Deck 3: Ethical and Legal Issues in Critical Care Nursing

Question 1

Warning signs that can assist the critical care nurse in recognizing that an ethical dilemma may exist include which of the following? (Select all that apply.)

A) Family members are confused about what is happening to the patient.
B) Family members are in conflict as to the best treatment options. They disagree with each other and cannot come to consensus.
C) The family asks that the patient not be told of treatment plans.
D) The patient's condition has changed dramatically for the worse and is not responding to conventional treatment.
E) The physician is considering trying a medication that is not approved to treat the patient's condition.
F) None of above

Answer 1

Family members are confused about what is happening to the patient.
Family members are in conflict as to the best treatment options. They disagree with each other and cannot come to consensus.
The family asks that the patient not be told of treatment plans.
The patient's condition has changed dramatically for the worse and is not responding to conventional treatment.
The physician is considering trying a medication that is not approved to treat the patient's condition.

Question 2

The nurse is caring for a patient who has been declared brain dead.The patient is considered a potential organ donor.In order to proceed with donation,the nurse understands that:

A) a signed donor card mandates that organs be retrieved in the event of brain death.
B) after brain death has been determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room.
C) the healthcare proxy does not need to give consent for the retrieval of organs.
D) once a patient has been established as brain dead, life support is withdrawn and organs are retrieved.

Answer 2

after brain death has been determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room.

Question 3

Ideally,an advance directive should be developed by the:

A) family, if the patient is in critical condition.
B) patient as part of the hospital admission process.
C) patient before hospitalization.
D) patient's healthcare surrogate.

Answer 3

patient before hospitalization.

Question 4

The critical care nurse wants a better understanding of when to initiate an ethics consult.After attending an educational program,she understands that the following situation would require an ethics consultation:

A) Conflict has occurred between the physician and family regarding treatment decisions. A family conference is held, and the family and physician agree to a treatment plan that includes aggressive treatment for 24 hours followed by re-evaluation.
B) Family members disagree as to a patient's course of treatment. The patient has designated a healthcare proxy and has a written advance directive.
C) Patient postoperative coronary artery bypass surgery who sustained a cardiopulmonary arrest in the operating room. He was successfully resuscitated, but now is not responding to treatment. He has a written advance directive and his wife is present.
D) Patient with multiple trauma and is not responding to treatment. No family members are known, and care is considered futile.

Question 5

The American Nurses Credential Center Magnet Recognition Program supports many actions to ensure that nurses are engaged and empowered to participate in ethical decision making.Which of the following would assist nurses in being involved in research studies?

A) Education on protection of human subjects
B) Participation of staff nurses on ethics committees
C) Written descriptions of how nurses participate in ethics programs
D) Written policies and procedures related to response to ethical issues

Question 6

The nurse is caring for a patient who is not responding to medical treatment.The intensivist holds a conference with the family,and a decision is made to withdraw life support.The nurse's religious beliefs are not in agreement with withdrawal.However,she assists with the process to avoid confronting the charge nurse.Afterward she feels guilty and believes she "killed the patient." This scenario is likely to cause:

A) abandonment.
B) family stress.
C) moral distress.
D) negligence.

Question 7

Which of the following statements about resuscitation is true?

A) Family members should never be present during resuscitation.
B) It is not necessary for a physician to write "do not resuscitate" orders in the chart if a patient has a healthcare surrogate.
C) "Slow codes" are ethical and should be considered in futile situations if advanced directives are not available.
D) Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders.

Question 8

The nurse is caring for a patient admitted with a traumatic brain injury following a motor vehicle crash.The patient's Glasgow Coma Score is 3 and intermittently withdraws when painful stimuli are introduced.The patient is ventilator dependent and occasionally takes a spontaneous breath.The physician explains to the family that the patient has severe neurological impairment and he does not expect the patient to recover consciousness.The nurse recognizes that this patient is:

A) an organ donor.
B) brain dead.
C) in a persistent vegetative state.
D) terminally ill.

Question 9

The nurse is aware that a shortage of organs exists.She knows that which of the following statements is true?

A) Anyone who is comfortable approaching the family should discuss the option of organ donation.
B) Brain death determination is required before organs can be retrieved for transplant.
C) Donation of selected organs after cardiac death is ethically acceptable.
D) Family members should consider withdrawing life support so that the patient can become an organ donor.

Question 10

The nurse is caring for an elderly patient who is in cardiogenic shock.The patient has failed to respond to medical treatment.The intensivist in charge of the patient conducts a conference to explain that they have exhausted treatment options and suggest that the patient be made a "do not resuscitate" status.This scenario illustrates the concept of:

A) brain death.
B) futility.
C) incompetence.
D) life-prolonging procedures.

