Ethical Issues (21 Questions)

1. You are working the night shift as the charge nurse in the Emergency Department. One of your colleagues, Mr. Lapointe, returns from his break appearing unsteady on his feet. As you approach him to discuss a new admission, you detect a strong odor of alcohol on his breath and his speech is slurred. He is currently preparing a syringe of insulin for a diabetic patient.

Question:
According to your ethical duty to protect the public and regulate the profession, what is your priority action? *

Ask another nurse to verify if they also smell alcohol to confirm your suspicion before acting.

Wait until the end of the shift to report the incident to the nurse manager so as not to cause a scene.

Suggest that he go to the break room to sleep it off for a few hours.

Intervene immediately to stop him from administering the medication and remove him from patient care duties.

2. You have been caring for Mrs. Gauthier, a 45-year-old patient recovering from a complex surgery, for the past 3 weeks. You have developed a strong therapeutic rapport. On the day of her discharge, she hands you a thank-you card containing a $200 gift card to a local spa, stating, "This is just a small token of appreciation for how wonderful you were to me."

Question:
How should you respond to maintain professional boundaries and adhere to ethical standards regarding gratuities? *

Accept the gift to avoid offending the patient, but donate it to the unit's social fund.

Decline the gift politely, explaining that providing care is your job and accepting money or significant gifts is contrary to your code of ethics.

Accept the gift but write a note in the patient's chart that you received it to ensure transparency.

Accept the gift only if the patient insists three times.

3. You are working in a clinic. A 15-year-old girl comes in requesting a prescription for oral contraceptives and screening for sexually transmitted infections (STIs). She specifically asks, "Please don't tell my parents. My father would kick me out of the house." Two days later, her mother calls the clinic demanding to know what her daughter was seen for.

Question:
Based on Quebec legislation (Civil Code of Quebec) and nursing ethics regarding confidentiality, what is the correct response? *

Tell the mother that her daughter was seen for a general check-up but do not mention the STIs.

Inform the mother that her daughter is a minor and, therefore, the parents have a right to access her medical file.

Respect the patient's confidentiality and state that you cannot confirm or deny whether her daughter is a patient at the clinic.

Call the daughter to get her verbal permission to speak to her mother.

4. Mr. Dubé, an 80-year-old patient with end-stage COPD, is admitted for respiratory distress. He is alert and oriented. He tells you, "I am tired of fighting. If my heart stops, I do not want you to restart it. No CPR." However, you check his chart and there is no "Do Not Resuscitate" (DNR) order signed by a physician yet. Suddenly, Mr. Dubé goes into cardiac arrest.

Question:
From a strictly legal and ethical standpoint, what must you do? *

Respect the patient's verbal wish and do not perform CPR; document his statement.

Initiate CPR immediately because there is no medical order to withhold it.

Perform "slow code" (ineffective CPR) to respect the patient's wishes while appearing to follow protocol.

Call the physician immediately to get a telephone order for DNR before doing anything.

5. You are caring for Mrs. Tremblay, who has severe chronic pain. Her physician, Dr. Roy, believes she is addicted to opioids and is "seeking." He writes an order: "Administer 2 mL of Normal Saline IV and tell the patient it is a strong painkiller (Placebo)."

Question:
How does the ethical principle of veracity (truth-telling) guide your action in this situation? *

Administer the saline as ordered; the physician is responsible for the prescription.

Refuse to administer the placebo and discuss your ethical concerns with the physician, as deceiving the patient damages trust.

Administer the saline but tell the patient, "This is a hydration fluid," to avoid lying.

Administer the saline because the placebo effect might actually help her pain without using narcotics.

6. You are a nurse on a surgical unit. You receive a text message from your neighbor: "Hey, I saw an ambulance at the house across the street, the Gagnon family. I know Mr. Gagnon was taken to your hospital. Is he okay? Is it a heart attack?" You have access to the computer system and could easily check Mr. Gagnon’s status.

Question:
What is your ethical obligation regarding this request? *

Access the file to make sure he is stable, then tell your neighbor "He is stable" without giving details.

Ignore the text message but check the file to satisfy your own curiosity.

Tell the neighbor to call Mr. Gagnon's wife directly, confirming that he is indeed on your unit.

Do not access the file and reply to your neighbor that you cannot discuss any patient information or confirm his presence.

7. You are the primary nurse for Mr. Cote, who has requested Medical Assistance in Dying (MAID). He meets all the criteria. However, you hold strong personal religious beliefs that oppose MAID, and you feel you cannot participate in the administration of the life-ending medication.

Question:
According to the OIIQ Code of Ethics regarding conscientious objection, what is your responsibility? *

You must put aside your personal beliefs and participate in the procedure to prevent abandonment.

You may refuse to participate, but you must inform the nursing manager immediately so that a replacement nurse can be assigned to ensure continuity of care.

You should try to convince the patient to reconsider his decision based on moral grounds.

You must call in sick on the day of the procedure to avoid the conflict.

8. Mrs. Lefebvre, 88, is being discharged from the hospital today. She lives alone and has mild dementia. During your assessment, you notice she is confused, unsteady, and unable to recall how to take her medications. The physician has signed the discharge order because "we need the bed for an urgent admission."

Question:
Acting as a patient advocate, what is the appropriate nursing action? *

Process the discharge as ordered; the physician has assessed the patient and deemed her ready.

Call the family to pick her up and tell them to keep an eye on her.

Delay the discharge and voice your concerns to the physician and the discharge planning team, stating that the current plan is unsafe.

Give the patient written instructions in large print to help her remember.

9. While preparing medications, you accidentally administer 50 mg of Metoprolol to Mr. Roy instead of Mr. Roi. You immediately realize the error. You assess Mr. Roy, and his vital signs remain stable (BP 120/80, HR 72). He does not seem to have noticed the extra pill.

Question:
Regarding the ethical duty of transparency and safety, what is the required sequence of actions? *

Monitor the patient; if he remains stable, there is no need to document the error to avoid alarming him.

Document the medication as "given" in Mr. Roy's file but do not mention it was an error since no harm occurred.

Notify the physician, monitor the patient, complete an incident report, and disclose the error to the patient.

Notify the nurse manager but do not tell the patient, as it might cause him unnecessary anxiety.

10. You notice that a nursing student on your unit has posted a "selfie" on Instagram. The photo shows the student smiling in the hallway, but in the background, a patient board with names and diagnosis codes is clearly visible.

Question:
What is the correct action regarding this breach of privacy? *

"Like" the photo to show support for the student but tell her privately to be careful next time.

Contact the student immediately to demand she remove the photo, and report the incident to the nursing instructor/manager.

Ignore it because the student is not a licensed nurse yet and not subject to the OIIQ code.

Comment on the photo publicly, explaining why it is a HIPAA/privacy violation.

11. You are working in the Emergency Department. An 18-year-old female, Ms. Caron, was admitted earlier for palpitations and extreme agitation. She is currently resting in a cubicle. Her mother arrives at the triage desk, appearing extremely anxious and tearful. She tells you, "I know my daughter is here. She has a history of substance abuse. Please, you have to tell me—is she using cocaine again? Did you find drugs in her system? I’m her mother, I need to know so I can help her."

Question:
Based on the laws regarding the age of majority and professional secrecy in Quebec, what is your appropriate response? *

"I can confirm she is here and stable, but I cannot discuss the specific cause of her admission without her permission."

"Because she is 18, she is legally an adult. I cannot confirm or deny that she is a patient here, nor can I share any medical information without her consent."

"I understand your concern as a mother. If you promise to keep it confidential, I can tell you that the toxicology screen was positive."

"You should go into her room and ask her yourself; I will show you where she is."

12. Mr. St-Pierre, a 68-year-old male, suffered a severe stroke and is currently unconscious and unable to make decisions (incapacitated). He has not prepared a protection mandate. The physician has proposed a new treatment plan. Mr. St-Pierre’s sister has arrived from Toronto and is loudly insisting, "I do not want you to do that treatment. I know what is best for my brother." However, Mr. St-Pierre’s wife (who lives with him) and his two adult children are present and agree with the physician’s plan.

Question:
According to the Civil Code of Quebec regarding consent to care for an incapacitated person, whose decision takes precedence? *

The sister from Toronto, because she claims to know the patient's wishes best.

The physician, because the family members are in disagreement.

The adult children, because they are the direct blood relatives.

The wife (spouse), as she ranks highest in the hierarchy of decision-makers after a legal representative.

13. You are preparing Mrs. Wang, a 65-year-old patient who speaks only Mandarin, for a cholecystectomy (gallbladder removal). The surgeon has just left the room after explaining the risks and benefits. You enter to witness the signing of the consent form. Mrs. Wang’s 20-year-old son says, "I told her everything the doctor said, and she agrees. She is ready to sign."

Question:
To ensure valid informed consent and adhering to ethical standards, what is your priority action? *

Allow the patient to sign the form, as the son has acted as the interpreter.

Delay the signature and request a professional medical interpreter to review the procedure and risks with the patient again.

Ask the son to sign the consent form on behalf of his mother.

Use a translation app on your phone to ask the patient if she understands.

14. You are caring for Mr. Lavoie, an 85-year-old patient with dementia who has been wandering into other patients' rooms. The night shift is short-staffed. A colleague suggests, "Let's just put a waist restraint (Posey) on him for the night so he doesn't fall or bother anyone. It’s for his own safety."

Question:
What is your response? *

Apply the restraint immediately to prevent a fall, which is the priority safety concern.

