VABC Ethical Considerations 5 — Questions and Answers
Question 1: A patient with decision-making capacity requests removal of their tunneled catheter against medical advice. Which response is most ethically appropriate?
- Refuse removal because it endangers the patient
- Honor the request after ensuring the patient understands the risks (Correct answer)
- Call security to prevent the patient from leaving
- Contact the ethics board before taking any action
Correct answer: Honor the request after ensuring the patient understands the risks
A competent patient's right to refuse or discontinue treatment must be respected after ensuring informed understanding of the consequences.
Question 2: When participating in vascular access research involving patients, which ethical requirement is paramount?
- Enrollment of the maximum number of patients to increase statistical power
- Voluntary informed consent free from coercion before study participation (Correct answer)
- Keeping the study purpose confidential to avoid bias
- Using patients who cannot refuse to ensure adequate enrollment
Correct answer: Voluntary informed consent free from coercion before study participation
Ethical research requires voluntary, informed participation; coercion or deception violates foundational research ethics principles established by codes such as Belmont.
Question 3: A nurse documents a complication that occurred during catheter insertion that was not caused by her but by a previous clinician. The ethical obligation is to:
- Omit the documentation to protect the other clinician
- Accurately document the finding as observed, without assigning blame in the record (Correct answer)
- Alert the media about the complication
- Document that the complication was present on arrival without further detail
Correct answer: Accurately document the finding as observed, without assigning blame in the record
Accurate documentation of clinical findings is an ethical duty; assigning blame in the chart is inappropriate, but omitting findings is dishonest.
Question 4: Which scenario represents an ethically appropriate use of a patient's vascular access for blood draws in a teaching hospital?
- Having medical students practice draws without patient knowledge
- Informing the patient that trainees may be involved and obtaining their permission (Correct answer)
- Allowing any hospital employee to collect samples from the line
- Performing draws when patients are asleep to minimize anxiety
Correct answer: Informing the patient that trainees may be involved and obtaining their permission
Patients must be informed and consent to trainee involvement in their care, balancing education needs with patient rights.
Question 5: An oncology patient's family asks the vascular access nurse to hide the cancer diagnosis from the patient. The nurse should:
- Comply to avoid family conflict
- Explain that withholding a diagnosis from a competent patient violates the patient's rights (Correct answer)
- Agree to withhold information until the physician decides
- Tell the patient anyway without discussing it with the family
Correct answer: Explain that withholding a diagnosis from a competent patient violates the patient's rights
Withholding a diagnosis from a competent patient violates their right to truth and autonomous decision-making, regardless of family wishes.
Question 6: Which action represents appropriate ethical behavior when a nurse is unsure whether a vascular access order is in the patient's best interest?
- Execute the order without question to avoid conflict
- Seek clarification from the ordering physician and voice clinical concerns (Correct answer)
- Refuse all orders from that physician in the future
- Wait until the patient asks about the order before acting
Correct answer: Seek clarification from the ordering physician and voice clinical concerns
Nurses have an ethical obligation to question orders that appear inconsistent with patient welfare and to advocate for clarification before proceeding.
Question 7: A nurse notices that venipuncture is repeatedly attempted on elderly patients by trainees without adequate supervision, causing unnecessary pain. This situation is an ethical concern related to:
- Justice and resource distribution
- Nonmaleficence — the duty to avoid causing unnecessary harm (Correct answer)
- Autonomy — patients need more information
- Veracity — trainees are not disclosing their skill level
Correct answer: Nonmaleficence — the duty to avoid causing unnecessary harm
Allowing repeated unnecessary failed attempts that cause pain violates nonmaleficence, which requires that care does not impose avoidable harm.
VABC Ethical Considerations 5
A patient with decision-making capacity requests removal of their tunneled catheter against medical advice.
Which response is most ethically appropriate?