Test bank for contemporary psychiatric mental health nursing 3rd edition by kneisl

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Test Bank for Contemporary Psychiatric Mental Health Nursing 3rd Edition
by Kneisl
Chapter 12
Question 1
Type: MCSA
For a nurse studying bioethics, which of the following statements would indicate
that learning has occurred regarding autonomy?
1.
2.
3.
4.

“All clients should be given their due.”
“Part of our profession is doing good things for others.”
“We must always be honest with clients.”
“After I provide information, I will respect my client’s right to make a
decision.”

Correct Answer: 4
Rationale 1: Autonomy is the freedom to choose a course of action, to act on that
choice, and to live with the consequences of that choice. Nurses help clients by
providing them with the information they need in order to choose, helping them to
understand and sort through the information, and supporting their choice. The
statement, “All clients should be given their due” demonstrates justice. The
statement, “Part of our profession is doing good things for others” demonstrates
beneficence. The statement, “We must always be honest with clients” demonstrates
veracity.
Rationale 2: Autonomy is the freedom to choose a course of action, to act on that

choice, and to live with the consequences of that choice. Nurses help clients by
providing them with the information they need in order to choose, helping them to
understand and sort through the information, and supporting their choice. The
statement, “All clients should be given their due” demonstrates justice. The
statement, “Part of our profession is doing good things for others” demonstrates
beneficence. The statement, “We must always be honest with clients” demonstrates
veracity.
Rationale 3: Autonomy is the freedom to choose a course of action, to act on that
choice, and to live with the consequences of that choice. Nurses help clients by
providing them with the information they need in order to choose, helping them to




understand and sort through the information, and supporting their choice. The
statement, “All clients should be given their due” demonstrates justice. The
statement, “Part of our profession is doing good things for others” demonstrates
beneficence. The statement, “We must always be honest with clients” demonstrates
veracity.
Rationale 4: Autonomy is the freedom to choose a course of action, to act on that
choice, and to live with the consequences of that choice. Nurses help clients by
providing them with the information they need in order to choose, helping them to
understand and sort through the information, and supporting their choice. The
statement, “All clients should be given their due” demonstrates justice. The
statement, “Part of our profession is doing good things for others” demonstrates
beneficence. The statement, “We must always be honest with clients” demonstrates
veracity.
Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: Relate the six principles of bioethics to the practice of
psychiatric–mental health nursing.

Question 2
Type: MCSA
A nurse observes an acutely psychotic client scratching at his arms with his
fingernails until his arms bleed. When asked what is happening, the client states he
is trying to let the evil spirits out of his body. He is easily redirected by the nurse,
but resumes scratching when the nurse leaves his side. The nurse orders 1:1
supervision of the client to keep him from harming himself. Which principle of
bioethics was applied in this situation?
1. Justice




2. Fidelity
3. Beneficence
4. Veracity
Correct Answer: 3
Rationale 1: The nurse’s actions are taken to protect the client from harming
himself. The client requires 1:1 supervision because his mental status is
contributing to self-harm. Fidelity is loyalty and commitment to clients. Veracity is
the intention to tell the truth. Justice is the principle of treating others fairly and
equally.
Rationale 2: The nurse’s actions are taken to protect the client from harming
himself. The client requires 1:1 supervision because his mental status is

contributing to self-harm. Fidelity is loyalty and commitment to clients. Veracity is
the intention to tell the truth. Justice is the principle of treating others fairly and
equally.
Rationale 3: The nurse’s actions are taken to protect the client from harming
himself. The client requires 1:1 supervision because his mental status is
contributing to self-harm. Fidelity is loyalty and commitment to clients. Veracity is
the intention to tell the truth. Justice is the principle of treating others fairly and
equally.
Rationale 4: The nurse’s actions are taken to protect the client from harming
himself. The client requires 1:1 supervision because his mental status is
contributing to self-harm. Fidelity is loyalty and commitment to clients. Veracity is
the intention to tell the truth. Justice is the principle of treating others fairly and
equally.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Relate the six principles of bioethics to the practice of
psychiatric–mental health nursing.




