Deck 8: Informed Consent and Patient Self-Determination

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?

A) "Surely there would be no way for the personnel department to find out that information."
B) "There is a federal law that prohibits genetic information from being used in employment decisions."
C) "Worrying about these concerns is not good for your health."
D) "It should be a problem only if you intend to use the insurance plan."

Answer 1

"There is a federal law that prohibits genetic information from being used in employment decisions."

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?

A) Remind the patient that the surgery is to remove his lower leg, not just his toe.
B) Check to see if the patient signed consent for the above-the-knee amputation.
C) Continue the transfer, as the patient is not reliable since opioid medications have been administered.
D) Stop the transfer and notify the surgeon of the patient's comment.

Answer 2

Stop the transfer and notify the surgeon of the patient's comment.

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?

A) That the health care providers who abide by the document cannot be charged with criminal negligence associated with the patient's death.
B) The document is legally binding and all health care providers will abide by its provisions.
C) The directions of the document will be followed, even if the patient makes a verbal request that directly contradicts the provisions of the document.
D) In order to revoke the document, the patient must sign a subsequent living will.

Answer 3

That the health care providers who abide by the document cannot be charged with criminal negligence associated with the patient's death.

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?

A) Tell the patient how much pain medication would be needed to cause death.
B) Administer pain medication with the intention of causing respiratory arrest.
C) Administer sedative medications sufficient to cause unconsciousness.
D) Encourage the patient to stop eating and drinking.

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?

A) It will have little effect since the program was developed for emergency medical service providers.
B) The program will provide research regarding best practice in end-of-life care for all health care providers, including nurses.
C) The document will provide insight into the patient's preferences for end-of-life care.
D) The document will provide the name of the person holding the patient's durable power of attorney.

Question 6

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

A) Description of risks and alternatives of the proposed procedure, including no treatment
B) Estimated cost of the procedure
C) Date and time the procedure is scheduled
D) Signature of the competent patient or a legal representative
E) Name and full description of the proposed procedure

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?

A) Continue with the preparation as consent may not be revoked.
B) Try to convince the patient to go through with the procedure.
C) Stop the preparation as the patient can revoke consent at any time.
D) Have the patient document the question in writing since the original consent was written.

Question 8

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

A) The patient is deaf.
B) The physician feels the disclosure of information required for informed consent might cause the patient to commit suicide.
C) A visitor suffers a cardiopulmonary arrest in the emergency department waiting room.
D) The patient has signed a waiver at the suggestion of the primary nurse.
E) Informed consent was obtained when the patient had the same procedure last week.

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?

A) The patient had no part in the decision to operate.
B) The procedure's known risk of paralysis was not explained to the patient.
C) Since the decision making was shared, no malpractice suit is possible.
D) It was the procedure that caused the harm.
E) That the amount of damage to the patient cannot be determined.

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?

A) Oral
B) Implied
C) Partial
D) Expressed

Question 11

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

A) If the child is consenting to treatment for an emergency surgery
B) If the child is consenting to treatment for a venereal disease
C) Under no circumstances can a 13-year-old give valid consent.
D) When the parents are not readily available
E) The patient is seeking treatment for drug dependency.

Question 12

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

A) The patient asks questions that are not pertinent to the information provided.
B) A patient reports that she took many herbal medications before emigrating from Viet Nam.
C) The patient fiddles with his hearing aid during instruction.
D) The nurse finds the medication information sheets she gave the patient tucked into a novel as a bookmark.
E) The patient's wife cannot visit in the evenings because of her work schedule.

Question 13

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

A) The nurse helps withdraw treatments that are life-saving.
B) The nurse tells the patient that suicide is a sin.
C) The nurse goes to the pharmacy and procures medication the patient intends to use to commit suicide.
D) The nurse asks questions about why the patient is considering suicide.

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?

A) Yes, as long as there is no physical risk to the students.
B) Probably, depending upon university regulations on course content.
C) Yes, if the participation is outlined as a course requirement in the syllabus.
D) No, the individual must be given the choice to participate or not.

Question 15

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

A) The patient has an illness that poses a threat to public health if left untreated.
B) A competent adult refuses a blood transfusion based on religious belief.
C) The patient refuses treatment to slow the advancement of an inoperable brain tumor.
D) The patient's insurance refuses to pay if treatments are refused.