ACCS Ethics and Communication 3 — Questions and Answers
Question 1: An ICU patient with end-stage liver disease lacks capacity. No advance directive exists and no family is available. Who typically serves as the default decision-maker?
- The bedside nurse
- The hospital ethics committee
- A court-appointed guardian or, per state law, the attending physician (Correct answer)
- The hospital administrator
Correct answer: A court-appointed guardian or, per state law, the attending physician
When no surrogate or advance directive exists, state law typically designates the attending physician or a court-appointed guardian to make decisions in the patient's best interest.
Question 2: The doctrine of double effect is MOST relevant when a critical care nurse administers high-dose opioids to a dying patient primarily to:
- Hasten the patient's death at the family's request
- Relieve refractory pain, with death as an unintended secondary effect (Correct answer)
- Sedate the patient against their will
- Comply with a court order
Correct answer: Relieve refractory pain, with death as an unintended secondary effect
The doctrine of double effect justifies an action with a harmful secondary effect (hastened death) when the primary intent is to relieve suffering.
Question 3: A patient in the ICU who has decision-making capacity refuses a blood transfusion on religious grounds. The team believes he will die without it. What is the ethical obligation?
- Transfuse the patient to prevent death, overriding his refusal
- Respect the patient's refusal and provide supportive care aligned with his wishes (Correct answer)
- Seek a court order to mandate transfusion
- Transfer the patient to a facility with different policies
Correct answer: Respect the patient's refusal and provide supportive care aligned with his wishes
A capacitated adult's refusal of treatment, even life-saving treatment, must be respected as an exercise of autonomy.
Question 4: Which statement BEST describes the concept of therapeutic privilege in the ICU context?
- The nurse's right to withhold treatment they disagree with
- Withholding information from a patient when disclosure would cause serious psychological harm (Correct answer)
- A physician's ability to override an advance directive
- The right of the family to make decisions without physician input
Correct answer: Withholding information from a patient when disclosure would cause serious psychological harm
Therapeutic privilege allows withholding information if disclosure would directly harm the patient, but it is considered ethically controversial and rarely justified.
Question 5: During an interdisciplinary ICU family meeting, the nurse's PRIMARY role is to:
- Lead all medical discussions and prognostic conversations
- Represent the patient's perspective and clarify misunderstandings (Correct answer)
- Document the meeting and refrain from speaking
- Advocate exclusively for the family's emotional needs
Correct answer: Represent the patient's perspective and clarify misunderstandings
The bedside nurse has unique insight into the patient's condition, values, and concerns, making them vital advocates and clarifiers in family meetings.
Question 6: Which approach BEST supports shared decision-making with a family whose cultural background discourages direct disclosure of terminal diagnoses to the patient?
- Always disclose directly to the patient regardless of cultural context
- Explore the patient's own preferences about information disclosure before making assumptions (Correct answer)
- Automatically defer all information to the family spokesperson
- Refuse to participate in culturally different communication practices
Correct answer: Explore the patient's own preferences about information disclosure before making assumptions
Asking patients whether and how they want information disclosed respects both autonomy and cultural values without stereotyping.
Question 7: A family requests that the ICU team 'do everything' for their loved one. What is the MOST effective initial nursing response?
- Immediately implement full aggressive interventions
- Explore what 'everything' means to the family and clarify realistic goals of care (Correct answer)
- Explain that 'everything' is not a medical order
- Defer the response to the attending physician only
Correct answer: Explore what 'everything' means to the family and clarify realistic goals of care
The phrase 'do everything' often reflects hope and fear rather than a specific medical directive; clarifying meaning guides appropriate care planning.
ACCS Ethics and Communication 3
An ICU patient with end-stage liver disease lacks capacity.
No advance directive exists and no family is available.
Who typically serves as the default decision-maker?