CMC Communication & Stakeholder Relations 5 — Questions and Answers
Question 1: A patient in the cardiac ICU is intubated and cannot communicate. Their healthcare proxy is unavailable. Who should make urgent treatment decisions?
- The bedside nurse as the closest team member
- The attending physician acting in the patient's best interest until the proxy is reached (Correct answer)
- The patient's roommate if willing
- No decisions should be made until the proxy is available
Correct answer: The attending physician acting in the patient's best interest until the proxy is reached
When a proxy is unavailable for urgent decisions, the physician acts in the patient's best interest using substituted judgment and documents the reasoning.
Question 2: A patient asks to see their cardiac catheterization report. Under HIPAA, the appropriate response is to:
- Decline, as the report contains complex clinical information
- Provide access to the record within the required timeframe and offer to review findings with the patient (Correct answer)
- Require written physician approval before releasing the report
- Share a summary only and retain the full report
Correct answer: Provide access to the record within the required timeframe and offer to review findings with the patient
HIPAA grants patients the right to access their medical records, and clinicians should facilitate this while offering to explain findings.
Question 3: A cardiac rehabilitation nurse notices a patient is consistently disengaged during group sessions. The best communication approach is to:
- Remove the patient from group sessions
- Have a private conversation to explore barriers and tailor the rehabilitation approach (Correct answer)
- Increase session intensity to re-engage the patient
- Notify the physician without speaking to the patient first
Correct answer: Have a private conversation to explore barriers and tailor the rehabilitation approach
Exploring individual barriers through private conversation supports patient-centered care and improves rehabilitation engagement.
Question 4: A patient's family from a different cultural background declines autopsy for religious reasons. The clinical team should:
- Proceed with autopsy because it is medically indicated
- Respect the family's wishes and document that an autopsy was offered and declined (Correct answer)
- Require the family to provide religious documentation
- Defer the decision to hospital administration
Correct answer: Respect the family's wishes and document that an autopsy was offered and declined
Culturally competent care requires respecting religious and cultural beliefs around autopsy when there is no legal mandate.
Question 5: Which behavior best demonstrates closed-loop communication during a medication administration in the cardiac ICU?
- The nurse nods to confirm receipt of a verbal order
- The nurse reads back the order and the prescriber confirms accuracy before administration (Correct answer)
- The nurse administers the medication and documents it afterward
- The prescriber texts the order to the nurse
Correct answer: The nurse reads back the order and the prescriber confirms accuracy before administration
Closed-loop communication requires the receiver to read back the message and the sender to confirm accuracy, reducing verbal order errors.
Question 6: A hospital implements a new cardiac protocol. To maximize staff compliance, the most effective stakeholder engagement strategy is to:
- Mandate compliance through administrative memo
- Involve frontline cardiac staff in protocol development and provide training before implementation (Correct answer)
- Implement immediately and address concerns as they arise
- Pilot in one unit without staff input to test acceptance
Correct answer: Involve frontline cardiac staff in protocol development and provide training before implementation
Involving frontline staff in protocol development increases buy-in, identifies practical barriers, and improves implementation fidelity.
Question 7: A patient with atrial fibrillation declines anticoagulation after being informed of stroke risk. The most appropriate documentation should include:
- Only the patient's refusal without further detail
- The risks disclosed, patient's stated reasons, confirmed comprehension, and alternatives offered (Correct answer)
- A note that the patient is non-compliant
- An ethics consultation request
Correct answer: The risks disclosed, patient's stated reasons, confirmed comprehension, and alternatives offered
Thorough documentation of informed refusal protects the patient's autonomy and provides a clinical-legal record of the shared decision-making process.
CMC Communication & Stakeholder Relations 5
A patient in the cardiac ICU is intubated and cannot communicate.
Their healthcare proxy is unavailable.
Who should make urgent treatment decisions?