ABA Professionalism, Ethics & Patient Safety 2 — Questions and Answers
Question 1: A patient scheduled for elective surgery reveals during the preoperative assessment that they are undocumented and fears deportation if their identity is recorded. What is the most appropriate response?
- Refuse to proceed until legal status is verified
- Provide care based on clinical need while maintaining confidentiality (Correct answer)
- Report the patient's status to hospital administration before proceeding
- Postpone surgery indefinitely until the issue is resolved
Correct answer: Provide care based on clinical need while maintaining confidentiality
Anesthesiologists must provide care based on clinical need; patient confidentiality obligations do not exclude undocumented individuals.
Question 2: During a busy OR day, a circulating nurse verbally alerts you that the syringe labeled 'succinylcholine' appears to have been drawn up in the wrong concentration. What is the highest-priority action?
- Administer the drug as labeled and document the concern
- Immediately verify the syringe contents before proceeding (Correct answer)
- Ask the surgeon whether to continue with induction
- File a near-miss report and proceed with the original plan
Correct answer: Immediately verify the syringe contents before proceeding
Medication verification at the point of use is a critical safety step; all concerns about drug identity must be resolved before administration.
Question 3: Which ASA Standard most directly mandates the continual monitoring of oxygenation, ventilation, circulation, and temperature during all anesthetics?
- Standards for Basic Anesthetic Monitoring (Correct answer)
- Guidelines for Nonoperating Room Anesthetizing Locations
- Practice Advisory for Preanesthesia Evaluation
- Policy on Granting Privileges for Sedation
Correct answer: Standards for Basic Anesthetic Monitoring
The ASA Standards for Basic Anesthetic Monitoring define the mandatory intraoperative surveillance parameters for every anesthetic.
Question 4: A colleague is repeatedly found sleeping during cases and leaves early without handoffs. Colleagues have complained, but no formal report has been made. As the department chief, what is your professional obligation?
- Counsel the colleague privately with no formal documentation
- Initiate a formal review process to protect patients and the colleague (Correct answer)
- Allow the behavior to continue as long as no adverse event has occurred
- Report the colleague directly to the state medical board without internal review
Correct answer: Initiate a formal review process to protect patients and the colleague
Physician health and impairment programs require formal structured review to protect patients while affording due process to the provider.
Question 5: A Jehovah's Witness adult patient with full decision-making capacity refuses all blood products preoperatively. Intraoperatively, the patient hemorrhages and approaches exsanguination. What should the anesthesiologist do?
- Transfuse immediately because it is a life-threatening emergency
- Continue non-blood strategies and respect the documented refusal (Correct answer)
- Contact the hospital ethics committee before taking any action
- Transfer the patient to another surgeon who will transfuse
Correct answer: Continue non-blood strategies and respect the documented refusal
A competent adult's advance refusal of blood products is legally and ethically binding even in life-threatening circumstances.
Question 6: Which of the following best describes the ethical principle of 'justice' in the context of anesthesia care?
- Providing the highest possible level of care to every individual patient regardless of resource constraints
- Fair distribution of healthcare resources and equitable treatment of all patients (Correct answer)
- Prioritizing the patient's long-term well-being over immediate desires
- Ensuring that patients are fully informed before consenting to procedures
Correct answer: Fair distribution of healthcare resources and equitable treatment of all patients
Justice refers to the equitable allocation of healthcare resources and non-discriminatory treatment across patient populations.
Question 7: After a wrong-site nerve block is discovered postoperatively, which action is MOST important for maintaining a culture of safety?
- Quietly correct the error and document only what is clinically relevant
- Disclose the error to the patient and conduct a root-cause analysis (Correct answer)
- Assign blame to the supervising resident to protect attending liability
- Delay disclosure until the outcome is fully determined
Correct answer: Disclose the error to the patient and conduct a root-cause analysis
Transparent disclosure to the patient and systematic root-cause analysis are essential pillars of a just and learning safety culture.
ABA Professionalism, Ethics & Patient Safety 2
A patient scheduled for elective surgery reveals during the preoperative assessment that they are undocumented and fears deportation if their identity is recorded.
What is the most appropriate response?