Apply the restraint but check on him every 15 minutes.

Refuse to apply the restraint immediately and attempt alternative measures first, such as moving him closer to the nursing station or offering a distraction.

Call the family to come and sit with him; if they cannot come, apply the restraint.

15. You are working on a neurological unit. A famous professional hockey player is admitted to the Intensive Care Unit (ICU) on a different floor following a concussion. You are a huge fan. During your lunch break, you log into the electronic health record system to see how he is doing, just out of concern. You do not tell anyone what you saw.

Question:
Which statement accurately describes the legal and ethical implication of this action? *

It is acceptable because you are a hospital employee and bound by professional secrecy, so you won't tell anyone.

It is a breach of privacy and professional ethics, leaving you liable for disciplinary action and firing.

It is acceptable as long as you only view the "Summary" page and not the detailed progress notes.

It is only a breach if you post the information on social media.

16. You are administering medications on a busy medical unit. You realize that you forgot to administer the 08:00 dose of antibiotics to Mr. Gagnon. It is now 14:00. You administer the dose now.

Question:
When documenting this administration in the Medication Administration Record (MAR), what is the ethically correct practice? *

Document the time as 08:00 to show that the schedule was followed, but write a note in the progress notes explaining the delay.

Document the time as 14:00 and file an incident report regarding the late dose.

Skip the documentation for this dose so it doesn't look like a medication error.

Ask the physician to change the order time to 14:00 so your documentation matches the order.

17. Mr. Dubé, a 50-year-old patient, was your patient on the psychiatric unit for 6 weeks. He was discharged 2 days ago. He finds you on Facebook and sends you a friend request and a message saying, "I really felt a connection with you. Would you like to go for coffee?"

Question:
According to the OIIQ guidelines on professional boundaries, what is the appropriate response? *

Accept the request since he is no longer your patient and has been discharged.

Decline the request and do not reply, as entering a personal relationship immediately after a therapeutic one is a breach of ethics.

Accept the coffee invitation but tell him you cannot be "Facebook friends" due to privacy settings.

Wait 3 months, and if he is still interested, you can accept.

18. You are part of the team caring for Mrs. Lemieux, who has requested Medical Assistance in Dying (MAID). The procedure is scheduled for today. The IV is started. Just as the physician is about to administer the first medication, Mrs. Lemieux looks frightened and whispers, "Wait, I don't know if I want to go today."

Question:
What is the absolute ethical and legal obligation of the team in this moment? *

Pause the procedure immediately to assess the patient's withdrawal of consent.

Continue the procedure, assuming this is just last-minute anxiety, since she signed the consent forms yesterday.

Administer a sedative to help her relax, then proceed with the MAID medications.

Tell her that the process has already begun and cannot be stopped now.

19. You are a home care nurse visiting Mrs. Roy, an 88-year-old woman who lives with her grandson. You notice Mrs. Roy has several large bruises in various stages of healing on her upper arms and back. She appears fearful and avoids eye contact when her grandson enters the room. The grandson states, "She is just clumsy and falls a lot."

Question:
You suspect elder abuse. According to the OIIQ Code of Ethics and Quebec law, what is your duty? *

You must confront the grandson immediately about the bruises.

You have a mandatory duty to report your suspicions to the appropriate authority.

You cannot say anything because of professional secrecy; you must just document the bruises.

You should wait until Mrs. Roy explicitly tells you she is being hit before taking action.

20. You are working in a remote community clinic. A patient arrives with a deep laceration on his leg. The physician is currently managing a cardiac arrest in the next room and yells, "I can't come! Just suture that leg yourself, I trust you!" You have observed suturing many times but have never been trained or certified to perform it.

Question:
How should you respond to this order? *

Perform the suturing carefully since the physician gave you a direct verbal order.

Refuse to perform the procedure because it is outside your scope of practice and personal competence.

Ask a colleague to talk you through it while you do it.

Apply superglue instead, as that is safer than suturing.

21. You are working on a medical-surgical unit. You are caring for Mrs. Gagnon, a 45-year-old patient recovering from a complex abdominal surgery. Throughout the morning, she has appeared anxious and mistrustful of the surgical team. While you are at the bedside documenting her vital signs, she points to the physical medical file (chart) sitting on the bedside table and demands, "I want to read my chart right now. I have a feeling something went wrong during the surgery and the doctor isn't telling me the truth. I know I have a legal right to see what is written in there, so hand it to me."

Question:
What is the appropriate nursing response? *

Hand the file to the patient immediately to build trust and demonstrate transparency, staying with her to answer questions.

Inform the patient that the file belongs to the hospital and she is legally not permitted to read its contents.

Explain that while she has the legal right to access her information, she must submit a formal request to the Medical Records (Archives) department to obtain a copy.

Tell her that you must call the surgeon to get his verbal permission before you are allowed to show her the operative report.