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A nurse is caring for a patient who is hospitalized for a mental disorder. The nurse is legally obligated to breach the patient?s confidentiality if the patient states which of the following?
- A. I think that the federal government is spying on me.
- B. I get really ?turned on? by your appearance.
- C. That doctor I had today really made me angry.
- D. When I get out of here, I?m going to kill my neighbor.
Correct Answer: D
Rationale: Nurses are legally obligated to breach confidentiality when there is a credible threat of harm to others, such as a statement of intent to kill someone, under the duty to warn (Tarasoff principle).
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A nursing instructor is preparing a class discussion on the topic of self-determinism. Which of the following would the instructor expect to include?
- A. Personal autonomy as a key value
- B. Choices based on pleasing others
- C. Activities reflect personal goals
- D. Right to refuse treatment
- E. Lack of empowerment
Correct Answer: A,C,D
Rationale: Self-determinism involves personal autonomy, activities reflecting personal goals, and the right to refuse treatment, emphasizing patient control over their healthcare decisions.
A nurse working on the psychiatric unit receives a telephone call from the employer of one of the patients on the unit. The employer asks to be sent a copy of Mr. Murray?s latest laboratory work and psychological testing results so Mr. Murray?s medical records in employee health can be kept up to date. Based on the nurse?s knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate?
- A. I?m sorry; we?re not allowed to give out that information about our patient.
- B. I?ll have to get the patient?s signed consent before we can send that information to you.
- C. I am unable to acknowledge whether or not a Mr. Murray is a patient on this unit.
- D. Sure, give me your address, and I will see that the information is sent to you.
Correct Answer: C
Rationale: Under HIPAA, nurses cannot confirm or deny a patient?s presence without consent, as this protects patient privacy. Acknowledging a patient?s presence or sharing records requires written authorization.
A group of students are preparing a class presentation about negligence. Which of the following would the group include as an element required for proving negligence?
- A. Duty to provide care
- B. Proximate cause
- C. Resultant damages
- D. Breach of duty
- E. Cause in fact
- F. Evidence of mistake
Correct Answer: A,B,C,D,E
Rationale: Proving negligence requires establishing a duty to provide care, breach of that duty, cause in fact (the breach caused harm), proximate cause (the harm was foreseeable), and resultant damages.
A patient receives a court order for commitment. Which of the following best exemplifies the concept of least restrictive environment?
- A. Involuntary commitment to an outpatient community mental health center
- B. Medication administration for sedation so the patient cannot get out of bed
- C. Placing the patient in a locked padded room in response to threats of self-harm
- D. Allowing the patient to make the decision about whether treatment is necessary
Correct Answer: A
Rationale: The least restrictive environment principle requires that treatment occur in the least confining setting possible, such as outpatient community mental health care, unless more restrictive measures are necessary for safety.
A nurse is explaining advance care directives, or living wills, to a patient and the ascendancy spouse. Which of the following would the nurse include in the description?
- A. The document tells what treatment is to be omitted if the patient is unable to make the decision.
- B. It requires that the patient sign the living will document while an attorney is present.
- C. The patient?s physician must act as a witness when the patient signs the document.
- D. An attorney draws up the papers to be given to the patient and his or her family.
Correct Answer: A
Rationale: An advance care directive, or living will, specifies a patient?s preferences for medical treatment, including what treatments to omit, in cases where they are unable to make decisions due to incapacity.