CARN Ethical and Legal Principles 5 — Questions and Answers
Question 1: Which of the following is an example of distributive justice in addiction treatment?
- A nurse honestly informs a patient about the risks of buprenorphine
- A facility allocates more treatment beds to patients with better insurance coverage
- A program implements sliding-scale fees to ensure equitable access regardless of income (Correct answer)
- A nurse keeps a promise to meet with a patient daily during detox
Correct answer: A program implements sliding-scale fees to ensure equitable access regardless of income
Distributive justice requires fair allocation of resources; sliding-scale fees promote equitable access to treatment across socioeconomic levels.
Question 2: A CARN suspects a patient is selling their prescribed buprenorphine. The nurse's initial response should be to:
- Immediately discontinue the prescription without discussion
- Conduct a clinical assessment, discuss concerns with the patient, and consult the prescriber (Correct answer)
- Report the patient to law enforcement without clinical evaluation
- Ignore the concern since buprenorphine diversion is common
Correct answer: Conduct a clinical assessment, discuss concerns with the patient, and consult the prescriber
Clinical assessment and direct therapeutic discussion with the patient, followed by prescriber consultation, balances patient care needs with program integrity.
Question 3: A nurse in an addiction program is asked by law enforcement to confirm whether a specific individual is enrolled in the program. Under 42 CFR Part 2, the nurse should:
- Confirm or deny enrollment since law enforcement has authority to access this information
- Neither confirm nor deny that the individual is a patient without a court order or patient consent (Correct answer)
- Provide enrollment information if the officer shows a badge and states it is an investigation
- Release the information only if the patient is suspected of a violent crime
Correct answer: Neither confirm nor deny that the individual is a patient without a court order or patient consent
42 CFR Part 2 prohibits even confirming or denying program enrollment to law enforcement without a specific court order or patient consent.
Question 4: Which scenario best illustrates a dual relationship that a CARN must avoid?
- Treating a patient who was referred by a mutual acquaintance
- Providing addiction counseling to a close personal friend who enters the program (Correct answer)
- Assessing a patient who shares the same cultural background as the nurse
- Working with a patient who is employed at the same hospital in a different department
Correct answer: Providing addiction counseling to a close personal friend who enters the program
Treating a close personal friend creates a dual relationship that compromises clinical objectivity and violates professional boundaries.
Question 5: A patient in opioid treatment is pregnant and refuses naltrexone, requesting buprenorphine instead. The ethical principle supporting the nurse's advocacy for the patient's preferred treatment is:
- Paternalism
- Autonomy (Correct answer)
- Fidelity
- Distributive justice
Correct answer: Autonomy
Autonomy supports the patient's right to participate in treatment decisions and choose among clinically appropriate options.
Question 6: The NAADAC Code of Ethics obligates addiction professionals to maintain competence by:
- Completing the minimum CE hours required for license renewal only
- Engaging in ongoing education, supervision, and self-assessment throughout their career (Correct answer)
- Delegating complex cases to more experienced colleagues indefinitely
- Limiting practice to the techniques learned during initial training
Correct answer: Engaging in ongoing education, supervision, and self-assessment throughout their career
Professional competence requires a career-long commitment to continuing education, supervision, and reflective practice beyond minimum licensure requirements.
Question 7: A CARN documents inaccurate information in a patient's chart at a supervisor's request to justify a treatment decision that was made incorrectly. This action constitutes:
- Acceptable practice when ordered by a supervisor
- Falsification of medical records, which is both illegal and unethical (Correct answer)
- A minor documentation variance that does not affect patient care
- A protected internal quality improvement action
Correct answer: Falsification of medical records, which is both illegal and unethical
Falsifying medical records is illegal regardless of who requests it and violates the nurse's ethical obligation to maintain accurate documentation.
CARN Ethical and Legal Principles 5
Which of the following is an example of distributive justice in addiction treatment?