Question 3
Type: MCSA
The nurse acts on the client’s behalf as an advocate for the client’s needs and best
interests. What principle of bioethics is being demonstrated by the nurse?
1.

2.
3.
4.

Veracity
Beneficence
Fidelity
Justice

Correct Answer: 3
Rationale 1: Fidelity is loyalty and commitment to clients. The nurse demonstrates
fidelity when advocating for the best interests of the client. Veracity is the intention
to tell the truth. Beneficence is the principle of attempting to do things that promote
the good of others. Justice is the principle of treating others fairly and equally.
Rationale 2: Fidelity is loyalty and commitment to clients. The nurse demonstrates
fidelity when advocating for the best interests of the client. Veracity is the intention
to tell the truth. Beneficence is the principle of attempting to do things that promote
the good of others. Justice is the principle of treating others fairly and equally.
Rationale 3: Fidelity is loyalty and commitment to clients. The nurse demonstrates
fidelity when advocating for the best interests of the client. Veracity is the intention
to tell the truth. Beneficence is the principle of attempting to do things that promote
the good of others. Justice is the principle of treating others fairly and equally.
Rationale 4: Fidelity is loyalty and commitment to clients. The nurse demonstrates
fidelity when advocating for the best interests of the client. Veracity is the intention
to tell the truth. Beneficence is the principle of attempting to do things that promote
the good of others. Justice is the principle of treating others fairly and equally.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Relate the six principles of bioethics to the practice of
psychiatric–mental health nursing.

Question 4
Type: MCSA
The nurse conducts ongoing evaluation of the crisis situation to ensure the client’s
right to the least restrictive intervention. This means the assessment factor
receiving the highest priority is:
1. The client’s condition in comparison to the adequacy of the environment
designed to prevent injury.
2. The client’s mental status.
3. The client–staff ratio.
4. The comfort level of the environment.
Correct Answer: 1
Rationale 1: Decisions that impact the client’s individual freedom are moral
decisions. There must be consideration of what other interventions were attempted
and what possibly could work, whether the client’s behavior warrants a particular
level of restrictive intervention, and how the level of the intervention will affect the
client and the milieu. The client–staff ratio will not be a priority in determining the
level of intervention. The client’s mental status will be considered in conjunction
with the environment. The comfort level of the milieu will not be a priority.
Rationale 2: Decisions that impact the client’s individual freedom are moral
decisions. There must be consideration of what other interventions were attempted
and what possibly could work, whether the client’s behavior warrants a particular

level of restrictive intervention, and how the level of the intervention will affect the
client and the milieu. The client–staff ratio will not be a priority in determining the
level of intervention. The client’s mental status will be considered in conjunction
with the environment. The comfort level of the milieu will not be a priority.
Rationale 3: Decisions that impact the client’s individual freedom are moral
decisions. There must be consideration of what other interventions were attempted
and what possibly could work, whether the client’s behavior warrants a particular




level of restrictive intervention, and how the level of the intervention will affect the
client and the milieu. The client–staff ratio will not be a priority in determining the
level of intervention. The client’s mental status will be considered in conjunction
with the environment. The comfort level of the milieu will not be a priority.
Rationale 4: Decisions that impact the client’s individual freedom are moral
decisions. There must be consideration of what other interventions were attempted
and what possibly could work, whether the client’s behavior warrants a particular
level of restrictive intervention, and how the level of the intervention will affect the
client and the milieu. The client–staff ratio will not be a priority in determining the
level of intervention. The client’s mental status will be considered in conjunction
with the environment. The comfort level of the milieu will not be a priority.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: Apply ethical guidelines in reconciling crucial ethical dilemmas.

