ANM Ethical and Legal Standards 5 — Questions and Answers
Question 1: A terminally ill patient requests information about palliative sedation to manage refractory suffering. The ethical principle most directly supporting the ANM's obligation to facilitate this discussion is:
- Fidelity — keeping promises made to the patient during admission
- Veracity — ensuring honest communication about all care options (Correct answer)
- Paternalism — the team knows what is best for the patient
- Nonmaleficence — avoiding all sedation to prevent respiratory depression
Correct answer: Veracity — ensuring honest communication about all care options
Veracity obligates healthcare providers to disclose all relevant care options honestly, including palliative sedation, enabling truly informed patient decision-making.
Question 2: When a staff nurse raises a concern about a patient care practice through a formal grievance, the ANM is legally protected from retaliating against that nurse under:
- Title VII of the Civil Rights Act
- The Occupational Safety and Health Act whistleblower provisions (Correct answer)
- The National Labor Relations Act only
- The Americans with Disabilities Act
Correct answer: The Occupational Safety and Health Act whistleblower provisions
OSHA's whistleblower protection provisions prohibit retaliation against employees who report safety concerns, and the ANA Code of Ethics also prohibits such retaliation.
Question 3: A 16-year-old patient presents to the clinic requesting STI testing and treatment without parental notification. In most U.S. states, the nurse should know that:
- Parental consent is always required for minors under age 18
- Minors can typically consent to STI testing and treatment without parental knowledge under minor consent laws (Correct answer)
- Treatment can begin but parents must be notified within 24 hours
- Only emancipated minors may consent to any form of healthcare
Correct answer: Minors can typically consent to STI testing and treatment without parental knowledge under minor consent laws
Most U.S. states have minor consent laws that specifically allow minors to consent to STI testing, treatment, and counseling without parental notification to encourage care-seeking.
Question 4: The concept of 'moral distress' in nursing refers to:
- Ethical uncertainty about the right course of action in complex cases
- Knowing the ethically correct action but being constrained from performing it (Correct answer)
- Disagreement among team members about treatment plans
- A nurse's personal discomfort with a patient's lifestyle choices
Correct answer: Knowing the ethically correct action but being constrained from performing it
Moral distress occurs when a nurse knows the right ethical action but institutional, legal, or authority constraints prevent them from taking that action.
Question 5: A hospital policy requires nurses to use restraints for all post-surgical elderly patients to prevent falls. An ANM should recognize this policy as potentially violating:
- Staffing ratio regulations under state nursing practice acts
- CMS Conditions of Participation requiring restraints be the least restrictive option and individually ordered (Correct answer)
- Joint Commission standards requiring restraints be used only for behavioral management
- HIPAA regulations regarding documentation of restraint use
Correct answer: CMS Conditions of Participation requiring restraints be the least restrictive option and individually ordered
CMS Conditions of Participation mandate that restraints be used only when clinically necessary, be individually ordered by a physician, and be the least restrictive intervention — blanket policies violate these requirements.
Question 6: An ANM identifies that a nurse manager colleague is impaired by alcohol while on duty. The ANM's primary obligation is to:
- Speak to the colleague privately and allow them to finish the shift
- Remove the impaired manager from patient care immediately and notify administration (Correct answer)
- Document the observation and report it at the next scheduled staff meeting
- Encourage the colleague to voluntarily seek help before taking any official action
Correct answer: Remove the impaired manager from patient care immediately and notify administration
An impaired colleague poses an immediate patient safety threat; the ANM must act immediately to remove them from care and notify administration, prioritizing nonmaleficence.
Question 7: Which of the following best describes the standard of care against which a nurse's actions are legally measured in a malpractice case?
- What the most experienced nurse on the unit would have done
- What a reasonably prudent nurse with similar training would do under similar circumstances (Correct answer)
- The exact actions specified in the hospital's nursing procedure manual
- The highest possible level of care achievable with available resources
Correct answer: What a reasonably prudent nurse with similar training would do under similar circumstances
The legal standard of care is defined as what a reasonably prudent nurse with comparable training and experience would do in the same or similar circumstances.
ANM Ethical and Legal Standards 5
A terminally ill patient requests information about palliative sedation to manage refractory suffering.
The ethical principle most directly supporting the ANM's obligation to facilitate this discussion is: