Question 1

The patient who has tested positive for a gene associated with breast cancer is concerned that this finding will affect her ability to get a government job position for which she has applied. How should the nurse respond to this concern?

Accepted Answer

Rationale 1: This statement does not offer the patient guidance and is not therapeutic. It may increase the patient's concern as it indicates that the nurse is not certain about the confidentiality of the information.
Rationale 2: The Genetic Information Nondiscrimination Act of 2008 prevents discrimination from health insurers and employers. The Act specifically applies to Congress and federal executive branch agencies.
Rationale 3: The nurse should address the patient's concerns rather than giving health advice.
Rationale 4: This information should not be disclosed or used in an employment decision, whether or not the patient intends to subscribe to the potential employer's insurance plan.

Question 2

The patient scheduled for an above-the-knee amputation for a gangrenous toe received preoperative medication 20 minutes ago. When the transfer team arrives to take the patient to the operating suite, the nurse overhears the patient say, "I'll be so glad to get rid of my sore toe. I was afraid they would have to take my whole foot." What action should be taken by the nurse?

Accepted Answer

Rationale 1: This action is based on the assumption that the patient has full understanding of the surgery and that his memory is affected by medication. This may not be the case, so this is not the best option.
Rationale 2: The nurse has assessed that this patient does not understand the planned surgery. The presence of a signed consent does not change that fact.
Rationale 3: It is unknown if the presence of medications has impaired the patient's judgment. This is not the best option.
Rationale 4: The nurse should advocate for the patient by stopping the transfer and contacting the surgeon. The surgery should not be done until it is certain that the patient is fully informed.

Question 3

The nurse determines that an adult patient has signed a statutory living will, also known as a natural death act. What does this mean to the nurse?

Accepted Answer

Rationale 1: Natural death acts are much like the living wills of the 1960s and function as a living will with statutory enforcement. This means that practitioners are protected from potential civil and criminal lawsuits.
Rationale 2: There is no way to determine if all health care providers will abide by the provisions of this document.
Rationale 3: The patient's expressed wishes always take precedence over the document, and the patient can verbally revoke the living will.
Rationale 4: The patient does not have to sign a subsequent document in order to revoke the living will.

Question 4

A patient who is terminally ill is experiencing extreme pain and suffering. The patient says, "If I were an animal, you would put me out of this misery." Which intervention would the nurse be ethically correct in providing as a last-resort option for this patient?

Accepted Answer

Rationale 1: According to ANA standards, the nurse should not participate in assisted suicide.
Rationale 2: The nurse should not intentionally give medication to cause arrest. This is active euthanasia, which is not ethical according to the ANA.
Rationale 3: Sedation to unconsciousness is a valid alternative at the end-of-life.
Rationale 4: The nurse should not encourage this action, but should not intervene if the patient makes this decision independently.

Question 5

The nurse has recently moved to a state that has fully enacted a Physician Orders for Life Sustaining Treatment (POLST) program. How will this affect the nurse's practice?

Accepted Answer

Rationale 1: The POLST documents were first developed to provide guidance to emergency medical service providers. However, they are also used to provide direction to nurses and other health care providers.
Rationale 2: POLST documents do not provide best practice information.
Rationale 3: POLST documents outline a person's preferences for end-of-life care.
Rationale 4: POLST documents do not address the identity of the patient's decision surrogate.

Question 6

The state now mandates a detailed consent for all hospitals receiving state funding. Which information should the committee designing this form include?

Accepted Answer

Rationale 1: Full informed consent includes a description of the risks associated with the proposed procedure. If alternative procedures exist, they should also be listed. If no treatment is an option, that should also be noted.
Rationale 2: The cost of the procedure is not part of the consent form.
Rationale 3: The date and time of a procedure are often fluid and are not included in the consent form.
Rationale 4: The consent form should include the signature of the patient, if competent. The form should also include space for the signature of a legal representative to be used if the patient is not competent.
Rationale 5: The exact name and a full description of the proposed procedure should be included in the consent form.

Question 7

The nurse is preparing a patient for a procedure. The patient has signed a consent form but states, "I don't really know anything about this procedure. I wonder if there is something else I could do instead?" How should the nurse proceed?

Accepted Answer

Rationale 1: Since the patient has expressed lack of knowledge about the procedure, the preparation should not be continued.
Rationale 2: The nurse should not attempt to talk the patient into a procedure.
Rationale 3: The patient always retains the right to verbally revoke consent at any time during the course of treatment. The preparation should be stopped and the physician notified.
Rationale 4: Whether the question is verbal or written is not pertinent and does not make this a situation of informed consent.

Question 8

In which instances would the nurse feel comfortable providing care without first obtaining informed consent?