Question 5
Type: MCSA
The client is concerned that the information given to the nurse remains confidential.
Which is the nurse’s best response?
1. “If the information is important to your care, I will need to share it with the
staff.”
2. “We can keep the information just between the two of us if you prefer.”
3. “I will share the information with staff members only with your approval.”
4. “You can make the decision concerning whether your physician needs this
information for your care.”
Correct Answer: 1




Rationale 1: The nurse is obligated to share with the client the limits of
confidentiality in their exchanges. Information gathering and sharing are part of the
mental health nurse’s role and the expectation is that the nurse will accurately
portray and convey data about the client. The nurse would not keep information
from the rest of the mental health team.
Rationale 2: The nurse is obligated to share with the client the limits of
confidentiality in their exchanges. Information gathering and sharing are part of the
mental health nurse’s role and the expectation is that the nurse will accurately
portray and convey data about the client. The nurse would not keep information
from the rest of the mental health team.
Rationale 3: The nurse is obligated to share with the client the limits of
confidentiality in their exchanges. Information gathering and sharing are part of the
mental health nurse’s role and the expectation is that the nurse will accurately
portray and convey data about the client. The nurse would not keep information
from the rest of the mental health team.

Rationale 4: The nurse is obligated to share with the client the limits of
confidentiality in their exchanges. Information gathering and sharing are part of the
mental health nurse’s role and the expectation is that the nurse will accurately
portray and convey data about the client. The nurse would not keep information
from the rest of the mental health team.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Apply ethical guidelines in reconciling crucial ethical dilemmas.

Question 6
Type: MCSA




The nurse educator is teaching a group of students about the ethical dilemma of
involuntary commitment. Which of the following would the educator use as a
situation that would support the use of an involuntary commitment?
1.
2.
3.
4.

The client uses profanity when angry
The client self-medicates with marijuana
The client has threatened family members

The client reports auditory hallucinations

Correct Answer: 3
Rationale 1: Involuntary commitment is reserved for those individuals who are
dangerous to self or others or unable to meet their basic needs. The threats to the
client’s family are considered a danger to others. The client’s use of profanity,
reports of auditory hallucinations, or the use of marijuana are not criteria for
involuntary commitment.
Rationale 2: Involuntary commitment is reserved for those individuals who are
dangerous to self or others or unable to meet their basic needs. The threats to the
client’s family are considered a danger to others. The client’s use of profanity,
reports of auditory hallucinations, or the use of marijuana are not criteria for
involuntary commitment.
Rationale 3: Involuntary commitment is reserved for those individuals who are
dangerous to self or others or unable to meet their basic needs. The threats to the
client’s family are considered a danger to others. The client’s use of profanity,
reports of auditory hallucinations, or the use of marijuana are not criteria for
involuntary commitment.
Rationale 4: Involuntary commitment is reserved for those individuals who are
dangerous to self or others or unable to meet their basic needs. The threats to the
client’s family are considered a danger to others. The client’s use of profanity,
reports of auditory hallucinations, or the use of marijuana are not criteria for
involuntary commitment.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: Apply ethical guidelines in reconciling crucial ethical dilemmas.

Question 7
Type: MCSA
The student nurse is learning how to reduce the stigma associated with mental
illness. Which of the following statements by the student nurse reflects that learning
has taken place?
1. “We’re admitting another schizophrenic who hears God talking.”
2. “A 19-year-old who reports hearing voices is being admitted with a diagnosis
of psychosis not otherwise specified.”
3. “We’re admitting another crazy client.”
4. “They’ve added another paranoid to the unit.”
Correct Answer: 2
Rationale 1: It is the nurse’s role to address the stigma associated with diagnostic
labeling. It is essential that clients not be referred to by their disease or in ways that
discredit their social identity.
Rationale 2: It is the nurse’s role to address the stigma associated with diagnostic
labeling. It is essential that clients not be referred to by their disease or in ways that
discredit their social identity.
Rationale 3: It is the nurse’s role to address the stigma associated with diagnostic
labeling. It is essential that clients not be referred to by their disease or in ways that
discredit their social identity.
Rationale 4: It is the nurse’s role to address the stigma associated with diagnostic
labeling. It is essential that clients not be referred to by their disease or in ways that
discredit their social identity.
Global Rationale:

Cognitive Level: Creating
Client Need: Safe Effective Care Environment




Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Describe how psychiatric–mental health nurses can avoid
indirectly contributing to the stereotypes associated with psychiatric diagnostic
categories.

