CDP Ethics & Patient Safety 3 — Questions and Answers
Question 1: An advance directive specifies that a patient with end-stage dementia should receive comfort care only, but a newly appointed surrogate requests aggressive intervention. The care team should:
- Follow the surrogate's current request as it supersedes the advance directive
- Honor the patient's previously expressed wishes in the advance directive (Correct answer)
- Wait for a court order before making any decision
- Ask the patient to re-state their wishes despite severe cognitive impairment
Correct answer: Honor the patient's previously expressed wishes in the advance directive
Advance directives represent the patient's autonomous wishes made while competent and should be honored over surrogate preferences that conflict with them.
Question 2: When a person with dementia refuses a bath, the ethical principle of autonomy requires the care team to:
- Force the bath immediately to maintain hygiene
- Respect the refusal, attempt alternative hygiene approaches, and document the interaction (Correct answer)
- Medicate the patient so they comply with the bath
- Notify the family and wait indefinitely before attempting hygiene care
Correct answer: Respect the refusal, attempt alternative hygiene approaches, and document the interaction
Autonomy requires respecting refusals while creatively problem-solving alternative hygiene approaches and documenting all attempts.
Question 3: Which scenario represents a potential elder abuse situation requiring mandatory reporting by a CDP?
- A resident refuses their afternoon snack
- A family member yells at and threatens a resident with dementia during a visit (Correct answer)
- A resident with dementia experiences a fall in their room
- A physician disagrees with the care plan
Correct answer: A family member yells at and threatens a resident with dementia during a visit
Verbal threats and yelling directed at a vulnerable adult constitute emotional abuse and require mandatory reporting per state and federal law.
Question 4: The principle of justice in dementia care most directly relates to:
- Keeping all medical information confidential
- Ensuring fair access to quality care regardless of a patient's race, gender, or financial status (Correct answer)
- Making decisions that benefit the care team's workflow
- Respecting the patient's right to refuse treatment
Correct answer: Ensuring fair access to quality care regardless of a patient's race, gender, or financial status
Justice requires equitable distribution of care and resources without discrimination based on personal characteristics or socioeconomic status.
Question 5: A resident with moderate dementia says 'I don't want to take that pill.' Under which condition would administering the medication over this objection be ethically justifiable?
- When a family member insists the medication be given
- When the care team believes the medication is beneficial
- When a legally authorized surrogate consents and the medication is clearly necessary to prevent serious harm (Correct answer)
- When the resident has refused the same medication on a prior occasion
Correct answer: When a legally authorized surrogate consents and the medication is clearly necessary to prevent serious harm
Overriding a refusal requires legal surrogate authorization and clinical necessity to prevent serious harm, not simply staff or family preference.
Question 6: A CDP discovers that a resident's HIPAA-protected health information was shared with an unauthorized visitor. The correct action is to:
- Inform the visitor to keep the information confidential
- Document and report the breach per facility policy and applicable law (Correct answer)
- Confront the staff member who shared the information privately
- Take no action if the resident is unaware the breach occurred
Correct answer: Document and report the breach per facility policy and applicable law
HIPAA breaches require formal documentation and reporting through established organizational and regulatory channels regardless of whether the patient was aware.
Question 7: Which environmental modification best addresses safety risks for a person with dementia who has a tendency to wander?
- Locking the patient in their room at all times
- Using camouflage techniques on exit doors combined with secured perimeters and door alarms (Correct answer)
- Physically restraining the patient during waking hours
- Increasing sedative medication to reduce mobility
Correct answer: Using camouflage techniques on exit doors combined with secured perimeters and door alarms
Environmental design approaches like door camouflage with secured perimeters address wandering safely without the harms associated with restraints or sedation.
CDP Ethics & Patient Safety 3
An advance directive specifies that a patient with end-stage dementia should receive comfort care only, but a newly appointed surrogate requests aggressive intervention.
The care team should: