Egan’s Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek – Test Bank

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Chapter 05: Ethical and Legal Implications of Practice

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MULTIPLE CHOICE

1.All of the following sanctions can apply when one breaks a law except:

a.	reparations or fines
b.	incarceration
c.	licensure suspension
d.	professional censure

ANS: D

The force behind law is statutory punishment, ranging from reparations and fines to licensure suspension and incarceration.

DIF: Recall REF: p. 84 OBJ: 1

2.What simple question does ethics try to answer?

a.	Who is right and who is wrong?
b.	How should we act?
c.	What treatment is best?
d.	Who benefits most?

ANS: B

Ethics is primarily concerned with the question, How should we act?

DIF: Recall REF: p. 84 OBJ: 1

3.What ethical issue has recently become a significant concern for respiratory therapists and all healthcare providers due to a congressional act?

a.	patient’s right to privacy
b.	patient’s right to care
c.	patient’s right to consultation
d.	patient’s right to refuse treatment

ANS: A

The new century has brought one particular challenge, although not new to health care or to respiratory therapists: a heightened awareness of the patient’s right to privacy.

DIF: Recall REF: p. 84 OBJ: 1

4.In most professions, specific guidance in resolving ethical dilemmas is provided by which of the following?

a.	an ethical theory
b.	a code of ethics
c.	civil statutes
d.	criminal statutes

ANS: B

Specific guidance in resolving ethical dilemmas is usually provided by a professional code of ethics. General approaches involve the use of ethical theories and principles to reach a decision.

DIF: Recall REF: p. 85 OBJ: 2

5.The AARC Code of Ethics holds professionals to which of following principles?

1. actively maintaining and improving one’s competence

2. following sound scientific procedures and ethical principles in research

3. promoting disease prevention and wellness

4. striving to improve the access, efficacy, and cost of patient care

5. respecting and protecting the rights of patients they treat

a.	1, 2, 3, 4, and 5
b.	2, 3, 4, and 5
c.	1, 2, 3, and 5
d.	3, 4, and 5

ANS: A

The current code appears in Box 5-1.

DIF: Recall REF: p. 85 OBJ: 3

6.Contemporary ethical principles have evolved from all of the following sources except:

a.	natural law (Aristotle and Aquinas)
b.	psychoanalysis (Freud)
c.	Jewish and Christian morality
d.	universal duties (Kant)

ANS: B

These principles include Aristotle’s and Aquinas’ natural law, Judeo-Christian morality, Kant’s universal duties, and the values characterizing modern democracy.

DIF: Recall REF: p. 86 OBJ: 3

7.Primary guiding principles in contemporary ethical decision-making include which of the following?

1. nonmaleficence

2. autonomy

3. justice

4. role fidelity

a.	2, 3, and 4
b.	1, 2, 3, and 4
c.	3 and 4
d.	2 and 3

ANS: B

Autonomy, veracity, nonmaleficence, beneficence, confidentiality, justice, and role fidelity are primary guiding principles in contemporary ethical decision making

DIF: Recall REF: p. 86-89 OBJ: 4

8.Which ethical principle obliges a respiratory therapist to uphold a patient’s right to refuse a treatment?

a.	autonomy
b.	veracity
c.	role fidelity
d.	beneficence

ANS: A

Under the principle of autonomy, a respiratory therapist’s use of deceit or coercion to get a patient to reverse the decision to refuse a treatment is considered unethical.

DIF: Application REF: p. 86 OBJ: 4

9.A health professional who withholds the truth from a patient, saying it is for his of her own good, is engaged in what practice?

a.	fraud
b.	infidelity
c.	benevolent deception
d.	nonmaleficence

ANS: C

Problems with the veracity principle revolve around such issues as benevolent deception.

DIF: Application REF: p. 87 OBJ: 4

10.What ethical principle can be used to justify the pain that might occur in drawing blood from a patient for a diagnostic test?

a.	nonmaleficence
b.	benevolent deception
c.	do no harm
d.	double effect

ANS: D

The double effect brings us to the essence of the definition of the word dilemma.

