VA-BC Ethical Considerations 4 — Questions and Answers
Question 1: A nurse discovers that a coworker has been falsifying vascular access procedure records. The MOST appropriate first step is to:
- Confront the coworker privately and give them a chance to correct the records
- Report the findings to the appropriate supervisor or compliance officer (Correct answer)
- Ignore it if patient outcomes have not been affected
- Document personal observations in personal notes only
Correct answer: Report the findings to the appropriate supervisor or compliance officer
Falsified records represent a serious breach of professional ethics and patient safety that must be reported through official channels.
Question 2: Which situation BEST illustrates the ethical principle of beneficence in vascular access practice?
- Selecting the smallest gauge catheter to minimize patient discomfort when clinically appropriate (Correct answer)
- Inserting a catheter without consent because the nurse believes it is necessary
- Proceeding with a procedure despite patient refusal to avoid treatment delays
- Choosing a device based on availability rather than patient need
Correct answer: Selecting the smallest gauge catheter to minimize patient discomfort when clinically appropriate
Beneficence means acting in the patient's best interest; selecting the least traumatic appropriate device exemplifies this principle.
Question 3: A patient asks the vascular access nurse not to share procedure details with their family. The nurse is ethically obligated to:
- Share information with family members who seem concerned
- Honor the patient's confidentiality unless a legal exception applies (Correct answer)
- Inform the physician, who may then decide what to share with family
- Document the request but share information if family insists
Correct answer: Honor the patient's confidentiality unless a legal exception applies
Patient confidentiality is a fundamental ethical and legal right that the nurse must protect except in legally defined circumstances.
Question 4: In the context of VA nursing, 'moral distress' is BEST defined as:
- Uncertainty about which ethical framework to apply
- Knowing the right action but being constrained from taking it (Correct answer)
- Disagreeing with a patient's autonomous decision
- Feeling overworked during a shift
Correct answer: Knowing the right action but being constrained from taking it
Moral distress occurs when a clinician knows the ethically correct action but institutional or situational constraints prevent them from taking it.
Question 5: A patient with decision-making capacity refuses a blood transfusion for religious reasons despite life-threatening blood loss from a vascular complication. The nurse should:
- Override the refusal because it is a life-threatening emergency
- Respect the refusal, document it, and ensure the care team is aware (Correct answer)
- Involve the ethics committee to override the patient's wishes
- Delay honoring the refusal until a family member can be contacted
Correct answer: Respect the refusal, document it, and ensure the care team is aware
A competent patient's informed refusal based on religious beliefs must be honored even in life-threatening situations.
Question 6: When performing a vascular access procedure on a patient under correctional custody, the nurse's ethical duty is to:
- Prioritize correctional officer instructions over patient care needs
- Provide the same standard of care as any other patient, regardless of custody status (Correct answer)
- Limit interventions to only those authorized by the correctional facility
- Refuse to treat patients in custody to avoid legal liability
Correct answer: Provide the same standard of care as any other patient, regardless of custody status
All patients are entitled to the same standard of care; incarcerated status does not diminish a patient's right to ethical, evidence-based treatment.
Question 7: A nurse feels that placing a central line in a patient with a very poor prognosis is futile. The ethical course of action is to:
- Refuse to place the line based on personal judgment of futility
- Raise the concern with the care team and pursue a goals-of-care discussion with the patient and family (Correct answer)
- Place the line without comment to avoid conflict
- Ask the charge nurse to assign the case to another nurse
Correct answer: Raise the concern with the care team and pursue a goals-of-care discussion with the patient and family
Concerns about medical futility should be addressed through team communication and structured goals-of-care conversations rather than unilateral refusal.
VA-BC Ethical Considerations 4
A nurse discovers that a coworker has been falsifying vascular access procedure records.
The MOST appropriate first step is to: