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 ethics 31 to 40  
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  #1

31. A 70 yr old man has been brought to a chronic care facility for long term ventilator management., the pt has advanced COPD and is unable to be weaned from the ventilator. A tracheostomy has been placed.

A nasogastric tube is in place to deliver tube feeding. The pt is fully alert & understands the situation. He is asking to have the nasogastric tube removed because of discomfort.

What should u tellhim?

a.i will get that tube out right away Sir.

B lets see how much u are able to eat first

c. I will pull it out if u allow me to insert a gastric tube

d. let me talk to your family.

e.i cant let my pt starve to death.

32.A pt comes to your office with a + pregnancy test , she is 8 weeks pregnant & requests a referral for an abortion. U are an extremely religious person & opposed to abortion.

What should u do?

a.inform the pt that u are morally opposed to abortion & cannot provide the referral

b.discuss other options with pt

c.terminate the doc/pt relationship.

d.Tell her u will make the referral after a 30 day consideration , time can change her mind

e.Refer the pt for an abortion.

33.A man comes to the ER after a stab wound. Your notes document a 500 ml loss of blood. Later that night the pt develops asystole & dies. You find that the loss of blood was originally really 3000ml,which was not recorded by you.

What should u do to correct the documentation?

A use correction fluid to eliminate the original note

B erase the original note

C remove the original note from the chart

D write a new note timing & dating it at the same time as the original note

E write a new note with the current date & time.

34.An 84 yr old woman is admitted with abdominal pain , on the 2 day she becomes febrile ,hypotensive & tachycardic from an intestinal perforation. The pt is disoriented with no capacity to understand her medical problems., there is no response to AB, fluids, dopamine for the next 48 hours, & there are signs of significant anoxic encephalopathy. Although there is no health care proxy the family is in uniform agreement on what the pt would have wanted for herself, had she been able to speak.

Which of the foll cannot be stopped at the direction of the family

a.Ventilator

b blood tests

c dopamine

d fluids & nutrition

e there are no limits.

35. 42 yr old man comes to see u for routine management when u inquire about multiple scratches & contusions as well as a black eye. He says his wife routinely abuses him & “is beating me up pretty regularly”.he denies hitting his wife. You see him a few weeks later & he has a new version of the same injuries. You are very concerned. He clealy states that he does not want the abuse reported.

What do you tell him ?

a.u have no choice but to report

b.u will report the injury only with his consent

c.u will honor his wish but must report if there is another episode

d.there is no spousal abuse reporting

e.u will report if u find the wife is the attacker

36. A 92 yr old man with Alzheimer;s disease has been admitted to the hospital with aspiration pneumonia , he is on a ventilator & has a naso gastric tube in place but does not have the medical capacity to understand his medical condition.

You find a living will that is in an old chart (dated 2 yrs ago) that says “ no heroic measures, I want to be DNR,& I wish to be kept comfortable”. There is no proxy & no family available with him to discuss the matter. He has no private physician with whom u can discuss .

What should u do regarding the ventilator & naso gastric tube.??

a.continue both for now

b remove the ventilator & tube feeding

c remove the naso gastric tube but continue the ventilator

d.seek a court appointed guardian

e.decide what u think is best for pt.

37.U are in the process of finalizing the results of your research for publication. I are the principla investigator of a clinical trial studying the effects of HMG-Co A reductase inhibitors on cardiac mortality. A prominent manufacturer of one of these medications provided the major funding for the study.

Which of the foll is the most accurate in an ethical preparation for authorship of the publication?

a.Accepting money from a company prohibits u from being listed as an Author

b Funding source has no impact on publication requirements

c U can be listed as the author after the institutional review board checks the paper for evidence of bias

d There are no restrictions on your authorship as long as u disclose the financial affiliation

e. there are no requirements as long as the data is accurate

38.U are an attending physician at the University hospital (hurray!!!!!!!!!!!!). one of the attendins from another division seems to be having memory difficult . U found him twice in the hallway having forgotten where he was going .

The residents tell u on the side that they don’t rely on him at all because “ he forgets everything we say anyway”. The chief of service knows but doesn’t have enough attendings to fill a yearly schedule so he remains in place supervising both the resident performance as welll as patient care.

What should u do?

a.Nothing, the chief of service already knows

b. talk ti him directly

c.tell your division head

d.report him to the state licensing board.

39.A medical resident admits a pt overnight with uncontrolled BP. He means to write an order for AG receptor bloacker Diovan at 10 mg once a day. Because of his sloppy handwrtiting the nurses & pharmacy administer Digoxin at 10 mg a day. This is a drug that is rarely used at ther dose above 0.5 mg a day. 3 days later , the pt develops a hemodynamically unstable rhythm disorder that the resident very sincerely tries to decipher but he is unable until the pt is transferred to the ICU. At this point they discover the overdose of digoxin. The pt and the family never discover the overdose.

Which of the foll most acuurately describes this situation??

a.there is no liability for the resident because the overdose was unintentional

b.there is no liability for the resident because the pharmacy should have detected the error

c.No liability exists because the error was unknown to the pt

d.No liability exists because it was an accident

e.The resident and the hospital are both liable for harm to the pt

40.A 27 yr old man is seen by you after the diagnosis of syphilis. As you are administering his treatment U find that he is quite promiscuous ( Don’t ask me how!!!!!!!). U inform him that u must notify the Dept of health & that his sexual contacts need to be treated. He is extremely embarrassed(little late for that I think) & asks how will they find out.

a.u will notify them yourself but u will not give his name

b.U will notify them & must let them know he was the contact

c.U will tell the Dept of health but he himself must tell the others

d.The dept of health will call or send letters to the contacts regarding a serious health
issue.They will test & treat but without revealing his name.

e.He doesn’t have a choice ,he has to give the names

f.Their individual doctors will inform the contacts


  #2

Could u give us those correct answers? Thanks u so much!





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