Question 8
Type: MCSA
The nurse is having lunch with colleagues from a medical-surgical unit. One of the
medical-surgical nurses states, “I don’t know how you can work with psych patients!
They scare the heck out of me.” How should the nurse respond?
1. “It’s not that bad, and most of the clients are not that scary.”
2. “The clients I work with have physical disorders just like the clients you work
with.”
3. “I don’t know; sometimes I wonder what I am doing.”
4. “I must have better nursing skills than you do.”
Correct Answer: 2
Rationale 1: The stigma associated with psychiatric diagnostic labels has to be
confronted directly. It is important that the nurse communicate to peers that the
clients have physical disorders that are no different from those physical disorders
found on the medical-surgical unit.
Rationale 2: The stigma associated with psychiatric diagnostic labels has to be
confronted directly. It is important that the nurse communicate to peers that the
clients have physical disorders that are no different from those physical disorders

found on the medical-surgical unit.
Rationale 3: The stigma associated with psychiatric diagnostic labels has to be
confronted directly. It is important that the nurse communicate to peers that the
clients have physical disorders that are no different from those physical disorders
found on the medical-surgical unit.
Rationale 4: The stigma associated with psychiatric diagnostic labels has to be
confronted directly. It is important that the nurse communicate to peers that the




clients have physical disorders that are no different from those physical disorders
found on the medical-surgical unit.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Describe how psychiatric–mental health nurses can avoid
indirectly contributing to the stereotypes associated with psychiatric diagnostic
categories.

Question 9
Type: MCSA
A psychiatric–mental health nurse is attending a seminar. The speaker discusses
how certain psychiatric diagnoses are associated with stereotypes. Which of the
following actions ensures that the client’s social identity is not discredited?
1.
2.

3.
4.

Refer to a client as delusional and psychotic.
Refer to a client as a schizophrenic.
Refer to a client as a paranoid.
Refer to a client as X who has a diagnosis of schizophrenia.

Correct Answer: 4
Rationale 1: There are many negative stereotypes attached to the diagnostic label
of schizophrenia. It is essential that clients not be referred to by their disease or in
ways that discredit their social identity.
Rationale 2: There are many negative stereotypes attached to the diagnostic label
of schizophrenia. It is essential that clients not be referred to by their disease or in
ways that discredit their social identity.




Rationale 3: There are many negative stereotypes attached to the diagnostic label
of schizophrenia. It is essential that clients not be referred to by their disease or in
ways that discredit their social identity.
Rationale 4: There are many negative stereotypes attached to the diagnostic label
of schizophrenia. It is essential that clients not be referred to by their disease or in
ways that discredit their social identity.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Describe how psychiatric–mental health nurses can avoid
indirectly contributing to the stereotypes associated with psychiatric diagnostic
categories.

Question 10
Type: MCSA
A client becomes upset when touched by a staff member who is attempting to assess
the client’s blood pressure. The nurse recognizes that there is a problem with:
1.
2.
3.
4.

Confidentiality.
Staff control.
Duty to protect.
Informed consent.

Correct Answer: 4
Rationale 1: A client has the right to understand the treatment process prior to
consenting to treatment. This is called informed consent and is required by all
states. Staff members do not control clients, but work with clients. Duty to protect is
a safeguard that is an exception to confidentiality and privilege. Confidentiality is
the mechanism to ensure the client’s privacy.




