Consent to Treatment

 

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 of the above

ANS:  D

Correct D: All of the above apply. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of foregoing the treatment; the treatment options and benefits; and who will perform the procedure.

Incorrect A: All of the above apply. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of foregoing the treatment; the treatment options and benefits; and who will perform the procedure.

Incorrect B: All of the above apply. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of foregoing the treatment; the treatment options and benefits; and who will perform the procedure.

Incorrect C: All of the above apply. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of foregoing the treatment; the treatment options and benefits; and who will perform the procedure.

DIF:    Cognitive level: Knowledge            REF:   pp. 160–161

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

a.
Abuse
b.
Battery
c.
Misconduct
d.
Negligence

ANS:  B

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

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

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

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

DIF:    Cognitive level: Application           REF:   p. 156

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

a.
Autonomy
b.
Accountability
c.
Fidelity
d.
Beneficience

ANS:  A

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

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

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

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

DIF:    Cognitive level: Knowledge            REF:   p. 159

     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?

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 of the above

ANS:  D

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

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

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

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

DIF:    Cognitive level: Analysis                REF:   pp. 162–163

     5.   The nurse tells a patient, through speech and motions, 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?

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.

ANS:  D

Correct D: 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.

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

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

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

DIF:    Cognitive level: Synthesis               REF:   p. 163

     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 inserted and continues until the task is completed. Is this nurse liable for battery?

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.

ANS:  C

Correct C: 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.

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

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

Incorrect D: Consent must always be obtained.

DIF:    Cognitive level: Analysis                REF:   p. 166

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

a.
The client’s spouse
b.
The client’s adult child
c.
The physician
d.
The client’s parent

ANS:  A

Correct A: The client’s spouse is considered to be a substitute decision maker before any others are considered.

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

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

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

DIF:    Cognitive level: Analysis                REF:   p. 168

     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 in order to consent to treatment?

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.

ANS:  B

Correct B: 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.

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

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

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

DIF:    Cognitive level: Application           REF:   p. 169

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

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.
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.

ANS:  D

Correct D: 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.

Incorrect A: This statement is incorrect.

Incorrect B: Negligence is not the issue in this situation.

Incorrect C: This statement is incorrect.

DIF:    Cognitive level: Synthesis               REF:   pp. 171, 175

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

a.
Custom
b.
Common law
c.
Regulations
d.
Statute law

ANS:  D

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

Incorrect A: Custom has no relevance regarding consent.

Incorrect B: Common law does not directly regulate consent.

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

DIF:    Cognitive level: Knowledge            REF:   p. 171

TRUE/FALSE

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

ANS:  F

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               REF:   p. 157

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

ANS:  F

Correct: It is unethical for a nurse to withhold explaining 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 foregoing the treatment, in order for the client’s consent to be informed.

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

DIF:    Cognitive level: Analysis                REF:   p. 160

     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

Correct: It is the patient’s choice whether to have a friend or family member present, not only to provide support but to interpret or clarify the information being given.

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

DIF:    Cognitive level: Knowledge            REF:   p. 161

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

ANS:  F

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. The patient may be fearful of impending illness and 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           REF:   p. 167