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PRE-ASSESSMENT: HEALTHCARE
VALUES AND ETHICS PKEC C
In a hospital setting, a caregiver must inform a patient there is no cure for the patient's disease. To avoid possibly causing serious psychological harm by telling the patient, "There is nothing else I can do for you," the caregiver tells the patient, "Although there is currently no cure for your disease, I will treat your symptoms and make you more comfortable. I will also keep you informed as to any significant research regarding development of a cure for your disease." Which ethical principle is being used in resolving this dilemma? Justice Veracity Autonomy Nonmaleficence - ✔✔Nonmaleficence A patient with tuberculosis was admitted to the hospital and is refusing treatment. When the patient's nurse leaves the room, the patient leaves the hospital. Which ethical duty should the nurse perform? Treat Warn Maintain privacy Maintain confidentiality - ✔✔Warn A 23-year-old Christian scientist has been hit by a car and taken to the emergency room (ER). The patient presents to the ER and complains of pain. The patient's leg appears to be broken, so the ER staff prepares to take the patient's X-rays. When the staff arrives, the patient becomes angry, refuses the X-rays, and leaves the emergency room. Which ethical factor influences this patient's refusal of treatment?
Justice Religion Beneficence Nonmaleficence - ✔✔Religion A 55-year-old patient has a rare autoimmune disorder with no cure. However, there are non- approved hospital-based treatments shown to be somewhat effective in controlling the symptoms and possibly prolonging life. The patient does not have the financial means to afford these uncovered treatments. What is a financial recourse for this patient? Finding available state funding Getting approval from Medicare Changing hospital insurance coverage Asking the hospital for a payment plan - ✔✔Getting approval from Medicare An 86-year-old patient is suffering from a tumor and only has Medicare for insurance. The tumor will eventually grow to occlude the airway, so surgery is required even though the patient's medical history makes this a high-risk procedure. The patient must decide whether to proceed with the surgery. Which cost must this patient consider? Hospice care Probate court Hospitalization Affordable healthcare plan - ✔✔Hospitalization A hospital patient is placed on a ventilator after having a heart attack. The hospital staff believes the patient will never regain consciousness and will die in two to six months. The family is divided on whether or not to remove the patient from life support. What is the role of the healthcare ethics committee in advising on this case?
The manager was rewarded for work completed by other staff. - ✔✔The manager used the relationship for personal financial gain. The National Association for Healthcare Quality (NAHQ) covers many principles that pertain to the ethical operation of an organization. Which standard addresses this concept? Supporting access to medical information by health providers Providing updated, relevant training to organizational leadership Establishing quality as the guiding principle for controlling costs Emphasizing programs that provide better patient reimbursement - ✔✔Providing updated, relevant training to organizational leadership Security staff were called to restrain a psychiatric patient in a hospital's behavioral medicine unit. The security staff were not accustomed to responding to the unit, leading to trauma that nearly made the patient die. Which Joint Commission policy will assist the hospital in this situation? - ✔✔Sentinel event policy A patient who is religious has an appointment with an ear, nose, and throat doctor to have his ears cleaned of wax buildup. When the patient arrives at the doctor's office, the nurse says his appointment is for another procedure the doctor determined to be necessary. After the appointment, the patient requested the doctor change the reason for the visit to increase reimbursement. Which aspect of a code of ethics did this physician violate? The patient will be provided with care of the highest quality. The patient's culture, religion, and heritage will be honored. The patient will be treated with honesty, dignity, and respect.
The patient's right to execute advance directives will be followed. - ✔✔The patient will be treated with honesty, dignity, and respect. Many provisions of the Patient Protection and Affordable Care Act (PPACA) were enacted to assist citizens in obtaining access to healthcare insurance and coverage. How does this act impact healthcare? Insurance companies must limit their premium charges to 85% of what they were charging prior to the implementation of the act on March 23, 2010. A provision for auto insurance in the act requires that auto insurance policies must cover usual and customary expenses associated with vehicular accidents. Group or individual health insurers providing dependent coverage of children must make coverage available to adult children up to age 26. Health insurers must offer part A, B, C, and D of Medicare to non-Medicare policy holders with a reasonable premium increase to cover the cost of this enhanced coverage. - ✔✔Group or individual health insurers providing dependent coverage of children must make coverage available to adult children up to age 26. The Patient Protection and Affordable Care Act (PPACA) of 2010 is projected to expand health insurance coverage to an estimated 30 million people. How has this act expanded coverage? It has subsidized insurance companies. It has created a universal healthcare plan. It has allowed for a major Medicaid expansion.