Rationale 2: A client has the right to understand the treatment process prior to

consenting to treatment. This is called informed consent and is required by all
states. Staff members do not control clients, but work with clients. Duty to protect is
a safeguard that is an exception to confidentiality and privilege. Confidentiality is
the mechanism to ensure the client’s privacy.
Rationale 3: A client has the right to understand the treatment process prior to
consenting to treatment. This is called informed consent and is required by all
states. Staff members do not control clients, but work with clients. Duty to protect is
a safeguard that is an exception to confidentiality and privilege. Confidentiality is
the mechanism to ensure the client’s privacy.
Rationale 4: A client has the right to understand the treatment process prior to
consenting to treatment. This is called informed consent and is required by all
states. Staff members do not control clients, but work with clients. Duty to protect is
a safeguard that is an exception to confidentiality and privilege. Confidentiality is
the mechanism to ensure the client’s privacy.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Explain why psychiatric–mental health nurses need to be
knowledgeable about the mental health statutes and regulations in the state in
which they practice.

Question 11
Type: MCSA
The nurse is working with a client who has just stated that she beats her toddler
with a wooden paddle. The nurse determines that the client’s verbal admission
warrants:
1. A report to appropriate government authorities.

2. A report to the nursing supervisor.
3. A report to the physician.
4. A report to the chief of staff.
Correct Answer: 1
Rationale 1: Nurses are legally obligated to report suspected child abuse to the
proper government authorities. This is part of the duty to protect. The information
will also be communicated to the nursing supervisor, the physician, and the chief
staff, but the priority notification is to the government authorities.
Rationale 2: Nurses are legally obligated to report suspected child abuse to the
proper government authorities. This is part of the duty to protect. The information
will also be communicated to the nursing supervisor, the physician, and the chief
staff, but the priority notification is to the government authorities.
Rationale 3: Nurses are legally obligated to report suspected child abuse to the
proper government authorities. This is part of the duty to protect. The information
will also be communicated to the nursing supervisor, the physician, and the chief
staff, but the priority notification is to the government authorities.
Rationale 4: Nurses are legally obligated to report suspected child abuse to the
proper government authorities. This is part of the duty to protect. The information
will also be communicated to the nursing supervisor, the physician, and the chief
staff, but the priority notification is to the government authorities.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain why psychiatric–mental health nurses need to be
knowledgeable about the mental health statutes and regulations in the state in
which they practice.

Question 12




Type: MCSA
A client who was admitted voluntarily to the unit verbally refuses his medication.
The nurse proceeds to give the medication over the client’s objections. What is the
legal significance of the nurse’s actions?
1.
2.
3.
4.

The nurse could be charged with malpractice.
The nurse could be charged with negligence.
The nurse cannot be held liable.
The nurse could be charged with battery.

Correct Answer: 4
Rationale 1: Medication can be administered against the client’s wishes only if
there is a treatment order from a judge or the client is a danger to self or others.
Malpractice refers to the negligent acts of health care professionals when they fail to
act in a responsible and prudent manner. Negligence occurs when a nurse fails to act
in a manner in which most reasonable and prudent people would act. The nurse is
liable for her actions.

Rationale 2: Medication can be administered against the client’s wishes only if
there is a treatment order from a judge or the client is a danger to self or others.
Malpractice refers to the negligent acts of health care professionals when they fail to
act in a responsible and prudent manner. Negligence occurs when a nurse fails to act
in a manner in which most reasonable and prudent people would act. The nurse is
liable for her actions.
Rationale 3: Medication can be administered against the client’s wishes only if
there is a treatment order from a judge or the client is a danger to self or others.
Malpractice refers to the negligent acts of health care professionals when they fail to
act in a responsible and prudent manner. Negligence occurs when a nurse fails to act
in a manner in which most reasonable and prudent people would act. The nurse is
liable for her actions.
Rationale 4: Medication can be administered against the client’s wishes only if
there is a treatment order from a judge or the client is a danger to self or others.
Malpractice refers to the negligent acts of health care professionals when they fail to
act in a responsible and prudent manner. Negligence occurs when a nurse fails to act
in a manner in which most reasonable and prudent people would act. The nurse is
liable for her actions.
Global Rationale:




Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Explain why psychiatric–mental health nurses need to be
knowledgeable about the mental health statutes and regulations in the state in
which they practice.

