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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.
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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 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.
The nurse is providing care to a male patient who is hospitalized with a diagnosis of schizophrenia. Which of the following would be appropriate for the nurse to include in the patient?s medical record?
- A. Patient states that he had a good night with no complaints.
- B. Complained of being unable to sleep because he heard voices throughout the night.
- C. Had a typical night without incidence of insomnia or nightmares.
- D. Acted crazily throughout the night; kept hearing voices and noises.
Correct Answer: B
Rationale: Documentation should be specific, objective, and reflect patient statements or symptoms, such as reporting inability to sleep due to hearing voices, which is relevant to schizophrenia. Terms like ?crazily? are unprofessional.
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.