Question 11

The nurse is caring for a patient whose condition has deteriorated and who is not responding to standard treatment.The physician calls for an ethical consultation with the family to discuss potential withdrawal versus aggressive treatment.The nurse understands that applying a model for ethical decision making involves which of the following? (Select all that apply.)

A) Burden versus benefit
B) Family's wishes
C) Patient's wishes
D) Potential outcomes of treatment options

Question 12

The nurse is caring for a critically ill patient with terminal cancer.The monitor alarms and shows ventricular tachycardia.The patient does not have a "do not resuscitate" order written on the chart.What is the appropriate nursing action?

A) Contact the attending physician immediately to determine if CPR should be initiated.
B) Contact the family immediately to determine if they want CPR to be started.
C) Give emergency medications but withhold intubation.
D) Initiate CPR and call a code.

Question 13

A nurse caring for a patient with neurological impairment often must use painful stimuli to elicit a patient's response.The nurse uses subtle measures of painful stimuli,such as nailbed pressure.She neither slaps the patient nor pinches the nipple to elicit a response to pain.In this scenario,the nurse is exemplifying the ethical principle of:

A) beneficence.
B) fidelity.
C) nonmaleficence.
D) veracity.

Question 14

A critically ill patient has a living will in his chart.His condition has deteriorated.His wife says she wants "everything done," regardless of the patient's wishes.Which ethical principle is the wife violating?

A) Autonomy
B) Beneficence
C) Justice
D) Nonmaleficence

Question 15

When addressing an ethical dilemma,contextual,physiological,and personal factors of the situation must be considered.Which of the following is an example of a personal factor?

A) The hospital has a policy that everyone must have an advanced directive on the chart.
B) The patient has lost 20 pounds in the past month and is fatigued all of time.
C) The patient has told you what quality of life means and his or her wishes.
D) The physician considers care to be futile in a given situation.

Question 16

Which statement regarding ethical concepts is true?

A) A living will is the same as a healthcare proxy.
B) A signed donor card ensures that organ donation will occur in the event of brain death.
C) A surrogate is a competent adult designated by a person to make healthcare decisions in the event the person is incapacitated.
D) A persistent vegetative state is the same as brain death in most states.

Question 17

Which of the following organizations requires a mechanism for addressing ethical issues?

A) American Association of Critical-Care Nurses
B) American Hospital Association
C) Society of Critical Care Medicine
D) The Joint Commission

Question 18

The nurse is caring for a critically ill patient on mechanical ventilation.The physician identifies the need for a bronchoscopy,which requires informed consent.If the physician were to obtain consent from the patient,the patient must be able to:

A) be weaned from mechanical ventilation.
B) have knowledge and competence to make the decision.
C) nod his head that it is okay to proceed.
D) read and write in English.

Question 19

The nurse is caring for a patient who is declared brain dead and is an organ donor.The following events occur: 1300 Diagnostic tests for brain death are completed.1330 Intensivist reviews diagnostic test results and writes in the progress note that the patient is brain dead.1400 Patient is taken to the operating room for organ retrieval.1800 All organs have been retrieved for donation.The ventilator is discontinued.1810 Cardiac monitor shows flatline.What is the official time of death recorded in the medical record?

A) 1300
B) 1330
C) 1400
D) 1800
E) 1810

Question 20

A specific request made by a competent person that directs medical care related to life-prolonging procedures if the patient loses capacity to make decisions is called a:

A) do not resuscitate order.
B) healthcare proxy.
C) informed consent.
D) living will.

Question 21

The nurse is caring for a patient with severe neurological impairment following a massive stroke.The physician has ordered tests to determine brain death.The nurse understands that criteria for brain death include: (Select all that apply.)

A) absence of cerebral blood flow.
B) absence of brainstem reflexes on neurological examination.
C) Cheyne-Stokes respirations.
D) flat electroencephalogram.

Question 22

The nurse understands that many strategies are available to address ethical issues that may occur; these strategies include which of the following? (Select all that apply.)

A) Change-of-shift report updates
B) Ethics consultation services
C) Formal multiprofessional ethics committees
D) Pastoral care services

Question 23

The nurse is caring for 80-year-old patient who has been treated for gastrointestinal bleeding.The family has agreed to withhold or withdraw additional treatment.The patient has a written advance directive specifying requests.The directive notes that the patient wants food and fluid to be continued.The nurse anticipates that several orders may be written to comply with this request,including which of the following? (Select all that apply.)

A) "Do not resuscitate."
B) Change antibiotic to a less expensive medication.
C) Discontinue tube feeding.
D) Stop any further blood transfusions.