CPNRE Professional and Ethical Practice 2 — Questions and Answers
Question 1: The CNA Code of Ethics identifies seven primary values. Which value is demonstrated when a practical nurse ensures a client understands their diagnosis before making a treatment decision?
- Safe, compassionate, competent, and ethical care
- Health and well-being
- Autonomy and self-determination (Correct answer)
- Accountability
Correct answer: Autonomy and self-determination
Ensuring a client understands their diagnosis before decision-making demonstrates respect for autonomy and self-determination.
CNA Code of Ethics (2017) seven primary values: (1) Providing safe, compassionate, competent, and ethical care; (2) Promoting health and well-being; (3) Promoting and respecting informed decision-making (autonomy); (4) Preserving dignity; (5) Maintaining privacy and confidentiality; (6) Promoting justice; (7) Being accountable. Ensuring client understanding before treatment decision embodies value 3, autonomy/self-determination. While practical nurses are regulated by provincial colleges (CNO, CRNBC), the CNA Code of Ethics provides a foundational ethical framework referenced in CPNRE preparation.
Question 2: A practical nurse is asked to perform a task outside their scope of practice. What is the most appropriate response?
- Perform the task since refusing appears unhelpful
- Decline clearly and explain why, then identify who has the appropriate scope (Correct answer)
- Perform the task after receiving verbal physician instruction
- Perform it once while seeking training
Correct answer: Decline clearly and explain why, then identify who has the appropriate scope
Declining a task outside scope and directing to an appropriate provider protects client safety and demonstrates professional accountability.
Scope of practice is defined by provincial legislation (Regulated Health Professions Act in Ontario; Health Professions Act in BC) and regulatory college standards. When asked to perform a task outside scope: clearly decline ('That task is outside my scope of practice as a practical nurse'); explain the regulatory reason; identify who has appropriate scope (RN, NP, physician, respiratory therapist); offer to assist within your scope. Performing a task outside scope (even with good intentions, physician instruction, or ongoing education) constitutes unauthorized practice, exposing the nurse to regulatory discipline, civil liability, and potential criminal liability.
Question 3: Which action by a practical nurse demonstrates the ethical principle of justice in healthcare delivery?
- Providing extra care to verbally appreciative clients
- Advocating for a marginalized client to receive the same quality of care as other clients (Correct answer)
- Offering emotional support only to clients with serious diagnoses
- Prioritizing care based on the client's socioeconomic status
Correct answer: Advocating for a marginalized client to receive the same quality of care as other clients
Justice in healthcare means equitable distribution of care regardless of personal characteristics. Advocating for equal quality care demonstrates this principle.
The ethical principle of justice: fair, equitable distribution of healthcare resources and services; requires equal quality of care regardless of race, gender, socioeconomic status, age, disability, sexual orientation, Indigenous identity, immigration status, or other characteristics. Advocating for a marginalized client (person experiencing homelessness, Indigenous client facing systemic bias, newcomer with language barriers) directly demonstrates justice. The CNA Code of Ethics and TRC Calls to Action (Call 23 on cultural safety training) reinforce the obligation to identify and address inequitable care. Anti-racism and culturally safe practice are justice imperatives in Canadian healthcare.
Question 4: A practical nurse witnesses a colleague falsifying a client's vital signs documentation. What is the ethical and professional obligation?
- Counsel privately and give an opportunity to correct the record
- Report the behavior through appropriate channels (charge nurse, management, regulatory college if required) (Correct answer)
- Ignore it since the colleague may have had a valid reason
- Document in the client's chart without notifying management
Correct answer: Report the behavior through appropriate channels (charge nurse, management, regulatory college if required)
Falsifying health records is a serious professional offence requiring mandatory reporting through appropriate channels to protect client safety.
Falsifying documentation is: a criminal offence (falsification of records, fraud); a serious professional misconduct violation reportable to provincial regulatory colleges; a patient safety risk. The practical nurse's obligation: report to charge nurse/manager immediately; do NOT attempt to correct the record themselves; document what was witnessed factually; if manager does not act appropriately, escalate to regulatory college if client safety is at risk. Private counseling as the sole response is insufficient for serious misconduct. The Just Culture framework distinguishes between honest mistakes and intentional harmful acts. Falsification is the latter.
Question 5: A client from a cultural background that uses herbal remedies asks about using them alongside their prescribed medications. What is the culturally competent response?
- Share personal experience and recommend specific supplements
- Acknowledge the cultural practice with respect, educate about potential herb-drug interactions, and encourage discussion with the prescribing physician (Correct answer)
- Dismiss herbal remedies as ineffective
- Tell the client to stop all traditional practices while in hospital
Correct answer: Acknowledge the cultural practice with respect, educate about potential herb-drug interactions, and encourage discussion with the prescribing physician
Culturally competent care acknowledges cultural practices respectfully while providing evidence-based safety education about herb-drug interactions and facilitating communication with the prescriber.
Culturally competent nursing care: acknowledge and respect diverse health beliefs without judgment; provide evidence-based safety information (many herbal supplements interact with prescription medications: St. John's Wort with antidepressants/warfarin, garlic with blood thinners, ginseng with warfarin); facilitate open communication between client and prescriber; document all herbal supplement use in medication history. Sharing personal anecdotes blurs professional boundaries. Dismissing cultural practices damages therapeutic relationship. Cultural safety is a priority in Canadian nursing education and practice, particularly given Canada's diverse population and Indigenous healing traditions.
Question 6: Before agreeing to participate in a research study conducted at their facility, what must the practical nurse ensure?
- That the research will benefit the facility financially
- That they have received a full explanation of the study, understand their rights, and can withdraw without penalty (Correct answer)
- That their participation is approved by their manager
- That the research involves minimal documentation
Correct answer: That they have received a full explanation of the study, understand their rights, and can withdraw without penalty
Research participation requires informed consent: full explanation, understanding of rights including the right to withdraw, and absence of coercion.
Research ethics in Canada are governed by the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2). Key principles: informed consent (full information about purpose, risks, benefits); voluntary participation (no coercion); right to withdraw at any time without penalty or adverse consequences to employment or care; confidentiality protections; Research Ethics Board (REB) approval. These principles apply to both client and healthcare worker research participation. Manager approval is not a substitute for personal informed consent. Practical nurses asked to participate in research studies must independently evaluate these elements.
CPNRE Professional and Ethical Practice 2
The CNA Code of Ethics identifies seven primary values.
Which value is demonstrated when a practical nurse ensures a client understands their diagnosis before making a treatment decision?