Chapter 06: Informed Consent: Rights and Obligations

Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition

Multiple Choice

1. Which of the following is a component of informed consent?

a. The consent must be voluntary.

b. The consent must be specific to the proposed treatment or procedure.

c. The patient must be legally capable.

d. All are correct.

ANS: D

Feedback

A Incorrect All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

B Incorrect All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

C Incorrect All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

D Correct! All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

DIF: Cognitive level: Knowledge a. Abuse b. Battery c. Misconduct d. Negligence

2. Which of the following terms best describes a nurse who touches a client without the client’s consent?

ANS: B

Feedback

A Incorrect Not enough details are known about this situation to determine if abuse of patient rights is definitely involved.

B Correct! Legally, to touch another person without permission constitutes battery.

C Incorrect Not enough details are known about this situation to determine if misconduct is definitely involved.

D Incorrect Not enough details are known about this situation to determine if negligence is definitely involved.

DIF: Cognitive level: Application a. Autonomy b. Accountability c. Fidelity d. Beneficence

3. Which of the following ethical principles is the hallmark of informed consent?

ANS: A

Feedback

A Correct! Autonomy, or the right to determine and act on a self-chosen plan, is the hallmark ethical principle of informed consent.

B Incorrect Being accountable is a primary nursing value, not an ethical principle.

C Incorrect Fidelity is an ethical principle involved in informed consent, but it is not the hallmark principle.

D Incorrect Beneficence is an ethical principle involved in informed consent, but it is not the hallmark principle.

DIF: Cognitive level: Knowledge a. Physician documentation of the patient’s consent b. Physician documentation related to risks, consequences, and benefits of the procedure c. Time and date the consent was received d. All are correct

4. A patient in the nurse’s care is having surgery today and has signed only a general consent form. What other information must be documented?

ANS: D

Feedback

A Incorrect All of the above are required in this situation.

B Incorrect All of the above are required in this situation.

C Incorrect All of the above are required in this situation.

D Correct! All of the above are required in this situation.

DIF: Cognitive level: Analysis a. The nurse is not liable because she explained the procedure and received the patient’s consent. b. The nurse is liable because she did not have written, procedure-specific consent from the patient. c. The nurse is liable because she did not note the date and time of the consent. d. The nurse is liable because she did not obtain informed consent.

5. The nurse tells a patient, through speech and miming, that she will be giving an enema to the patient. The patient implies consent by nodding her head. The patient suffers rectal trauma and bleeding during the procedure. Is the nurse liable, and why?

ANS: D

Feedback

A Incorrect Telling the patient that the procedure will be done is not the same as explaining the procedure.

B Incorrect Written, procedure-specific consent is not usually required for the administration this type of procedure.

C Incorrect Noting the date and time of the consent is important, but this does not relate to the nurse’s liability in this case.

D Correct! The nurse did not explain to the patient the possible risks of the procedure and is, therefore, liable because she did not obtain informed consent.

DIF: Cognitive level: Synthesis a. This nurse is not liable for battery because once a procedure is started, it must be completed. b. This nurse is liable for battery because there was too much fluid and this caused the patient discomfort. c. This nurse is liable for battery because the patient withdrew consent. d. This nurse is not liable for battery because consent was never obtained.

6. The nurse administering an enema is concerned because the patient appears to be trying to stop the procedure. The nurse does not stop because the fluid is only partially administered, and the nurse continues with the task until it is completed. Is this nurse liable for battery?

ANS: C

Feedback

A Incorrect A procedure can be stopped at any time because the patient has the right at any time to withdraw consent to treatment.

B Incorrect The amount of fluid administered is not the deciding factor in this situation.

C Correct! Patients have the right at any time to withdraw consent to treatment. Such withdrawal may occur in difficult circumstances, and it is important for the health care professional to ascertain whether the consent has been withdrawn. This may not always be clear.

D Incorrect Consent must always be obtained.

DIF: Cognitive level: Analysis a. The client’s spouse b. The client’s adult child c. The physician d. The client’s parent

7. Who is first considered to be a substitute decision maker if a married client cannot make decisions?

ANS: A

Feedback

A Correct! The client’s spouse is considered the substitute decision maker before any others are considered.

B Incorrect This client’s adult child would not first be considered a substitute decision maker.

C Incorrect The physician would not be considered the substitute decision maker.

D Incorrect This client’s parent would not first be considered the substitute decision maker.

DIF: Cognitive level: Analysis a. The child must be at least 12 years old. b. The child must be capable of understanding the treatment. c. The child must be living away from home. d. The child must be at least 16 years old.

8. In provinces where children have the right to make decisions about their own health care, at which of the following ages or stages must a child be to give consent to treatment?

ANS: B

Feedback

A Incorrect A child younger than 12 years of age may be able to make a decision about his or her own health care.

B Correct! In such provinces, the child must be old enough and mature enough to understand the nature and risks inherent in a medical procedure; there is no specific age requirement.

C Incorrect Whether a child is living at or away from home is not the criterion used to determine if the child can make decisions regarding his or her own health care.

D Incorrect Being 16 years of age or older is not a requirement for a child to make decisions regarding his or her own health care.

DIF: Cognitive level: Application a. Yes, because treatment without consent in this situation would be considered battery. b. No, because this is an emergency situation, and the nurse cannot be found negligent if treatment is not given. c. Yes, because in emergency situations the nurse is not protected against liability. d. No, because in emergency situations the nurse is protected against liability.

9. A nurse is working in a busy emergency room (ER), and an unconscious patient needs timely interventions to avoid rapid deterioration. Should treatment be withheld until consent can be obtained from a substitute decision maker?

ANS: D

Feedback

A Incorrect This statement is incorrect.

B Incorrect Negligence is not the issue in this situation.

C Incorrect This statement is incorrect.

D Correct! Provincial laws protect health care professionals providing emergency care. If there is an imminent risk of further deterioration and finding a substitute decision maker would cause further delays, consent is not required, and the health care professional may administer treatment without it.

DIF: Cognitive level: Synthesis a. Custom b. Common law c. Regulations d. Statute law

10. Which of the following type of law regulates consent to treatment?

ANS: D

A Incorrect Custom has no relevance regarding consent.

B Incorrect Common law does not directly regulate consent.

C Incorrect Regulations do not regulate consent, although they may describe procedural aspects related to consent.

D Correct! The existing common law requirements for an informed consent to treatment are enshrined in provincial statute law.

DIF: Cognitive level: Knowledge

TRUE/FALSE

1. Consent must be expressed either verbally or in writing and be based on relevant information.

ANS: F Feedback

Correct In addition to verbal and written consent, consent may also be implied. For any consent to be valid, it must be based on the relevant information required by the patient or client to make that choice. Incorrect This statement is only partially true; one type of consent is missing.

DIF: Cognitive level: Synthesis

2. It is ethically appropriate for a nurse to withhold explaining all the risks of a procedure to a client to decrease the client’s anxiety.

ANS: F Feedback

Correct It is unethical for a nurse to withhold explanation of the risks of a procedure to a client. The client must also be told all of the risks of a procedure, including the risks of forgoing the treatment, for the client’s consent to be informed. The nurses’ approach and other interventions may help the person’s anxiety.

Incorrect It is unethical for a nurse to withhold explanation of the risks of a procedure to a client.

DIF: Cognitive level: Analysis

3. It is the nurse’s responsibility to determine if anyone else may be present to help the patient interpret or clarify the information being given.

ANS: F Feedback

Correct It is the patient’s choice whether to have a friend or family member present, not only to provide support but also to interpret or clarify the information being given. Nurses should ensure that the patient is aware that he or she has this option.

Incorrect This decision is the patient’s to make; it is not the nurse’s choice.

DIF: Cognitive level: Knowledge

4. An older adult patient’s initial and seemingly irrational refusal to give consent indicates mental incompetence.

ANS: F Feedback

Correct There may be any number of reasons that an older adult patient may refuse to give consent; this refusal does not necessarily indicate mental incompetence. For example, the patient may be fearful of the procedure and any consequences, may not understand the information presented, or may be in a state of denial.

Incorrect There may be any number of reasons that an older adult patient may refuse to give consent; this refusal does not necessarily indicate mental incompetence.

DIF: Cognitive level: Application

5. The team caring for an incapable person must always respect the decisions of a legally appointed substitute decision maker.

ANS: F

Feedback

Correct If the team has concerns that the substitute decision maker is not acting in the person’s best interests, there are legal processes in place to challenge the authority of the substitute decision maker.

Incorrect If the team has concerns that the substitute decision maker is not acting in the person’s best interests, there are legal processes in place to challenge the authority of the substitute decision maker.