Accepted Answer

Rationale 1: The fact that the patient is deaf does not remove the requirement to obtain consent.
Rationale 2: Therapeutic privilege exists when the health care provider believes the disclosure of information poses immediate and serious harm to the patient.
Rationale 3: Emergency situations, such as a cardiopulmonary arrest, constitute an exception to the need for informed consent.
Rationale 4: The patient must initiate a waiver; it cannot be suggested by staff.
Rationale 5: Prior patient knowledge involves the patient to whom the risks and benefits were fully explained the first time the patient consented to the procedure.

Question 9

As a result of shared medical decision making, a patient undergoes a surgical procedure that results in paralysis. What must the patient prove to bring a successful malpractice suit based on informed consent?

Accepted Answer

Rationale 1: This patient participated in shared decision making and therefore had a part in the decision to operate. There is no need to prove that this participation did not occur in order for malpractice to be proved.
Rationale 2: To bring a successful malpractice suit based on informed consent, the plaintiff must prove that the health care provider breached responsibility to know and disclose risks.
Rationale 3: It is possible for malpractice to have occurred even if the consent to operate was based on shared decision making.
Rationale 4: To bring a successful malpractice suit based on informed consent, the plaintiff must prove that the the procedure caused the harm.
Rationale 5: To bring a successful malpractice suit based on informed consent, the plaintiff must prove that plaintiff suffered injury for which damages can be assessed.

Question 10

The patient presents to the emergency department with chest pain and collapses in the reception area before registering. Physicians and nurses rush to assist the patient. What type of consent protects these health care providers?

Accepted Answer

Rationale 1: There is no indication that the patient gave oral consent before collapsing.
Rationale 2: Implied consent is consent that may be inferred by the patient's conduct or that may be legally presumed in emergency situations. Because this patient presented to the ED, consent is implied.
Rationale 3: "Partial" is not a type of consent.
Rationale 4: Expressed consent is consent given by direct words, written or oral.

Question 11

In which instance would the nurse accept informed consent from a 13-year-old patient?

Accepted Answer

Rationale 1: A 13-year-old cannot give consent for surgery, even in an emergency. In the case of an emergency, if the parents are not available to give consent, the emergency doctrine applies and surgery would proceed.
Rationale 2: The law recognizes a minor's right to provide consent in some circumstances, including treatment for venereal diseases.
Rationale 3: In some circumstances minors can give consent for treatment.
Rationale 4: An attempt to reach parents must be made even if they are not readily available.
Rationale 5: Minors can give consent for diagnosis and treatment of drug dependency, drug addiction, or any condition directly related to drug usage.

Question 12

Which patient behavior would the nurse assess as possible indication that the patient will have health information literacy deficiency?

Accepted Answer

Rationale 1: Patients who ask questions that do not pertain to the education being provided may not understand the information.
Rationale 2: Persons who learned English as a second language are at high risk for health information illiteracy.
Rationale 3: Inability to hear well, which might be evidenced by "fiddling" with a hearing aid, can seriously affect ability to comprehend health care information.
Rationale 4: The fact that the patient is using the information sheets as a bookmark does not mean they were not read. Ability to read and comprehend a novel would likely indicate ability to understand health information that is presented on an appropriate level.
Rationale 5: The wife's work schedule would have little to do with the patient's health literacy.

Question 13

Which nurse action is appropriate according to the American Nurses Association's stance on assisted suicide and active euthanasia?

Accepted Answer

Rationale 1: Withdrawal of life-saving treatments can be construed as active euthanasia. The ANA opposes nurses' participation in active euthanasia.
Rationale 2: The nurse should never pass judgment on the patient's belief system.
Rationale 3: The ANA is opposed to the nurse obtaining lethal doses of medication for the purpose of suicide or euthanasia. The nurse may procure and/or administer medication for pain control.
Rationale 4: The ANA opposes nurses' participation either in assisted suicide or active euthanasia because they violate the ethical traditions embodied in the Code of Ethics for Nurses. The nurse should decline the patient's request, but should look beyond the request to what the patient may be saying.

Question 14

A nursing faculty has included a requirement that students participate as medical research subjects as a part of their clinical practice grade. Does this requirement meet the guidelines for research participants' rights?

Accepted Answer

Rationale 1: The students' rights to refuse this assignment are not affected by the risk of physical harm.
Rationale 2: University regulations do not supersede students' rights.
Rationale 3: The syllabus cannot supersede student rights.
Rationale 4: The rights of a person involved in research include the right to refuse to participate without penalty.

Question 15

In which case might the nurse expect the state to deny a patient's right of refusal for medical treatment?

Accepted Answer

Rationale 1: If the patient has an illness that poses a threat to public health, the state may require the patient to submit to treatment.
Rationale 2: In most instances, the competent adult patient has right of refusal for treatment of any illness or condition, including blood transfusion.
Rationale 3: In most instances, the competent adult patient has right of refusal for treatment of any illness or condition. This is true even if the refusal could cost the patient's life.
Rationale 4: Insurance reimbursement is not a factor in whether a patient has the right to refuse treatment.

Quiz 8: Informed Consent and Patient Self-Determination