VABC Ethical Considerations 2 — Questions and Answers
Question 1: A patient with dementia cannot verbally consent to PICC placement. Which action is most ethically appropriate?
- Proceed without consent since the patient cannot object
- Obtain consent from the legally authorized surrogate decision-maker (Correct answer)
- Delay all treatment until the patient regains capacity
- Document that consent was implied by the patient's condition
Correct answer: Obtain consent from the legally authorized surrogate decision-maker
When a patient lacks decision-making capacity, a legally authorized surrogate must provide informed consent on the patient's behalf.
Question 2: A vascular access nurse discovers a colleague routinely reuses single-use catheters to save costs. What is the ethical obligation?
- Ignore it since the colleague is experienced
- Report the practice through appropriate institutional channels (Correct answer)
- Confront the colleague publicly during rounds
- Adopt the same practice to maintain team cohesion
Correct answer: Report the practice through appropriate institutional channels
Reusing single-use devices violates patient safety standards, and clinicians have an ethical duty to report unsafe practices.
Question 3: Which ethical principle is BEST reflected when a nurse explains all risks, benefits, and alternatives before a vascular access procedure?
- Justice
- Fidelity
- Respect for autonomy (Correct answer)
- Nonmaleficence
Correct answer: Respect for autonomy
Providing complete information for informed decision-making directly supports the patient's right to autonomy.
Question 4: A patient refuses central venous access despite the physician's recommendation. The nurse should:
- Proceed with insertion at the physician's direction
- Document the refusal and advocate for the patient's decision (Correct answer)
- Persuade the patient until they agree
- Transfer care to another nurse who can convince the patient
Correct answer: Document the refusal and advocate for the patient's decision
A competent patient has the right to refuse treatment, and the nurse must document this and support the patient's autonomous decision.
Question 5: A pharmaceutical company offers a vascular access team expensive gifts in exchange for using their catheters exclusively. Accepting these gifts would violate which principle?
- Beneficence
- Justice
- Fidelity
- Impartiality and avoidance of conflicts of interest (Correct answer)
Correct answer: Impartiality and avoidance of conflicts of interest
Accepting gifts that influence clinical decisions creates a conflict of interest and compromises the integrity of patient-centered care.
Question 6: When a terminally ill patient has a documented DNR order, which vascular access action is ethically consistent with that order?
- Remove all existing IV access immediately
- Continue comfort-focused IV access while avoiding aggressive resuscitative lines (Correct answer)
- Insert a large-bore central line for potential resuscitation
- Defer all IV decisions to the family regardless of the DNR
Correct answer: Continue comfort-focused IV access while avoiding aggressive resuscitative lines
A DNR order prohibits resuscitative efforts but does not preclude comfort-oriented vascular access for symptom management.
Question 7: A nurse is asked to place a vascular access device for a purpose outside of their competency. The ethical response is to:
- Attempt the procedure to avoid inconveniencing the team
- Refuse and refer to a qualified clinician (Correct answer)
- Ask a fellow nurse with similar skill level to assist
- Consult the internet for guidance and proceed
Correct answer: Refuse and refer to a qualified clinician
Practicing beyond one's competence endangers patients; the ethical obligation is to acknowledge limits and involve a qualified provider.
VABC Ethical Considerations 2
A patient with dementia cannot verbally consent to PICC placement.
Which action is most ethically appropriate?