ACCS Ethics and Communication 3

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?

Accepted Answer

A court-appointed guardian or, per state law, the attending physician

Answer

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:

Accepted Answer

Relieve refractory pain, with death as an unintended secondary effect

Answer

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?

Accepted Answer

Respect the patient's refusal and provide supportive care aligned with his wishes

Answer

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?

Accepted Answer

Withholding information from a patient when disclosure would cause serious psychological harm

Answer

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:

Accepted Answer

Represent the patient's perspective and clarify misunderstandings

Answer

The bedside nurse has unique insight into the patient's condition, values, and concerns, making them vital advocates and clarifiers in family meetings.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Ethics and Communication 3