ACCS Ethics and Communication 2 — Questions and Answers
Question 1: A surrogate decision-maker for an incapacitated ICU patient insists on continuing aggressive treatment that the medical team believes is futile. What is the most appropriate initial step?
- Proceed with the surrogate's wishes without question
- Convene a family meeting to explore goals of care and the patient's prior expressed wishes (Correct answer)
- Obtain a court order to override the surrogate
- Transfer the patient to another facility immediately
Correct answer: Convene a family meeting to explore goals of care and the patient's prior expressed wishes
A structured goals-of-care meeting helps clarify the patient's values and may reveal advance directives that guide decision-making.
Question 2: Which ethical principle is MOST directly upheld when a critical care nurse advocates for adequate pain management for a dying patient whose family refuses opioids?
- Justice
- Veracity
- Beneficence (Correct answer)
- Autonomy
Correct answer: Beneficence
Beneficence obligates clinicians to act in the patient's best interest, which includes relieving suffering regardless of family preference.
Question 3: During a family meeting, the attending physician uses highly technical jargon when explaining a patient's prognosis. Which communication strategy should the nurse recommend?
- Ask the family to research medical terms on their own
- Request that the physician re-explain using plain language and check for understanding (Correct answer)
- Provide the family with a medical dictionary
- Document that education was provided and move on
Correct answer: Request that the physician re-explain using plain language and check for understanding
Plain language and teach-back methods ensure families truly comprehend prognosis information, supporting informed decision-making.
Question 4: An adult ICU patient with capacity states she does not want her diagnosis disclosed to her adult children. The children are calling the unit demanding information. What is the correct action?
- Provide general information to keep the family calm
- Refuse to disclose any information, respecting the patient's stated wishes (Correct answer)
- Tell the children the diagnosis but ask them to keep it confidential
- Refer the matter to the ethics committee immediately
Correct answer: Refuse to disclose any information, respecting the patient's stated wishes
A capacitated patient has the right under HIPAA and autonomy principles to restrict information sharing with family members.
Question 5: A nurse is caring for a patient whose advance directive specifies 'no resuscitation,' but the family is demanding a full code. Which action reflects best practice?
- Honor the family's request because they are legally next of kin
- Follow the advance directive as the expression of the patient's autonomous wishes (Correct answer)
- Delay resuscitation decisions until an ethics consult is completed
- Allow the attending physician to decide without involving the nurse
Correct answer: Follow the advance directive as the expression of the patient's autonomous wishes
A valid advance directive reflects the patient's autonomous decision and takes legal and ethical precedence over family preferences.
Question 6: Which factor MOST commonly contributes to moral distress in critical care nurses?
- Insufficient continuing education requirements
- Being compelled to provide care that conflicts with their ethical beliefs (Correct answer)
- Inadequate shift-change handoffs
- Lack of electronic health record access
Correct answer: Being compelled to provide care that conflicts with their ethical beliefs
Moral distress arises when nurses know the ethically correct action but institutional or external constraints prevent them from acting on it.
Question 7: When communicating a poor prognosis to a patient's family in the ICU, which approach is MOST consistent with evidence-based communication guidelines?
- Deliver the information quickly to minimize distress
- Allow silence after delivering bad news and invite questions (Correct answer)
- Begin with treatment options before discussing prognosis
- Avoid specific prognostic estimates to prevent false hope
Correct answer: Allow silence after delivering bad news and invite questions
Pausing after delivering bad news gives families time to process information and signals that the clinician is present and supportive.
ACCS Ethics and Communication 2
A surrogate decision-maker for an incapacitated ICU patient insists on continuing aggressive treatment that the medical team believes is futile.
What is the most appropriate initial step?