CPNRE - Canadian Practical Nurse Registration Examination Professional and Ethical Practice Questions and Answers 1 — Questions and Answers
Question 1: A practical nurse is caring for a client who has expressed a desire to refuse further life-sustaining treatment. The client's family is strongly opposed to this decision. Which of the following actions best demonstrates the practical nurse's adherence to ethical principles?
- Following the family's wishes, as they are the client's support system.
- Requesting a psychiatric evaluation to assess the client's decision-making capacity.
- Advocating for the client's right to autonomy and informed decision-making. (Correct answer)
- Organizing a meeting with the hospital's ethics committee without the client's knowledge.
Correct answer: Advocating for the client's right to autonomy and informed decision-making.
The core ethical principle of autonomy respects the client's right to make their own decisions about their healthcare, even if those decisions conflict with the views of their family or the healthcare team. The practical nurse's primary responsibility is to the client. Advocating for the client's decision upholds this principle. While assessing capacity is important, requesting a psychiatric evaluation without a clear indication of incapacity could be seen as challenging the client's autonomy. Following the family's wishes or involving the ethics committee without consent would violate the principles of client-centered care and confidentiality.
Question 2: A colleague, another practical nurse, is consistently documenting the administration of pain medication to a client, but the client continues to report severe, uncontrolled pain. The practical nurse notices that the colleague appears impaired during their shifts. What is the most appropriate initial action for the practical nurse to take?
- Confront the colleague directly and accuse them of diverting medication.
- Report the observations and concerns to the nursing supervisor or manager. (Correct answer)
- Discuss the situation with other colleagues to see if they have noticed similar behaviors.
- Document the colleague's behavior in the client's chart.
Correct answer: Report the observations and concerns to the nursing supervisor or manager.
The primary responsibility of the nurse is to ensure client safety. Reporting suspected impairment or unethical conduct to the appropriate authority (e.g., the nursing supervisor) is a professional and legal obligation. This action protects the client from potential harm and initiates the proper channels for investigation and support for the colleague. Confronting the colleague directly could be unsafe and unprofessional. Discussing with others could be a breach of confidentiality, and documenting suspicions in a client's chart is inappropriate.
Question 3: Which of the following scenarios constitutes a breach of client confidentiality by a practical nurse?
- Sharing client information with the oncoming nurse during a shift report.
- Discussing a client's difficult diagnosis with a spouse who is not the designated substitute decision-maker, without the client's consent. (Correct answer)
- Informing the pharmacist about a client's allergy before dispensing a new medication.
- Collaborating with the physiotherapist about a client's mobility status and care plan.
Correct answer: Discussing a client's difficult diagnosis with a spouse who is not the designated substitute decision-maker, without the client's consent.
Licensed Practical Nurses have a legal and ethical duty to protect the privacy and confidentiality of a client's personal health information. Disclosing information to anyone outside the immediate circle of care, including a spouse, without the client's explicit consent is a breach of this duty. Sharing information during shift report, with the pharmacist for medication safety, or with other members of the interdisciplinary team for care planning are all appropriate and necessary communications for providing safe care.
Question 4: A practical nurse is assigned to care for a client whose cultural and religious beliefs differ significantly from their own. The client is refusing a specific medical procedure recommended by the physician due to these beliefs. The nurse's first response should be to:
- Explain to the client why the procedure is medically necessary and attempt to change their mind.
- Document the refusal and proceed with other aspects of the care plan.
- Respect the client's decision and explore their beliefs and values with cultural sensitivity. (Correct answer)
- Request to be reassigned to another client to avoid a conflict of values.
Correct answer: Respect the client's decision and explore their beliefs and values with cultural sensitivity.
Ethical nursing practice requires respecting the rights of all individuals, regardless of their diverse values, beliefs, and cultures. The nurse's first action should be to seek understanding and demonstrate respect for the client's perspective. This client-centered approach promotes trust and opens a dialogue where the client's needs and wishes can be properly understood and advocated for. Attempting to change their mind disrespects their autonomy. Simply documenting the refusal without trying to understand the reasoning is a missed opportunity for holistic care. While re-assignment is a last resort in a true conflict of conscience, the initial step is always to engage respectfully with the client.
Question 5: A practical nurse is asked by a physician to perform a task that is outside the LPN's legislated scope of practice. Which of the following statements reflects the nurse's professional accountability?
- "I will do it this one time since you are here to supervise me."
- "I have not performed this task before, but I am a quick learner."
- "I am not authorized or competent to perform this task; we need to find an appropriate practitioner." (Correct answer)
- "I will document that you ordered me to perform this task to ensure I am covered."
Correct answer: "I am not authorized or competent to perform this task; we need to find an appropriate practitioner."
Licensed Practical Nurses are accountable for knowing and acting consistently with the laws and standards that govern their practice. This includes practicing only within their legislated scope and personal competencies. The nurse must recognize their limitations and refuse to perform tasks they are not authorized or competent to do. This protects the client from harm and upholds the professional standards of the profession. Agreeing to perform the task, even with supervision, or relying on documentation to absolve responsibility is inappropriate and unsafe.
Question 6: In the context of obtaining informed consent, the practical nurse's role is primarily to:
- Explain the risks and benefits of the medical procedure in detail.
- Select the best treatment option for the client.
- Ensure the consent form is signed and placed in the client's chart.
- Verify that the client understands the information provided by the primary healthcare provider and advocate for their rights. (Correct answer)
Correct answer: Verify that the client understands the information provided by the primary healthcare provider and advocate for their rights.
While the physician or other primary healthcare provider is responsible for explaining the procedure, its risks, benefits, and alternatives, the nurse plays a crucial role in the consent process. The nurse must advocate for the client, ensuring they have received adequate information, have had their questions answered, and are making a voluntary and informed choice. Simply witnessing a signature without ensuring understanding does not fulfill this ethical and professional responsibility. The nurse does not provide the primary explanation of medical procedures or choose treatments for the client.
CPNRE - Canadian Practical Nurse Registration Examination Professional and Ethical Practice Questions and Answers 1
A practical nurse is caring for a client who has expressed a desire to refuse further life-sustaining treatment.
The client's family is strongly opposed to this decision.
Which of the following actions best demonstrates the practical nurse's adherence to ethical principles?