CARN Ethical and Legal Principles 2 — Questions and Answers
Question 1: A patient in an addiction treatment program requests that their employer not be informed of their diagnosis. Which federal regulation primarily protects this confidentiality?
- HIPAA Privacy Rule
- 42 CFR Part 2 (Correct answer)
- ADA Title I
- FMLA provisions
Correct answer: 42 CFR Part 2
42 CFR Part 2 provides stricter confidentiality protections specifically for substance use disorder treatment records than general HIPAA rules.
Question 2: Under 42 CFR Part 2, which of the following disclosures is permitted WITHOUT patient consent?
- Sharing records with a patient's primary care physician
- Reporting to a state health department for public health surveillance
- Medical emergency involving immediate threat to life (Correct answer)
- Providing records to a managed care organization for billing
Correct answer: Medical emergency involving immediate threat to life
42 CFR Part 2 permits disclosure without consent in a bona fide medical emergency when the patient's life is at immediate risk.
Question 3: A CARN discovers that a colleague is diverting opioid medications intended for addiction treatment patients. What is the nurse's primary ethical and legal obligation?
- Confront the colleague privately and give them a chance to self-report
- Document the behavior and report to the nursing supervisor and appropriate authorities (Correct answer)
- Report only if the behavior continues after a warning
- Maintain silence to protect patient privacy
Correct answer: Document the behavior and report to the nursing supervisor and appropriate authorities
Nurses have a legal and ethical duty to report suspected drug diversion to protect patient safety and comply with state reporting laws.
Question 4: Which ethical principle is MOST at stake when a nurse provides inaccurate information about the risks of medication-assisted treatment to steer a patient toward a preferred abstinence-only program?
- Justice
- Fidelity
- Veracity (Correct answer)
- Autonomy
Correct answer: Veracity
Veracity (truth-telling) is violated when a nurse provides inaccurate or incomplete information that influences a patient's treatment decision.
Question 5: A patient with opioid use disorder is court-ordered to treatment but refuses medication-assisted treatment on religious grounds. The ethical principle most relevant to honoring this refusal is:
- Beneficence
- Nonmaleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Autonomy supports a patient's right to refuse treatment, including specific modalities, even when court-ordered for the treatment program itself.
Question 6: A CARN is asked to sign documentation attesting to treatment services that were not actually provided. This action would constitute:
- Boundary violation
- Healthcare fraud (Correct answer)
- Scope of practice violation
- Mandatory reporting failure
Correct answer: Healthcare fraud
Signing attestations for services not rendered constitutes healthcare fraud, which is illegal and violates professional ethics.
Question 7: When a patient threatens to harm a specific, identifiable third party, a nurse's legal duty under Tarasoff principles requires:
- Maintaining confidentiality and documenting the threat in the chart only
- Warning the potential victim and notifying appropriate authorities (Correct answer)
- Consulting an ethics committee before taking any action
- Increasing the patient's medication to reduce risk
Correct answer: Warning the potential victim and notifying appropriate authorities
Tarasoff establishes a duty to warn identifiable potential victims when a credible threat of harm exists, overriding typical confidentiality.
CARN Ethical and Legal Principles 2
A patient in an addiction treatment program requests that their employer not be informed of their diagnosis.
Which federal regulation primarily protects this confidentiality?