Question 13
Type: MCSA
A 15-year-old girl is brought by her mother to see a psychiatric nurse practitioner.
The client’s mother demands that her daughter be admitted for treatment of
“behavioral problems.” Her mother states that the daughter stays out until 4 a.m.
and is hanging out with “bad” kids. The nurse will recommend which of the
following?
1.
2.
3.
4.

Involuntary admission for the daughter
Therapy for the daughter
Outpatient therapy for the mother and daughter
Therapy for the mother

Correct Answer: 3
Rationale 1: The client has the right to treatment in the least restrictive
environment. The client does not quality for an involuntary commitment. Outpatient
therapy for the client and her mother provides the best treatment alternative.
Rationale 2: The client has the right to treatment in the least restrictive
environment. The client does not quality for an involuntary commitment. Outpatient
therapy for the client and her mother provides the best treatment alternative.
Rationale 3: The client has the right to treatment in the least restrictive
environment. The client does not quality for an involuntary commitment. Outpatient
therapy for the client and her mother provides the best treatment alternative.

Rationale 4: The client has the right to treatment in the least restrictive
environment. The client does not quality for an involuntary commitment. Outpatient
therapy for the client and her mother provides the best treatment alternative.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Compare admission and release procedures for voluntary
admission and involuntary commitment.

Question 14
Type: MCSA
The relative of a chronically mentally ill woman requests that the mentally ill
woman be committed because of her history of 12 previous hospitalizations and
because she sits around the house all day refusing to get dressed. The nurse tells the
relative that the woman cannot be committed because:
1.
2.
3.
4.

It is less than two weeks since her most recent hospital discharge.
She has used up her hospital coverage.
She has not voluntarily requested hospitalization.
There is no evidence that she is a danger to self or others.

Correct Answer: 4
Rationale 1: The woman does not meet the criteria for involuntary commitment as
she is not a danger to herself or others. If the client met the criteria for
hospitalization, she could be admitted even if she did not have hospital coverage or
had recently been hospitalized. The criteria for involuntary hospitalization does not
include the client’s request for hospitalization.
Rationale 2: The woman does not meet the criteria for involuntary commitment as
she is not a danger to herself or others. If the client met the criteria for




hospitalization, she could be admitted even if she did not have hospital coverage or
had recently been hospitalized. The criteria for involuntary hospitalization does not
include the client’s request for hospitalization.
Rationale 3: The woman does not meet the criteria for involuntary commitment as
she is not a danger to herself or others. If the client met the criteria for
hospitalization, she could be admitted even if she did not have hospital coverage or
had recently been hospitalized. The criteria for involuntary hospitalization does not
include the client’s request for hospitalization.
Rationale 4: The woman does not meet the criteria for involuntary commitment as
she is not a danger to herself or others. If the client met the criteria for
hospitalization, she could be admitted even if she did not have hospital coverage or
had recently been hospitalized. The criteria for involuntary hospitalization does not
include the client’s request for hospitalization.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Compare admission and release procedures for voluntary
admission and involuntary commitment.

Question 15
Type: MCSA
A client is voluntarily admitted to the mental health unit. The nurse knows that this
means:
1.
2.
3.
4.

The client gave informed consent for hospitalization.
The client has signed away all civil rights.
The client will need a court hearing within seven days.
The client has to remain hospitalized for three days.




