CCRN - Review Professional and Ethical Practice Questions and Answers 1 — Questions and Answers
Question 1: An alert and competent patient with end-stage cancer has a valid advance directive that explicitly refuses mechanical ventilation. The patient develops acute respiratory distress, and their panicked family insists the medical team "do everything possible." What is the nurse's primary ethical responsibility in this situation?
- Ask the physician to sedate the patient to reduce their anxiety and the family's distress.
- Initiate mechanical ventilation immediately to stabilize the patient as per the family's wishes.
- Advocate for the patient's wishes as stated in the advance directive and facilitate a discussion with the family and medical team. (Correct answer)
- Request an immediate ethics committee consultation before any further action is taken.
Correct answer: Advocate for the patient's wishes as stated in the advance directive and facilitate a discussion with the family and medical team.
The nurse's primary role is to be a patient advocate. The principle of patient autonomy dictates that a competent patient's wishes, especially when documented in a legal advance directive, must be respected. The nurse's most appropriate action is to uphold these wishes while compassionately communicating with the family and involving the medical team to ensure a unified, patient-centered approach.
Question 2: A critical care nurse ensures that a patient fully understands the risks, benefits, and alternatives to a proposed invasive procedure before the patient signs the consent form. This action primarily demonstrates which ethical principle?
- Justice
- Beneficence
- Non-maleficence
- Autonomy (Correct answer)
Correct answer: Autonomy
Autonomy is the ethical principle that recognizes a patient's right to make their own informed decisions about their healthcare. By ensuring the patient has all the necessary information to make a choice, the nurse is directly supporting their right to self-determination. Beneficence is doing good, non-maleficence is avoiding harm, and justice relates to fairness in care delivery.
Question 3: A nurse in the ICU notices that a colleague has become irritable, has had multiple charting errors, and frequently volunteers to administer narcotics for other nurses' patients. The nurse suspects the colleague may be diverting medications. What is the nurse's most appropriate and professional initial action?
- Confront the colleague directly during their next shift and demand an explanation.
- Report the specific observations and concerns to the nurse manager or charge nurse according to facility policy. (Correct answer)
- Begin an independent investigation by tracking the colleague's medication withdrawals to gather more proof.
- Warn other nurses on the unit to be cautious of the colleague in question.
Correct answer: Report the specific observations and concerns to the nurse manager or charge nurse according to facility policy.
The nurse's ethical and professional duty is to protect patients from harm. The appropriate action is to follow the established chain of command and report the objective concerns to management. This allows for a formal, confidential investigation while ensuring patient safety. Confronting the colleague can be unsafe, and discussing it with peers is unprofessional.
Question 4: A nurse is caring for a patient with a catastrophic brain injury. The medical team has determined that further treatment is futile, but the family insists on continuing all life-sustaining measures. The nurse feels powerless and emotionally conflicted by providing care they believe is not in the patient's best interest. This feeling is best described as:
- Burnout
- Compassion fatigue
- Moral distress (Correct answer)
- Anxiety disorder
Correct answer: Moral distress
Moral distress is the specific psychological and emotional suffering that occurs when a healthcare professional knows the ethically appropriate action to take but is constrained from doing so by institutional or other barriers. In this scenario, the nurse is providing care that conflicts with their professional judgment and values, leading to moral distress.
Question 5: During a pandemic, an ICU has only one available ventilator. Two patients require mechanical ventilation: a 28-year-old with a high probability of survival and a 85-year-old with multiple comorbidities and a very poor prognosis. Which ethical principle most directly guides the difficult decision to allocate the ventilator to the patient with the higher chance of survival?
- Justice (Correct answer)
- Fidelity
- Veracity
- Autonomy
Correct answer: Justice
The principle of justice, specifically distributive justice, addresses the fair and equitable allocation of scarce resources. In mass casualty or crisis situations, this often involves using triage criteria that aim to produce the greatest good for the greatest number, which includes prioritizing those with a higher likelihood of survival.
Question 6: A competent adult patient signs a legal document that names a specific person to make healthcare decisions on their behalf ONLY if they become incapacitated and are unable to speak for themselves. This document is known as a:
- Living Will
- Provider Orders for Life-Sustaining Treatment (POLST)
- Durable Power of Attorney for Health Care (Correct answer)
- Do Not Resuscitate (DNR) Order
Correct answer: Durable Power of Attorney for Health Care
A Durable Power of Attorney for Health Care (also called a healthcare proxy) is a legal document that appoints a specific agent to make medical decisions for a person if they lose decision-making capacity. A Living Will specifies treatment preferences, a POLST is a medical order, and a DNR is a specific order to withhold CPR.
CCRN - Review Professional and Ethical Practice Questions and Answers 1
An alert and competent patient with end-stage cancer has a valid advance directive that explicitly refuses mechanical ventilation.
The patient develops acute respiratory distress, and their panicked family insists the medical team "do everything possible." What is the nurse's primary ethical responsibility in this situation?