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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.
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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 psychiatric-mental health nurse is documenting information in a patient?s medical record. Which of the following would be least likely to increase the nurse?s legal liability?
- A. Patient reported that he was feeling better today than yesterday.
- B. Administered haloperidol 10 mg IM stat as ordered for agitation.
- C. Patient was talking with another staff member and started screaming.
- D. Applied restraints to all four patient extremities.
Correct Answer: A
Rationale: Documenting a patient?s subjective report of feeling better is factual and low-risk, whereas administering medication, describing behavior, or applying restraints carries higher legal risk if not properly justified or executed.
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 is explaining the distinction between confidentiality and privacy. Which of the following would the nurse include as reflecting privacy?
- A. Part of personal life not governed by society?s laws
- B. Ethical duty for nondisclosure
- C. Involvement of two individuals
- D. Knowledge of treatment costs and benefits
Correct Answer: A
Rationale: Privacy refers to an individual?s right to control personal information and aspects of their life not governed by laws, whereas confidentiality is the ethical and legal duty to protect disclosed information.
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).