VA-BC Ethical Considerations 2 — Questions and Answers
Question 1: A patient with advanced dementia requires a PICC line but cannot provide informed consent. Who is the most appropriate person to provide surrogate consent?
- The attending physician
- The legally designated healthcare proxy or durable power of attorney (Correct answer)
- The patient's adult child who is present
- The hospital ethics committee
Correct answer: The legally designated healthcare proxy or durable power of attorney
The legally designated healthcare proxy or durable power of attorney has legal authority to make medical decisions when the patient lacks decision-making capacity.
Question 2: A patient refuses a recommended central venous catheter despite being informed of the risks of the alternative. The nurse's ethical obligation is to:
- Override the refusal because it is medically necessary
- Document the refusal, ensure the patient is informed, and respect the decision (Correct answer)
- Involve the ethics committee to force compliance
- Delay treatment until the patient agrees
Correct answer: Document the refusal, ensure the patient is informed, and respect the decision
Respecting patient autonomy requires documenting an informed refusal and honoring the competent patient's decision.
Question 3: Which ethical principle is MOST directly applied when a vascular access nurse advocates for a patient who cannot afford a preferred device?
- Nonmaleficence
- Justice (Correct answer)
- Fidelity
- Veracity
Correct answer: Justice
Justice refers to fair distribution of resources and advocating for equitable access to care regardless of financial status.
Question 4: A VA nurse is asked by a family member to insert a peripheral IV in a hospice patient whose goals of care explicitly exclude invasive interventions. The nurse should:
- Defer to the family's wishes since they are present
- Decline and explain that the intervention conflicts with the patient's documented goals of care (Correct answer)
- Insert the IV but document the family's request
- Consult only the physician before proceeding
Correct answer: Decline and explain that the intervention conflicts with the patient's documented goals of care
Documented goals of care reflecting patient autonomy take precedence over family requests when the patient has clearly expressed wishes.
Question 5: When a nurse witnesses a colleague performing a vascular access procedure using non-sterile technique, the primary ethical obligation is to:
- Report it privately to the colleague after the procedure
- Intervene immediately to protect the patient from harm (Correct answer)
- Document the observation and submit it only during annual review
- Avoid involvement to maintain collegial relationships
Correct answer: Intervene immediately to protect the patient from harm
Nonmaleficence and patient advocacy require immediate intervention when a patient faces imminent harm from unsafe practice.
Question 6: A patient agrees to a PICC insertion but later states they did not understand the risks explained before signing the consent form. This situation most likely reflects a failure of:
- Fidelity
- Informed consent process (Correct answer)
- Institutional policy compliance
- Nonmaleficence
Correct answer: Informed consent process
Valid informed consent requires that the patient demonstrates comprehension of the risks, benefits, and alternatives, not merely signing a form.
Question 7: A terminally ill patient requests removal of a long-term tunneled catheter used for chemotherapy, stating they wish to stop treatment. The nurse should:
- Refuse removal until oncology provides written orders
- Support the patient's autonomous decision and coordinate care accordingly (Correct answer)
- Encourage the patient to reconsider given the prognosis
- Notify the ethics committee before any action
Correct answer: Support the patient's autonomous decision and coordinate care accordingly
A competent patient has the right to withdraw from treatment at any time, and the nurse's role is to support and coordinate that decision.
VA-BC Ethical Considerations 2
A patient with advanced dementia requires a PICC line but cannot provide informed consent.
Who is the most appropriate person to provide surrogate consent?