DIF: Application REF: p. 87 OBJ: 4

11.The debate over prolongation of life versus relief of suffering in elderly patients mainly involves differing opinions regarding what ethical principle?

a.	autonomy
b.	beneficence
c.	role fidelity
d.	justice

ANS: B

This presents real dilemmas for those who are confronted with the ability to prolong life but not the ability to restore any uniquely human qualities.

DIF: Application REF: p. 88 OBJ: 4

12.What type(s) of advanced directives can patients use to help resolve ethical dilemmas involving their life-sustaining care?

1. durable power of attorney

2. written interrogatory

3. living will

a.	2 and 3
b.	1 and 2
c.	1 and 3
d.	1, 2, and 3

ANS: C

The two types of advanced directives currently available and relatively widely used are the living will and the durable power of attorney for health care.

DIF: Application REF: p. 88 OBJ: 13

13.Under what conditions can the principle of confidentiality be breached?

a.	when the welfare of the community or a vulnerable individual is at stake
b.	when the health professional believes that the information is not vital
c.	when a patient tells the health professional that there are no secrets
d.	when a lawyer tells the health professional that the information must be revealed

ANS: A

For example, if the patient were planning to marry, the harm principle would require that confidentiality be broken because of the special vulnerability of the spouse.

DIF: Analysis REF: p. 88 OBJ: 4

14.The moral basis for rationing healthcare services falls under what ethical principle?

a.	compensatory justice
b.	harm
c.	distributive justice
d.	role duty

ANS: C

The principle of justice involves the fair distribution of care.

DIF: Recall REF: p. 89 OBJ: 4

15.Which of the following has played a minor role in increasing the cost of health care?

a.	beneficence
b.	compensatory justice
c.	distributive justice
d.	role fidelity

ANS: B

The Congressional Budget Office estimates that less than two percent (2%) of the cost of health care is related to medical malpractice. Studies by Zurich Insurance Company, Harvard University, and Dartmouth University showed little if any impact on the cost of health care. The Harvard study showed patients were uncompensated in the presence of actual malpractice more frequently than physicians were held accountable in the absence of actual malpractice.

DIF: Recall REF: p. 89 OBJ: 1

16.When a respiratory therapist defers a patient’s questions about a condition to the attending physician, what ethical principle is being practiced?

a.	autonomy
b.	beneficence
c.	role fidelity
d.	harm principle

ANS: C

For example, because of differences in role duty, a respiratory therapist might be ethically obliged not to tell a patient’s family how critical the situation is, instead having the attending physician do so.

DIF: Analysis REF: p. 89 OBJ: 4

17.A clinician who justifies support for withdrawing life support from a patient because “in the end, it would be best for all involved” is applying what ethical viewpoint?

a.	relativism
b.	formalism
c.	consequentialism
d.	virtue ethics

ANS: C

The principle of utility, in its simplest form, aims to promote the greatest general good for most people. The most common application of consequentialism judges acts according to the principle of utility.

DIF: Analysis REF: p. 90 OBJ: 4

18.A clinician who justifies not billing a poor patient for services rendered because “that’s what a professional should do” is applying what ethical viewpoint?

a.	relativism
b.	formalism
c.	consequentialism
d.	virtue ethics

ANS: D

When the professional is faced with an ethical dilemma, he or she need only envision what the “good practitioner” would do in a similar circumstance.

DIF: Application REF: p. 91 OBJ: 4

19.Before making any ethical decision, one should take which of the following actions?

1. Identify the individuals involved.

2. Identify what ethical principle(s) apply.

3. Identify who should make the decision.

4. Consider the alternatives.

a.	2, 3, and 4
b.	1, 2, 3, and 4
c.	3 and 4
d.	2 and 3

ANS: B

See Box 5-2.

DIF: Analysis REF: p. 92 OBJ: 5

20.Divisions of public law (the relationships of private parties and the government) include:

1. administrative

2. civil

3. criminal

a.	2 and 3
b.	1 and 2
c.	1 and 3
d.	1, 2, and 3

ANS: C

The two major divisions of public law are criminal law and administrative law.

DIF: Application REF: p. 93 OBJ: 6

21.What branch of law is concerned with the recognition and enforcement of the rights and duties of private individuals and organizations?

a.	administrative
b.	civil
c.	criminal
d.	common

ANS: B

Private or civil law protects private citizens and organizations from others who might seek to take unfair and unlawful advantage of them.

DIF: Recall REF: p. 93 OBJ: 6

22.What is the term for a civil wrong committed against an individual or property, for which a court provides a remedy in the form of damages?

a.	tort
b.	misdemeanor
c.	felony
d.	litigation

ANS: A

A tort is a civil wrong, other than a breach of contract, committed against an individual or property, for which a court provides a remedy in the form of an action for damages.

DIF: Recall REF: p. 93 OBJ: 6

23.Which of the following are necessary to validate a claim of professional negligence?

1. The practitioner owed a duty to the patient.

2. The practitioner was derelict with that duty.

3. The breach of duty was the direct cause of damages.

4. Damage or harm came to the patient.

a.	1, 2, 3, and 4
b.	2, 3, and 4
c.	2 and 3
d.	3 and 4

ANS: A

See Box 5-3.

DIF: Application REF: p. 93 OBJ: 7

24.In a case of professional negligence, all of the following are required to support a claim of res ipsa loquitur except:

a.	Evidence must exist to show that the defendant acted with malfeasance or intent.
b.	The action responsible for the injury was under the control of the defendant.
c.	The harm was such that it would not normally occur without someone’s negligence.
d.	Negligence or voluntary risk-taking by the plaintiff did not contribute to the injury.

ANS: A

The legal principle res ipsa loquitur (“the thing speaks for itself”) may apply. Res ipsa loquitur is sometimes invoked to show that the harm would not ordinarily have happened if those in control had used appropriate care.

DIF: Application REF: p. 93 OBJ: 7

25.A physician who participates in active euthanasia is committing what type of malpractice?

a.	civil
b.	professional
c.	criminal
d.	ethical

ANS: C

Criminal malpractice includes such crimes as assault and battery or euthanasia (handled in criminal court).

DIF: Analysis REF: p. 94 OBJ: 7

26.A nurse who practices below a reasonable standard of care is committing what type of malpractice?

a.	civil
b.	statutory
c.	criminal
d.	ethical

ANS: A

Civil malpractice is negligence or practice below a reasonable standard.

DIF: Application REF: p. 94 OBJ: 7

27.A respiratory therapist who engages in a questionable business practice is committing what type of malpractice?

a.	civil
b.	statutory
c.	criminal
d.	ethical

ANS: D

Questionable business practice is an example of ethical malpractice.

DIF: Application REF: p. 94 OBJ: 7

28.All of the following are considered intentional torts except:

a.	negligent practice
b.	assault and battery
c.	defamation of character
d.	invasion of privacy

ANS: A

Examples of intentional torts are those that involve defamation of character, invasion of privacy, deceit, infliction of mental distress, and assault and battery.

DIF: Recall REF: p. 94 OBJ: 6

29.When a practitioner performs a procedure that involves physical contact without the patient’s consent, it can result in what charge?

a.	assault
b.	negligence
c.	battery
d.	slander

ANS: C

The major element of battery is physical contact without consent

DIF: Application REF: p. 94 OBJ: 8

30.Which of the following is/are legitimate defenses against an intentional tort?

1. lack of intent to harm the patient

2. performance of ordinary procedures

3. informed consent given by patient

a.	1 and 2
b.	2 and 3
c.	1, 2, and 3
d.	1 and 3

ANS: D

The first defense is that there was a lack of intent to harm and that only clinicians who engage in intentional conduct are liable

DIF: Recall REF: p. 94-95 OBJ: 7

31.A physician specifies an incorrect dose in a prescription for a powerful bronchodilator drug to be given to an asthmatic patient. When the respiratory therapist gives the prescribed dose, the patient suffers a fatal response and dies. Based on the principle of duty, against whom could a suit of negligence be brought?