A patient is going to have a surgical procedure to remove a brain tumor. The patient's neurosurgeon is part of a research study in which patients' tumors are collected and stored. What must the surgeon obtain to keep the patient's tumor for research? Patient waiver Tumor registry Informed consent Research authority - ✔✔Informed consent A person is found unconscious and taken to the emergency room. It is determined that the patient is bleeding from the head and requires emergency surgery. Surgery is immediately performed and the patient recovers. Which assumption did the healthcare providers act upon? Adequacy Autonomy Implied consent Power of attorney - ✔✔Implied consent A terminally ill patient wants to remove aggressive life-sustaining measures. The patient's two children strongly disagree. What patient right must the physician consider?
Authority Adequacy Competency Informed consent - ✔✔Competency A patient participated in a clinical research trial that tests the effects of a new cancer-fighting drug. The patient develops a serious complication and dies. The patient's spouse, who was at every clinic visit, is convinced the patient was not provided alternatives to participation in the study. What is the alleged patient right violation? Authority Adequacy Autonomy Accountability - ✔✔Adequacy A physician feels a patient does not have the ability to make a rational decision regarding termination of hemodialysis. However, the nurse knows the patient has an understanding of the choices regarding medical management based on conversations with the patient. The physician insists on disregarding the patient's pleas. Which patient right does this situation describe? Privacy Capacity
A patient requests the withdrawal of hemodialysis, consistent with his advance directive. The physician, however, insists on disregarding the patient's wishes. Which ethical right of the patient pertains to this scenario? Justice Authority Autonomy Informed consent - ✔✔Autonomy A diabetic patient was going to eat a cream puff and take extra insulin. After being advised that this was not a good practice, the patient decided to eat the sugar-free cookies. Which two ethical principles are in conflict with each other in this medical decision? Justice Veracity Autonomy Beneficence - ✔✔Autonomy & Beneficence A 70-year-old patient is admitted to the hospital because of an accidental gunshot wound. The patient is pale and losing blood and needs a blood transfusion. The patient is responsive but refuses the transfusion based on religious beliefs. Which two rights is this patient exercising in regard to care? Dignity Justice Capacity Autonomy - ✔✔Capacity & Autonomy
patient was admitted into the hospital with a chronic condition. The hospital transporter came to pick up the patient for a surgical screening procedure. The patient refused because he was not aware that it was being done. Which type of consent should have been executed? Verbal Implied Informed Expressed - ✔✔Informed A patient is considering participating in a cancer research study that is being conducted by a government organization. Prior to enrollment, the patient is concerned about termination if the employer finds out about the patient's participation. Which right under informed consent should be discussed with this patient to alleviate any concerns? A right to confidentiality A right to continued employment A right to protection under HIPAA A right to job security under the ADA - ✔✔A right to confidentiality A patient signs an informed consent for an experimental trial. After three months of participating in the study, the patient does not want further doses of the medication. Which right is the patient exercising? Privacy Withdrawal Non-coercion Independence - ✔✔Withdrawal
What may the physician do in this situation? Refuse to treat the patient Treat the patient for chronic conditions specified by the Affordable Care Act (ACA) See the patient upon enrollment in the physician's clinical trial Explain that Health Insurance Portability and Accountability Act (HIPAA) prevents the patient from receiving medical care - ✔✔Refuse to treat the patient A patient comes to a healthcare clinic and is HIV positive. A nurse with an immune disorder refuses to participate in the patient's care. Why may the nurse refuse to care for the patient? Personnel policies allow refusal. Americans with Disabilities Act (ADA) regulations protect the nurse. HIV patients are excluded from treatment in public clinics. Potential harm to the nurse outweighs the gain for the patient. - ✔✔Potential harm to the nurse outweighs the gain for the patient. At a busy emergency room in the U.S., a doctor does not want to treat a patient because of the patient's foreign status. Which step should this doctor take? Activate the waiver of treatment protocol
Treat the patient regardless of national origin Refuse to treat the patient under the Emergency Medical Treatment and Active Labor Act (EMTALA) provision Transfer the patient to another hospital under Affordable Care Act (ACA) regulations - ✔✔Treat the patient regardless of national origin A patient visits a primary care office with flu symptoms. During the appointment, the patient threatens the physician. As a result, the physician terminates the patient relationship. Why may this physician refuse to treat this patient? There is a safety concern. The staff feels uncomfortable. There is a minor medical complaint. The office is an independent practice. - ✔✔There is a safety concern. A patient is hospitalized after a major traffic accident. The physician is paged to come to the hospital as soon as possible but decides to attend a previously scheduled meeting instead. By the time the physician reaches the hospital, the patient has lost consciousness due to severe blood loss. Which professional behavior did this physician ignore? First do no harm Patient self-autonomy Using knowledge correctly The most good for the most people - ✔✔First do no harm A nurse was present when the doctor told a patient of the confirmed diagnosis of advanced cancer. Because the patient's spouse is a friend of the nurse, the nurse called the spouse to provide information about the diagnosis.
