ANM Ethical and Legal Standards 3 — Questions and Answers
Question 1: The bioethical principle of justice in healthcare resource allocation primarily requires that:
- All patients receive identical treatments regardless of need
- Resources are distributed fairly based on need and established criteria (Correct answer)
- The wealthiest patients receive priority access to scarce resources
- Clinical decisions are made solely on expected survival outcomes
Correct answer: Resources are distributed fairly based on need and established criteria
Justice requires fair, equitable distribution of healthcare resources according to established, non-discriminatory criteria and patient need.
Question 2: A staff nurse reports to the ANM that they witnessed a physician alter a patient's medical record after an adverse event. The ANM's priority action is to:
- Advise the nurse to confront the physician directly
- Document the report and escalate to the chain of command and risk management (Correct answer)
- Wait to see if the physician self-reports the alteration
- Reassure the nurse and take no action to preserve staff relationships
Correct answer: Document the report and escalate to the chain of command and risk management
Falsification of medical records is fraud and a serious legal violation requiring immediate escalation to risk management and administration through proper channels.
Question 3: Which of the following best describes 'informed consent' in clinical practice?
- The patient signs a form acknowledging receipt of information
- The physician verbally tells the patient what procedure will be performed
- The patient receives, understands, and voluntarily agrees to treatment after receiving adequate information (Correct answer)
- A legal guardian signs consent forms when any adult patient is hospitalized
Correct answer: The patient receives, understands, and voluntarily agrees to treatment after receiving adequate information
True informed consent requires disclosure of information, patient comprehension, voluntariness, and capacity — a signature alone does not constitute informed consent.
Question 4: An ANM is asked by a hospital administrator to manipulate quality data before submitting it to accreditation bodies. The ANM should:
- Comply to protect the hospital's accreditation status
- Refuse and report the request through appropriate compliance channels (Correct answer)
- Manipulate only minor data points to avoid detection
- Consult with peers before deciding whether to comply
Correct answer: Refuse and report the request through appropriate compliance channels
Falsifying accreditation data is fraud and an ethical violation; the ANM must refuse and report through compliance or whistleblower channels.
Question 5: Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals with emergency departments are required to:
- Provide care only to patients with valid insurance
- Screen and stabilize all patients regardless of ability to pay (Correct answer)
- Transfer unstable patients to public hospitals for financial reasons
- Limit emergency services to residents of the hospital's service area
Correct answer: Screen and stabilize all patients regardless of ability to pay
EMTALA mandates that hospitals provide a medical screening examination and necessary stabilizing treatment to anyone presenting to the emergency department regardless of payment status.
Question 6: A patient discloses during assessment that they plan to harm a specific coworker upon discharge. The nurse manager's legal and ethical obligation includes:
- Maintain strict confidentiality since the patient disclosed this in a therapeutic relationship
- Notify the identified potential victim and appropriate authorities per Tarasoff duty (Correct answer)
- Document the threat but take no external action unless the patient attempts to leave
- Seek the patient's permission before warning anyone about the threat
Correct answer: Notify the identified potential victim and appropriate authorities per Tarasoff duty
The Tarasoff duty-to-warn doctrine requires clinicians to warn identifiable potential victims and notify authorities when a credible threat of harm is disclosed.
Question 7: What is the primary purpose of a hospital's ethics committee in clinical practice?
- To discipline nurses who violate patient rights
- To make final binding medical decisions for all patients
- To provide consultation and recommendations on ethically complex clinical situations (Correct answer)
- To review and approve all DNR orders before implementation
Correct answer: To provide consultation and recommendations on ethically complex clinical situations
Ethics committees serve a consultative and educational role, offering guidance on morally complex cases without replacing the decision-making authority of patients, families, and clinicians.
ANM Ethical and Legal Standards 3
The bioethical principle of justice in healthcare resource allocation primarily requires that: