CNO Consent and Capacity in Nursing Practice 1 — Questions and Answers
Question 1: Under Ontario's Health Care Consent Act, who is ultimately responsible for obtaining informed consent for a proposed treatment?
- The registered nurse administering the treatment
- The regulated health professional proposing the treatment (Correct answer)
- The charge nurse on duty
- The hospital administrator
Correct answer: The regulated health professional proposing the treatment
Under the HCCA, the health professional proposing a treatment bears responsibility for obtaining informed consent before proceeding.
Question 2: Which of the following elements is NOT required for consent to be considered informed under Ontario's Health Care Consent Act?
- The nature of the treatment
- The expected benefits of the treatment
- The cost of the treatment (Correct answer)
- The material risks of the treatment
Correct answer: The cost of the treatment
Informed consent requires disclosure of the nature, expected benefits, material risks, side effects, and alternatives — cost is not a legislated requirement.
Question 3: Under the Health Care Consent Act, how is capacity to consent assessed for a client with dementia who requires multiple procedures?
- Once upon admission, applying to all future treatments
- Globally for all decisions at the same time
- Specifically for each treatment decision being made (Correct answer)
- Only by a physician or psychiatrist
Correct answer: Specifically for each treatment decision being made
Capacity is decision-specific under the HCCA; a person may be capable of consenting to some treatments but incapable of consenting to others.
Question 4: According to the Health Care Consent Act, a person is presumed to be capable of making treatment decisions unless:
- They are over 75 years of age
- They have a diagnosed mental illness
- There are reasonable grounds to believe otherwise (Correct answer)
- A substitute decision maker has been appointed
Correct answer: There are reasonable grounds to believe otherwise
The HCCA establishes a presumption of capacity that can only be set aside when there are reasonable grounds to believe the person lacks capacity for the specific decision.
Question 5: A capable client refuses a treatment the nurse believes is in the client's best interest. What is the nurse's most appropriate response?
- Proceed with the treatment to prevent foreseeable harm
- Immediately contact the substitute decision maker
- Respect the refusal, document it, and report to the team (Correct answer)
- Request a psychiatric evaluation to reassess capacity
Correct answer: Respect the refusal, document it, and report to the team
A capable client has the legal and ethical right to refuse any treatment, and the nurse must respect and document this decision even when it may result in harm.
Question 6: Which of the following best describes 'implied consent' in nursing practice?
- Consent given verbally without a written signature
- Consent inferred from a client's actions or behavior (Correct answer)
- Consent given by a substitute decision maker on behalf of a client
- Consent obtained by a nurse in an emergency situation
Correct answer: Consent inferred from a client's actions or behavior
Implied consent is inferred from a client's voluntary actions, such as extending an arm for a blood pressure check, indicating agreement to the procedure.
Question 7: A client asks 'What is this medication for?' before the nurse administers it. What is the nurse's primary obligation?
- Administer the medication as ordered without detailed explanation
- Provide clear information about the medication to support ongoing informed consent (Correct answer)
- Refer all medication questions to the prescribing physician before proceeding
- Document that the client is being non-compliant with the treatment plan
Correct answer: Provide clear information about the medication to support ongoing informed consent
Nurses have a professional obligation to provide clients with information about medications and treatments to support ongoing, meaningful informed consent throughout care.
CNO Consent and Capacity in Nursing Practice 1
Under Ontario's Health Care Consent Act, who is ultimately responsible for obtaining informed consent for a proposed treatment?