NBME Behavioral Science 3 — Questions and Answers
Question 1: A competent adult patient refuses a blood transfusion on religious grounds despite life-threatening hemorrhage. The physician's ethical obligation is to:
- Transfuse the patient to save his life
- Obtain a court order to override the refusal
- Respect the patient's refusal and document it (Correct answer)
- Transfer care to a physician who will comply
Correct answer: Respect the patient's refusal and document it
Competent adults have the right to refuse any treatment; autonomy overrides beneficence in this scenario.
Question 2: A psychiatrist's patient discloses a specific, credible plan to kill a named neighbor. Under the Tarasoff ruling, the psychiatrist is legally obligated to:
- Maintain strict confidentiality
- Hospitalize the patient immediately
- Warn the identifiable potential victim (Correct answer)
- Report the threat to the FBI
Correct answer: Warn the identifiable potential victim
The Tarasoff duty-to-warn doctrine requires clinicians to protect identifiable third parties from credible threats.
Question 3: A 4-year-old child engages in parallel play, uses sentences of 4–5 words, and can draw a person with 4 parts. According to Erikson, this child is working through which psychosocial stage?
- Trust vs. Mistrust
- Autonomy vs. Shame and Doubt
- Initiative vs. Guilt (Correct answer)
- Industry vs. Inferiority
Correct answer: Initiative vs. Guilt
Initiative vs. Guilt is Erikson's stage for children aged approximately 3–5 years old.
Question 4: A 7-year-old understands that a tall, thin glass and a short, wide glass hold the same amount of water if the same amount was poured. According to Piaget, this child has achieved:
- Object permanence
- Conservation (Correct answer)
- Abstract reasoning
- Centration
Correct answer: Conservation
Conservation — the understanding that quantity remains the same despite changes in shape — is a hallmark of the concrete operational stage.
Question 5: An uninsured 68-year-old retired teacher with end-stage renal disease requires hemodialysis. Which program most likely covers this cost?
- Medicaid
- Medicare (Correct answer)
- CHIP
- COBRA
Correct answer: Medicare
Medicare covers ESRD regardless of age, as well as most Americans aged 65 and older.
Question 6: A physician learns that a patient has active tuberculosis but refuses to notify public health authorities. Which ethical principle most directly justifies mandatory reporting?
- Patient autonomy
- Justice (Correct answer)
- Nonmaleficence
- Veracity
Correct answer: Justice
Justice supports mandatory reporting because protecting public health overrides individual confidentiality in communicable disease.
Question 7: A 70-year-old woman with advanced dementia cannot make medical decisions. Her daughter presents a document the patient signed years ago designating the daughter as decision-maker. This document is best described as a:
- Living will
- Do-not-resuscitate order
- Durable power of attorney for healthcare (Correct answer)
- Physician order for life-sustaining treatment
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare designates a specific surrogate decision-maker and remains valid during incapacity.
NBME Behavioral Science 3
A competent adult patient refuses a blood transfusion on religious grounds despite life-threatening hemorrhage.
The physician's ethical obligation is to: