it is the only way I can feel relief from my fear."
B. "My husband does all the grocery shopping and errands since I can't leave the house."
C. "I know that my fear of being in public spaces is irrational and illogical."
D. "I am using positive reframing to tell myself that I am safe at home."
B. Secondary gain is the attention or relief from responsibilities received from others as a result of the behavior, such as family members assuming all errands. (Choice A represents primary gain) .
A nurse threatens to give a client an injection of sedative medication if the client does not stop pacing the hallways. This nurse could be found liable for which intentional tort?
A. Battery
B. Assault
C. False Imprisonment
D. Negligence
B. Assault is an action that causes a person to fear being touched in an offensive or injurious way, such as making threats to restrain or inject a client.
A client is in the "crisis phase" of the aggression cycle and is physically attacking a staff member. Which intervention is appropriate for the nurse to implement?
A. Encourage the client to use "I" statements to express their feelings.
B. Use a calm, firm voice to offer the client a choice of oral medications.
C. Discuss the triggers that led to the behavior to prevent future episodes.
D. Use seclusion or restraint following facility protocols to ensure safety.
D. In the crisis phase, the client is physically aggressive, and staff must take charge for safety, which may include the use of seclusion or restraint.
During the "honeymoon period" of the cycle of violence, what behavior should the nurse expect from the abusive partner?
A. Stony silence and increased complaints about the partner’s behavior.
B. Escalating physical violence and verbal name-calling.
C. Expressions of regret, apologies, and promises that the abuse will never happen again.
D. A total lack of remorse and refusal to speak to the person being abused.
Answer: C
Rationale: The honeymoon period (or period of contrition/remorse) is characterized by the abusive partner expressing regret, apologizing, and promising the violence will not recur. They may also engage in romantic behaviors like buying gifts.
A nurse is working with a client who has been diagnosed with a dissociative disorder. Which statement by the client best describes the phenomenon of derealization?
A. "I feel like I am a different person every few hours."
B. "I cannot remember anything about my childhood before the accident."
C. "I feel like I am in a dream and everything around me is foggy or unreal."
D. "I suddenly found myself in a new city and don't know how I got here."
C. Derealization is the sensation of being in a dreamlike state where the environment seems unreal. Option D describes a fugue state.
The nurse is providing discharge teaching for an older adult client prescribed a benzodiazepine for short-term anxiety. Which safety instruction is most important to include?
A. "Take the medication with a caffeinated beverage to prevent drowsiness."
B. "This medication is a permanent cure for your anxiety symptoms."
C. "You are at an increased risk for falls and hip fractures while taking this drug."
D. "You should use this medication for at least 3 to 6 months for best results."
C. In older adults, benzodiazepines are associated with a significantly increased risk for falls and injuries such as hip fractures. Use should be short-term (4-6 weeks) due to dependence risk.
A nurse is faced with a dilemma: a client refuses a life-saving treatment based on their own wishes, but the nurse wants to promote the client's health. The nurse is balancing which two ethical principles?
A. Veracity and Fidelity
B. Autonomy and Beneficence
C. Justice and Nonmaleficence
D. Utilitarianism and Deontology
B. Autonomy is the right to self-determination , while Beneficence is the duty to promote the good of others.
The nurse understands that "catharsis," such as hitting a punching bag, has what effect on an angry client?
A. It provides a healthy release and effectively decreases angry feelings.
B. It is a form of assertive communication that improves problem-solving.
C. It can increase rather than alleviate angry feelings and may be contraindicated.
D. It is more effective than non-aggressive activities like walking or talking.
C. While intended to release anger, catharsis can actually increase angry feelings; non-aggressive activities like walking are more effective.
A nurse is assessing a school-age child for suspected abuse. Which finding is a classic indicator of intentional physical abuse?
A. A single bruise on the shin from a reported fall while playing.
B. Burns with a "stocking and glove" distribution on the extremities.
C. Knowledge of sexual issues appropriate for the child's developmental age.
D. The child clings to their parent during the entire physical examination.
Answer: B
Rationale: A "stocking and glove" distribution of burns indicates scalding, which is a sign of intentional injury. Other indicators include bruises in recognizable shapes like belt buckles or teeth marks, and injuries that the provided history does not adequately explain.
Which nursing intervention is a priority for a client with PTSD who reports feeling overwhelmed by intrusive thoughts and a desire to "end the pain"?
A. Encouraging the client to join a local self-help group.
B. Teaching the client how to use a feelings journal.
C. Assessing the client's potential for self-harm or suicide.
D. Discussing the details of the traumatic event to process the memory.
C. Safety is the priority. If a client expresses a desire to "end the pain," the nurse must immediately assess for suicidal ideation.
A therapist is working with a client who has a specific phobia of spiders. The therapist has the client look at a picture of a spider, then a plastic model, and eventually a real spider in a cage. This is an example of which behavioral therapy?
A. Flooding
B. Systematic desensitization
C. Thought-stopping
D. Decatastrophizing
B. Systematic (serial) desensitization involves progressively exposing the client to the threatening object in a safe setting until anxiety decreases. (Flooding involves rapid, intense exposure) .