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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.
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A group of nursing students are reviewing information about internal rights protection systems. The students demonstrate understanding of this information when they identify which of the following as an example?
- A. American Hospital Association
- B. American Public Health Association
- C. State mental health provider
- D. The Joint Commission
Correct Answer: D
Rationale: The Joint Commission is an example of an internal rights protection system, as it sets standards for patient rights and safety within healthcare facilities, including mental health settings.
A patient?s psychiatrist informs her that he thinks she needs to participate in a 3-month outpatient aftercare program after her discharge. Which of the following would protect the patient?s right to request a second opinion before agreeing to this suggestion?
- A. Self-determinism
- B. Least restrictive environment
- C. Confidentiality
- D. Mandates to inform
Correct Answer: A
Rationale: Self-determinism refers to a patient?s right to make autonomous decisions about their treatment, including seeking a second opinion before agreeing to a recommended treatment plan.
A patient is going to be discharged this afternoon from the mental health unit. The patient asks the nurse if a copy of his medical record could be sent to the psychologist he will be seeing on an outpatient basis. Which response by the nurse would be most appropriate?
- A. Sure, we?ll have that information sent out in today?s mail.
- B. You will need to sign written authorization for us before we can do this.
- C. I think it would just be best if you just told your psychologist everything he needs to know.
- D. How are you feeling about being discharged this afternoon?
Correct Answer: B
Rationale: HIPAA requires written patient authorization to release medical records to another provider, ensuring confidentiality and patient control over their health information.
A psychiatric-mental health nurse determines that a patient is competent when he is able to do which of the following?
- A. Speak coherent English.
- B. Communicate his or her choices.
- C. Write a living will.
- D. Comply with the medical regimen.
Correct Answer: B
Rationale: Competency is determined by a patient?s ability to understand relevant information, appreciate their situation, and communicate choices effectively, not merely by language fluency, ability to write, or compliance.
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.