Correct Answer: 1
Rationale 1: Voluntary admission occurs when the client has completed a written
application for admission. The client retains all civil rights and will not require a
court hearing. The length of stay will vary, but the client can give written notice of
intent to terminate treatment.
Rationale 2: Voluntary admission occurs when the client has completed a written
application for admission. The client retains all civil rights and will not require a
court hearing. The length of stay will vary, but the client can give written notice of
intent to terminate treatment.

Rationale 3: Voluntary admission occurs when the client has completed a written
application for admission. The client retains all civil rights and will not require a
court hearing. The length of stay will vary, but the client can give written notice of
intent to terminate treatment.
Rationale 4: Voluntary admission occurs when the client has completed a written
application for admission. The client retains all civil rights and will not require a
court hearing. The length of stay will vary, but the client can give written notice of
intent to terminate treatment.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Compare admission and release procedures for voluntary
admission and involuntary commitment.

Question 16
Type: MCSA




When a client gives written notice of intention to leave the hospital after a voluntary
admission, what determines the number of hours or days between the notice and
the discharge?
1.
2.
3.
4.

Hospital policy
State law
Insurer
Federal law

Correct Answer: 2
Rationale 1: As the word voluntary implies, the client has a right to demand and
obtain release. Depending on the state, the client agrees to give notice, usually in
writing, of the intention to leave during a grace period of from 24 hours to 15 days.
The grace period is justified on the grounds that the hospital staff needs time to
examine the client to determine whether a change to involuntary status is indicated.
Rationale 2: As the word voluntary implies, the client has a right to demand and
obtain release. Depending on the state, the client agrees to give notice, usually in
writing, of the intention to leave during a grace period of from 24 hours to 15 days.
The grace period is justified on the grounds that the hospital staff needs time to
examine the client to determine whether a change to involuntary status is indicated.
Rationale 3: As the word voluntary implies, the client has a right to demand and
obtain release. Depending on the state, the client agrees to give notice, usually in
writing, of the intention to leave during a grace period of from 24 hours to 15 days.
The grace period is justified on the grounds that the hospital staff needs time to
examine the client to determine whether a change to involuntary status is indicated.
Rationale 4: As the word voluntary implies, the client has a right to demand and
obtain release. Depending on the state, the client agrees to give notice, usually in
writing, of the intention to leave during a grace period of from 24 hours to 15 days.
The grace period is justified on the grounds that the hospital staff needs time to
examine the client to determine whether a change to involuntary status is indicated.
Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment
Client Need Sub:




Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Deliver psychiatric–mental health nursing care in a manner
that preserves and protects client rights, dignity, and autonomy.

Question 17
Type: MCSA
The staff are discussing the competency of a client who was recently involuntary
admitted to the unit. Which of the following statements about competency is
inaccurate?
1. Competency is affected by client compliance with treatment.
2. Competency is a medical determination made by the client’s physician.
3. A guardian is appointed to make decisions on the person’s behalf when the
client is determined to be incompetent.
4. A competent client means the client can make reasonable judgments and
decisions.
Correct Answer: 2
Rationale 1: Competency is a legal determination that can only be determined by a
judge.
Rationale 2: Competency is a legal determination that can only be determined by a
judge.
Rationale 3: Competency is a legal determination that can only be determined by a
judge.
Rationale 4: Competency is a legal determination that can only be determined by a
judge.

Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub:




Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Deliver psychiatric–mental health nursing care in a manner
that preserves and protects client rights, dignity, and autonomy.

Question 18
Type: MCSA
A unit has a protocol for research on medications. The protocol identifies essential
items that must be shared with clients to ensure ethical nursing practice. Which of
the following factors should be shared with clients?
1.
2.
3.
4.

