CARN Ethical and Legal Principles 4 — Questions and Answers
Question 1: A nurse realizes they made a medication error that did not harm the patient. What is the ethical course of action?
- Document only if the patient experienced adverse effects
- Report the error through the facility's incident reporting system and notify the provider (Correct answer)
- Correct the situation quietly without documentation to avoid disciplinary action
- Discuss with a trusted colleague and decide together whether to report
Correct answer: Report the error through the facility's incident reporting system and notify the provider
Ethical practice requires transparent reporting of all medication errors through proper channels, regardless of whether harm occurred, to improve patient safety.
Question 2: The Americans with Disabilities Act (ADA) protects individuals with substance use disorders in which of the following scenarios?
- An employee currently using illegal drugs who is fired for on-the-job impairment
- A person in recovery from alcohol use disorder who is denied a job promotion (Correct answer)
- A patient who commits a crime while under the influence of substances
- A nurse who diverts medications and claims addiction as a legal defense
Correct answer: A person in recovery from alcohol use disorder who is denied a job promotion
The ADA protects individuals who are in recovery from substance use disorders from employment discrimination, but does not protect current illegal drug use.
Question 3: Which scenario represents a violation of professional boundaries in addiction nursing?
- A nurse attends a patient's graduation ceremony as a formal facility-sponsored event
- A nurse provides a patient in financial distress with their personal cell phone number for after-hours contact (Correct answer)
- A nurse uses motivational interviewing techniques to address ambivalence
- A nurse shares general educational information about relapse prevention with a patient's family
Correct answer: A nurse provides a patient in financial distress with their personal cell phone number for after-hours contact
Providing personal contact information to patients blurs professional boundaries and creates a dual relationship outside the therapeutic setting.
Question 4: A state law requires treatment programs to report patients with active opioid use disorder to the department of motor vehicles. This law conflicts with 42 CFR Part 2. The CARN should:
- Follow state law since it is more recent
- Follow 42 CFR Part 2 since federal law generally preempts state law in this area
- Report because public safety overrides all confidentiality protections
- Consult the facility's legal counsel to determine the appropriate course (Correct answer)
Correct answer: Consult the facility's legal counsel to determine the appropriate course
When federal and state law appear to conflict regarding 42 CFR Part 2 protections, facilities should seek legal counsel to determine the appropriate course of action.
Question 5: A patient in addiction treatment is also a licensed healthcare professional. Under 42 CFR Part 2, the treatment program may report the patient to their licensing board:
- Automatically, because public safety requires reporting impaired professionals
- Only with the patient's written consent that specifically authorizes this disclosure (Correct answer)
- When the treatment team believes the patient poses a risk to their own patients
- After notifying the patient's employer of the treatment admission
Correct answer: Only with the patient's written consent that specifically authorizes this disclosure
42 CFR Part 2 requires specific written patient consent for disclosure to licensing boards; no automatic professional reporting exception exists.
Question 6: The ethical principle of fidelity in addiction nursing refers primarily to:
- Providing equal treatment to all patients regardless of their substance of use
- Keeping promises and maintaining trust within the therapeutic relationship (Correct answer)
- Accurately representing one's qualifications and credentials
- Distributing limited treatment resources fairly
Correct answer: Keeping promises and maintaining trust within the therapeutic relationship
Fidelity involves maintaining loyalty, keeping commitments, and honoring agreements made with patients to build and sustain therapeutic trust.
Question 7: A patient with severe alcohol use disorder has decision-making capacity and refuses a life-saving liver transplant evaluation. The nurse's ethical obligation is to:
- Override the refusal because the patient's life is at risk
- Ensure the patient has full information and document the informed refusal (Correct answer)
- Seek a court order to compel the evaluation
- Contact the patient's family to intervene and reverse the decision
Correct answer: Ensure the patient has full information and document the informed refusal
A patient with intact decision-making capacity has the right to refuse treatment; the nurse must ensure informed refusal is documented after providing complete information.
CARN Ethical and Legal Principles 4
A nurse realizes they made a medication error that did not harm the patient.
What is the ethical course of action?