It is fraudulent, and the healthcare provider may be fined. It is a conflict of interest, and the provider may have to repay the payment. It violates the Debt Collector Act, and the provider's license may be revoked. It is against the Fair Trade Act, and the healthcare provider may face legal action. - ✔✔It is fraudulent, and the healthcare provider may be fined. A physician working in a hospital refers a Medicare patient to a radiology clinic in town. The physician does not disclose that he owns the clinic. Why is this failure to disclose considered unethical? It is malpractice. It violates HIPAA. It is a conflict of interest. It violates the False Claims Act. - ✔✔It is a conflict of interest. A medical assistant discloses a patient's pregnancy test results to the patient's spouse, without consulting the physician. There is no authorization for disclosure form on file. For which two reasons is this disclosure unethical and what are the potential consequences? Choose 2 answers It violates the ACA and the medical assistant may be fired or fined. It violates HIPAA and the medical assistant may be fined or terminated. It violates veracity and the medical assistant's certification may be revoked.
It violates the principle of role fidelity and the medical assistant may be terminated. - ✔✔It violates HIPAA and the medical assistant may be fined or terminated & It violates the principle of role fidelity and the medical assistant may be terminated. A nurse discusses a patient's diabetic meal planning on discharge. Sample meal planning includes listing foods that are used at home for diet compliance. Which patient-centered care value is the nurse demonstrating? Engagement Companionship Emotional support Personal care support - ✔✔Engagement A doctor explained an urgent surgical procedure to a patient. The patient indicated she understood, agreed, and requested to talk to her husband prior to the surgery. Which action will demonstrate patient-centered care value? Allow the patient time to confer with her spouse Discourage the patient's request due to lack of time Offer to communicate with the husband on her behalf Ask the patient why she wants to speak with her husband - ✔✔Allow the patient time to confer with her spouse A pregnant woman has had a non-invasive genetic screening, which has indicated a chromosomal disorder in the fetus. The woman has signed consent for a first trimester abortion. The father opposes the abortion. What are the rights of the mother and father?
Necessary sterilization Institutional sterilization Therapeutic sterilization - ✔✔Eugenic sterilization A 17-year-old has been diagnosed with a genetic disorder that results in 50 percent of the teenager's offspring carrying that gene. The teenager becomes pregnant and the teenager's mother demands the daughter have an abortion, but the teenager refuses. Which right is the teenager exercising? Fidelity Veracity Autonomy Beneficence - ✔✔Autonomy A teenager suffered massive head trauma in an automobile accident and has been in a prolonged persistent vegetative state. The teen's mother wants all treatment stopped but the teen's father wants everything done. Who has the authority to decide the rights of the patient in this situation? The mother can make the decision to discontinue life supporting care. The doctor can make the decision to continue or discontinue life supporting care. A court order can make the decision to continue or discontinue life supporting care. The ethics committee can make the decision to continue or discontinue life supporting care. - ✔✔A court order can make the decision to continue or discontinue life supporting care. A 35-year-old woman is suffering from a painful and aggressive stomach cancer. The woman is being cared for in the home by her husband. He has tried to make the wife more comfortable by giving
pain medicine the way the hospice nurse outlined. Because the pain was unrelieved from the medicine, he quickly gave his wife another dose. The husband's intent was to relieve the wife's pain and not to cause death, but the wife died within the hour of respiratory failure. What is the result of the husband's dilemma? Euthanasia Double effect Assisted suicide Death with dignity - ✔✔Double effect A patient has been brought to an emergency department with severe blood loss and needs a transfusion immediately. However, the patient, who is awake and appears competent, has refused to accept the blood transfusion because of religious beliefs. What are the requirements for the hospital? The hospital must have chaplains on duty to address patient needs. The ethics committee must determine the hospital's best course of action. Under the Patient Self Determination Act, all providers must comply with the patient's request in order to receive reimbursement under Medicare. Under the Emergency Medical Treatment and Labor Act, the hospital must do everything it can to save the patient regardless of what the patient has stated. - ✔✔Under the Patient Self Determination Act, all providers must comply with the patient's request in order to receive reimbursement under Medicare. Because of a traffic fatality, a donor heart becomes available. With so many people awaiting a heart transplant, the doctor at the regional transplant center needs to consider the key criteria for distributing the donor heart.