Problems that all other clients have had in the study
Risks that can be encountered
All aspects of the research study
Cost of the research

Correct Answer: 2
Rationale 1: A client has the right to understand the treatment process prior to

consenting to treatment. This is called informed consent and is required by all
states. The main purpose of the doctrine of informed consent is to encourage
individual autonomy and sound decision making.
Rationale 2: A client has the right to understand the treatment process prior to
consenting to treatment. This is called informed consent and is required by all
states. The main purpose of the doctrine of informed consent is to encourage
individual autonomy and sound decision making.
Rationale 3: A client has the right to understand the treatment process prior to
consenting to treatment. This is called informed consent and is required by all
states. The main purpose of the doctrine of informed consent is to encourage
individual autonomy and sound decision making.
Rationale 4: A client has the right to understand the treatment process prior to
consenting to treatment. This is called informed consent and is required by all
states. The main purpose of the doctrine of informed consent is to encourage
individual autonomy and sound decision making.
Global Rationale:




Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Deliver psychiatric–mental health nursing care in a manner
that preserves and protects client rights, dignity, and autonomy.

Question 19
Type: MCSA
A client with schizophrenia has decided to develop a psychiatric advance directive.

What would be included in this document?
1.
2.
3.
4.

Conditions under which life support will be discontinued
A legal representative for power of attorney
Do not resuscitate (DNR) requests
List of persons who can make decisions on the client’s behalf

Correct Answer: 4
Rationale 1: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent
persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to be put in place and used if the
person is incapacitated, found to be incompetent, or unable to make reliable
decisions about psychiatric care. PADs do not address medical needs such as DNR
orders or life support.
Rationale 2: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent
persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to be put in place and used if the
person is incapacitated, found to be incompetent, or unable to make reliable
decisions about psychiatric care. PADs do not address medical needs such as DNR
orders or life support.

Rationale 3: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent
persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to be put in place and used if the
person is incapacitated, found to be incompetent, or unable to make reliable
decisions about psychiatric care. PADs do not address medical needs such as DNR
orders or life support.
Rationale 4: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent
persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to be put in place and used if the
person is incapacitated, found to be incompetent, or unable to make reliable
decisions about psychiatric care. PADs do not address medical needs such as DNR
orders or life support.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Partner with clients and their families in developing a
psychiatric advance directive.

Question 20
Type: MCSA
The nurse and a client talk about the signs and symptoms of acute mania. The client
states, “When I am feeling really good and don’t need to sleep, I am manic, but the
last thing I want is treatment.” The nurse recognizes that this experience is
indicative of the need for:
1. Competency.

2. Psychiatric advance directive (PAD).




3. Right to treatment.
4. Informed consent.
Correct Answer: 2
Rationale 1: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent
persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to put in place should the person be
incapacitated, found to be incompetent, or unable to make reliable decisions about
psychiatric care. Informed consent is the right to understand the treatment process
prior to consenting to treatment. Being competent means that a client must be
cognitively able to understand the situation and the implications of treatment. Right
to treatment ensures that clients are not in a treatment setting for custodial
purposes only.
Rationale 2: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent
persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to put in place should the person be
incapacitated, found to be incompetent, or unable to make reliable decisions about
psychiatric care. Informed consent is the right to understand the treatment process
prior to consenting to treatment. Being competent means that a client must be
cognitively able to understand the situation and the implications of treatment. Right
to treatment ensures that clients are not in a treatment setting for custodial
purposes only.
Rationale 3: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent

persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to put in place should the person be
incapacitated, found to be incompetent, or unable to make reliable decisions about
psychiatric care. Informed consent is the right to understand the treatment process
prior to consenting to treatment. Being competent means that a client must be
cognitively able to understand the situation and the implications of treatment. Right
to treatment ensures that clients are not in a treatment setting for custodial
purposes only.
Rationale 4: Psychiatric advance directives (PADs) are modeled after advance
directives for end-of-life care. They are legal instruments that allow competent
persons to document their preferences regarding mental health treatment. Any
person can prepare a PAD as a contingency plan to put in place should the person be
incapacitated, found to be incompetent, or unable to make reliable decisions about