Treatment of Vulnerable Groups Questions: 1.

Nurse Linda is conducting a research on vulnerable subjects, she understands the definition of vulnerable subjects is she states which of the following? a. People who are fully capable of giving informed consent. b. People who are at high risk of unintended side effects because of their circumstances c. People who have no risk of unintended side effects because of their healthy bodies d. People who are capable of giving consent for the participation of others. 2. For children at least seven years of age, the following are obtained: a. Assent of the child only. b. Informed consent of the child and assent of the guardian or parent. c. Informed consent of the guardian and assent of the parent. d. Informed consent of the parent or guardian and advisably, the assent of the child. 3. A nurse can obtain a consent of child who is capable of understanding the basic concepts of an informed consent for: a. Respect of the childs right to self-determination. b. Respect of the childs name c. Respect of the childs parents d. Lesser hassle since a child is much easier to convince. 4. Nurse Myka is conducting a research involving institutionalized people. She feels that the people are forced to participate in the study even though theres a slight resistance. Which of the following can she do? a. Emphasize that the study has been tested in mice first and has been proven safe. b. Emphasize that the study is voluntary and they may opt not to participate. c. Emphasize that the researchers will ensure that their healthcare will be continued. d. Emphasize that the study is completely under her control and no one will be harmed. 5. A patient is severely ill, before obtaining the consent of the patient, which of the following must a nurse do? a. Assess the ability of the patient to write. b. Assess the ability of the patient to conduct a research. c. Assess the ability of the patient to make decisions. d. Assess the ability of the nurse to participate in the study. 6. A pregnant patient went to nurse Mike and forces him to put her on the list of the participants of a research. Upon knowing that the study has not been proven safe for pregnant women, which of the following must nurse Mike do? a. Allow her to participate since its her right to autonomy. b. Call the physician of the study. c. Call the nurse supervisor to explain the procedure. d. Tell her that she cannot be involved unless the risks to the woman and her child are minimal. 7. A nurse is caring for an eight-year-old child, she was tasked to ask for the patients assent. She needs further teaching if she states which of the following? a. An assent is the affirmation of a child for the participation in a research. b. Even though an assent is already obtained, a parents consent is still necessary.

c. Even though a parents or guardians consent is already obtained, an assent is necessary for a child to be allowed in a study. d. A parents consent has the final say even with the presence of an assent. 8. The following are considered vulnerable subjects except: a. Pregnant women. b. Prisoners c. Cancer patients d. Adults 9. The following can give a consent to a childs participation in a study except: a. The childs mother b. The childs father c. The childs legal guardian d. The childs house maid. 10. For mentally disabled people to legally participate in a research, which of the following should be obtained? a. The patients signature b. The legal guardians consent c. The patients address d. The patients thumb mark.

Answers with Rationale 1. B. Vulnerable subjects may either be people who are incapable of giving a fully informed consent or people who are at high risked for unintended side effects due to their circumstances. 2. D. A parents or a legal guardians consent is obtained for a child to be able to participate in a research and even though not required, an assent can also be obtained. The assent of a child would not ensure the legality of the childs participation in a research. An assent is only given by the child and not by adults. 3. A. An informed consent of the child serves as an evidence for the respect of rights to selfdetermination. 4. B. A study is voluntary thus patients can opt not to participate. 5. C. Severely ill patients may have compromised ability to make decisions thus should be assessed. 6. D. Pregnant women are not allowed to participate in a study unless it is for meeting her needs or the risks of the study is minimal for the fetus and the mother. 7. C. An assent, though advisable, is not necessary for a child to be allowed in a study. 8. D. Adults without any disabilities are not considered as vulnerable subjects. 9. D. All other choices are correct. 10. B. A mentally disabled person cannot make decisions regarding his participation thus a legal guardians consent is necessary.

Informed Consent Questions: 1. Consent is defined as a free and rational act that presupposes knowledge of the thing to which consent is being given for a person who is legally capable to give consent. All but one defines an informed consent except one: a. Consent that is signed by the patient or his authorized/legal upon admission is for the subsequent diagnosis and treatment. b. Subsequent treatment/operations require individual, informed consent. c. Before any medical or surgical procedure can be performed on a patient, consent must be obtained from the patient or his authorize representative who may be his parent or guardian. d. It is only in case of emergency where the consent requirement does not apply. 2. A patient was immediately rushed to the emergency department for severe injuries. As soon as the nurse enters the room, on duty Nurse Jackie immediately went on to do a nursing procedure on the patient. The patient then suddenly reacted violently, shouted loudly and exclaimed, I will sue you for this! Nurse Jackie knows that she commited: a. b. c. d. Negligence Battery Reckless imprudence Misdemeanour

3. Which medical professional actually secures the consent of the patient upon admission? This consent is usually for diagnostic procedures and initial treatment deemed necessary by the medical staff. a. b. c. d. The nurse The physician The midwife The hospital staff

4. The essential elements of an informed consent are (State all that apply): a. The diagnosis or the explanation of the condition. b. A fair explanation of the procedures to be done and used and the consequences. c. A description of alternative treatments or procedures. d. A description of benefits to be expected. e. Material rights if any. f. The prognosis, if the recommended care or procedure is refused. 5. Eponine has been asked to sign a consent for a diagnostic procedure to be done on her heart. Nurse Jackie understands that this is: a. b. c. d. Who Must Consent Consent of Minors Consent of Mentally Ill Proof of Consent

6. Eponine signs the consent herself, Nurse Jackie understands that this is: a. b. c. d. Who Must Consent Consent of Minors Consent of Mentally Ill Proof of Consent

7. 7 year old Cosette had been admitted to the emergency department for a fracture on left arm sustained from carrying a heavy pail full of water. Nurse Jackie understands that she should go to her parent or legal guardian for the consent to be signed:

a. b. c. d.

Who Must Consent Consent of Minors Consent of Mentally Ill Proof of Consent

8. A patient, Jean Valjean had been admitted talking loudly and was observed to be prancing about, with no coherency. Nurse Jackie knows that: a. b. c. d. Who Must Consent Consent of Minors Consent of Mentally Ill Proof of Consent

9. Marius had been admitted to the emergency department sustaining heavy wounds and is bleeding profusely, he is not responsive. Nurse Jackie knows that in getting a consent: a. b. c. d. Who Must Consent Emergency Situation Refusal to Consent Proof of Consent

10. Nurse Jackie understands that when a patient, Javert Vonjavert, had refused medical treatment and had not signed the consent. She should: a. b. c. d. Tell the patient that he needs to sign the consent to prevent legal matters. Ask for a guardian to sign the consent. Not insist the patient and document matters. Call the physician to talk to the patient to obtain consent.

Answers with Rationale: 1. 2. 3. 4. 5. A. The consent being signed here is for an initial diagnosis or treatment not a subsequent one. B. Nurse Jackie has touched the patient without authorization. A. The nurse actually secures the consent of the patient upon admission ALL CHOICES D. A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of the procedure, the risks involved and the possible consequences. A. The patient is the one who gives the consent on his own behalf. B. Parents, or someone standing in their behalf, give the consent to medical or surgical treatment of a minor C. A mentally incompetent person cannot legally consent to medical or surgical treatment. B. when an emergency situation exists, no consent is necessary because inaction at such time may cause greater injury. C. A patient who is mentally and legally competent (sane mind and of legal age) has the right to refuse the touching of his body or to submit to medical or surgical procedure.

6. 7. 8. 9. 10.

Debriefing and Referral Questions 1. In a 24 hour urine specimen started Friday, 9:00 A.M, which of the following if done by a Nurse indicate a NEED for further procedural debriefing? A. The nurse ask the client to urinate at 9:00 A.M, Friday and she included the urine in the 24 hour urine specimen B. The nurse discards the Friday 9:00 A M urine of the client C. The nurse included the Saturday 9:00 A.M urine of the client to the specimen collection D. The nurse added preservatives as per protocol and refrigerates the specimen 2. Which of the following terms refers to process during which participants are asked about their emotional reactions to the incident ? A. Defusing B. Debriefing C. Follow-up D. Critical incident stress management

3. James with a diagnosis of bipolar disorder has been referred to a local boarding home for consideration for placement. The social worker telephoned the hospital unit for information about the clients mental status and adjustment. The appropriate response of the nurse should be which of these statements? A. B. C. D. "I am sorry. Referral information can only be provided by the clients providers" "I can never give any information out by telephone. How do I know who you are?" "Since this is a referral, I can give you this information" "I need to get the clients written consent before I release any information to you"

4. How many hours does debriefing process usually occur? A. 2-4 B. 2-3 5. What is an example of CISM? A. brainstorming B. physical therapy C. 1-2 D. 1-5

C. debriefing D. silence

6. In Integrated Management of Childhood Illness, the nurse is aware that the severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital? A. Mastoiditis C. Severe pneumonia B. Severe dehydration D. Severe febrile disease 7. Ana brought her 4 years old daughter to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital? A. Inability to drink B. High grade fever C. Signs of severe dehydration D. Cough for more than 30 days

8. All of the following are included in a referral summary except: A. B. C. D. Description of clients physical, mental & emotional state Current medications Treatments that can be continued (e.g. wound care, oxygen therapy) None of the above

9.

It is a request for intervention from another professional who has the needed skills for the problem at hand. A. debriefing C. referral B. wills D. doctors order

10. As a nurse your interventions to discharge referrals would be: A. B. C. D. Initiate any discharge plans on admission evaluate family or client competencies involve the client and family in all care planning all of the above

Answers:

1. A. 2. B. Debriefing is a more complicated intervention of critical incident stress management (CISM); it involves 2- to 3- hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (e.g., flashbacks, difficulty sleeping, intrusive thoughts) and other psychological ramifications. 3. D. Clients have a right to informed consent which includes information about medications, treatments, and diagnostic studies. 4. B. Debriefing is a more complicated intervention of critical incident stress management (CISM); it involves 2- to 3- hour process during which participants are asked about their emotional reactions to the incident. 5. C. Debriefing is a more complicated intervention of critical incident stress management (CISM); it involves 2- to 3- hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (e.g., flashbacks, difficulty sleeping, intrusive thoughts) and other psychological ramifications 6. B. The order of priority in the management of severe dehydration is as follows: intravenous fluid therapy, referral to a facility where IV fluids can be initiated within 30 minutes, Oresol or nasogastric tube. When the foregoing measures are not possible or effective, then urgent referral to the hospital is done. 7. A. A sick child aged 2 months to 5 years must be referred urgently to a hospital if he/she has one or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken. 8. D. Regardless of format, it includes some or all of the following: Description of clients physical, mental & emotional state Resolved health problems Unresolved continuing health problems Treatments that can be continued (e.g. wound care, oxygen therapy) Current medications Restrictions that relate to activity, diet & bathing Functional/self-care abilities Comfort level Support networks Client education provided in relation to disease process Discharge destination Referral Services (e.g. social worker, home health nurse) 9. C. Referrals are a request for assistance from someone who specializes in a certain field of knowledge. A referral is often a request for intervention from another professional who has the needed skills for the problem at hand. 10. D. As a nurse your interventions to discharge referrals would be; Initiate any discharge plans on admission, evaluate family or client competencies and involve the client and family in all care planning. The nurse will support the client and their family with suitable consultations and referrals to any contacts they may need in the community.

Confidentiality Procedures Questions: 1. This refers to the protection of study participants so that data provided are never publicly divulged. A. Anonymity B. Confidentiality C. Privacy D. Certificate of Confidentiality 2. This refers to the protection of participants' confidentiality such that even the researcher cannot link individuals with data provided. A. Breach of Confidentiality B. Privacy C. Anonymity D. Confidentiality 3. It allows researchers to refuse to disclose identifying information on study participants in any civil, criminal, administrative, or legislative proceeding at the federal, state, or local level. A. Certificate of Confidentiality B. Anonymity C. Confidentiality D. Privacy 4. It occurs when a researcher by accident or direct action allows an unauthorized person to gain access to raw data of a study. A. Privacy B. Certificate of Confidentiality C. Anonymity D. Breach of Confidentiality Situation: Harry a new research staff of the Research and Development Department of a tertiary hospital is tasked to conduct a research study about the increased incidence of nosocomial infection in the hospital. 5. Which of the following ethical issues should he consider in the conduct of his study? 1. 2. 3. 4. Confidentiality of information given to him by the subjects Self-determination which includes the right to withdraw from the study group Privacy or the right not to be exposed publicly Full disclosure about the study to be conducted A. 1, 2, 3 C. 2, 3, 4 B. 1, 3, 4 D. 1, 2, 3, 4

6. Harry knows that he has to protect the rights of human research subjects. Which of the following actions of Harry ensures anonymity? A. Keep the identities of the subject secret B. Obtain informed consent C. Provide equal treatment to all the subjects of the study. D. Release findings only to the participants of the study 7. During data collection, Harry encounters a patient who refuses to talk to him. Which of the following is a limitation of the study? A. B. C. D. Patients refusal to fully divulge information. Patients with history of fever and cough Patients admitted or who seeks consultation at the ER and doctors offices Contacts of patients with history of fever and cough

8. It refers to the communication of complete, accurate information about the study to potential study participants. A. Full Disclosure B. Informed Consent C. Debriefing D. Certificate of Confidentiality

9. Which of the following procedures ensures that Ms. Montana has fully described to prospective subjects the nature of the study and the subjects rights? A. Debriefing B. Full disclosure C. Informed consent D. Covert data collection

10. The nurse researcher mutually agreed with the research subjects that all personal data of the subjects shall be kept confidential. To safeguard anonymity of data after the report is written, the nurse researcher should: A. B. C. D. throw the papers in a wastebasket keep the papers for 5 years and dispose of these after have the papers recycle but not as writing scratch paper burn or shred the papers Answers and Rationale 1. B. Confidentiality refers to the protection of study participants so that data provided are never publicly divulged. 2. C. Anonymity refers to the protection of participants' confidentiality such that even the researcher cannot link individuals with data provided. 3. A. Certificate of Confidentiality allows researchers to refuse to disclose identifying information on study participants in any civil, criminal, administrative, or legislative proceeding at the federal, state, or local level. 4. D. Breach of Confidentiality occurs when a researcher by accident or direct action allows an unauthorized person to gain access to raw data of a study. 5. D. This includes all the options as these are the four basic rights of subjects for research. 6. A. Keeping the identities of the research subject secret will ensure anonymity because this will hinder providing link between the information given to whoever is its source. 7. A. Patients refusal to divulge information is a limitation because it is beyond the control of Harry. 8. A. Full Disclosure refers to the communication of complete, accurate information about the study to potential study participants. 9. B. Full disclosure is giving the subjects of the research information that they deserve to know prior to the conduct of the study. 10. D. The nurse researcher should burn or shred the papers in order to safeguard anonymity of data after the report is written.