1. respiratory therapist

2. attending physician

3. dispensing pharmacist

a.	1 and 2
b.	2 and 3
c.	1, 2, and 3
d.	1 and 3

ANS: C

The suit could be brought against the physician for negligence for ordering the overdose, against the nurses and the respiratory therapist for failing to recognize that the dose was incorrect for the child, and, possibly, against the pharmacist for failing to gain adequate information as to the nature of the patient so that an appropriate dosage could be calculated.

DIF: Application REF: p. 95 OBJ: 8

32.HIPAA primarily is referred to as the Privacy Rule and is concerned with PHI. What do the letters PHI stand for?

a.	patient health information
b.	protected health information
c.	past health information
d.	protected health insurance

ANS: B

The letters PHI stand for protected health information.

DIF: Recall REF: p. 96 OBJ: 12

33.What legal doctrine holds superiors responsible for the actions of their workers?

a.	res ipsa loquitur
b.	respondeat superior
c.	caveat emptor
d.	promissory estoppel

ANS: B

The legal framework for this liability is found in the principle respondeat superior (“let the master answer”).

DIF: Recall REF: p. 96 OBJ: 8

34.What conditions are necessary to incur liability under the doctrine of respondeat superior?

1. The injury caused must be the result of an act of negligence.

2. The act must occur within the subordinate’s scope of employment.

3. The act must involve willful intent on the part of the subordinate.

a.	1 and 2
b.	2 and 3
c.	1, 2, and 3
d.	1 and 3

ANS: A

For this liability to be incurred, two conditions must be met: (1) the act must be within the scope of employment, and (2) the injury caused must be the result of an act of negligence.

DIF: Recall REF: p. 96 OBJ: 8

35.All of the following are common elements in a professional practice act except:

a.	scope of professional practice
b.	requirements and qualifications for licensure
c.	penalties and sanctions for unauthorized practice
d.	professional code of ethics

ANS: D

Some practice acts emphasize one area over another but most acts address the following elements:

• scope of professional practice

• requirements and qualifications for licensure

• exemptions

• grounds for administrative action

• creation of examination board and processes

• penalties and sanctions for unauthorized practice

DIF: Recall REF: p. 97 OBJ: 9

36.If a respiratory therapist refers a Medicare patient to a particular home care company and receives a finder’s fee in return, this is an example of:

a.	moonlighting
b.	Medicare referral
c.	providing care without physician direction
d.	Medicare fraud

ANS: D

Generally, these statutes state that anyone who knowingly or willfully solicits, receives, offers, or pays directly or indirectly any remuneration in return for Medicare business is guilty of a criminal offense.

DIF: Analysis REF: p. 97 OBJ: 8

37.How can ethical obligations be used in legal proceedings?

a.	as a tool of cross examination
b.	to prevent perjury
c.	to prevent a health care provider from self incrimination
d.	penalties and sanctions for unauthorized practice

ANS: A

In addition to the moral obligations that ethical duties impose on therapists, ethical obligations are also often cited in legal proceedings as a tool of cross examination

DIF: Recall REF: p. 86 OBJ: 3

38.When a decision-making tool isn’t helpful in a certain situation, how is the RT to make a decision?

a.	consult their colleagues
b.	wait until the next staff meeting and ask advice
c.	base it on their intuitional abilities
d.	immediately page the supervising physician

ANS: C

When a decision-making tool isn’t helping in certain situations, it will depend on the intuitional abilities of any specific caregiver

DIF: Recall REF: p. 91 OBJ: 5

39.In Tort Law, what is “Proximate Causation”?

a.	It turns on foreseeability to decide whether it is fair to impose damages on a defendant.
b.	helps keep record of all Medicare patients
c.	the collection of any needed evidence before filing charges
d.	finding legal aid for those in need

ANS: A

Proximate Causation or Legal Causation usually turns on foreseeability and whether it is fair to impose damages on a defendant. It tends to be a retrospective analysis.

DIF: Application REF: p. 93 OBJ: 6

40.What are the economic damages that can be imposed on a defendant during a negligence lawsuit?

1. loss of employment or business opportunities

2. loss of use of property

3. loss of past and future earnings

4. all of the above

a.	1, 2, and 3
b.	2, 3, and 4
c.	1 and 2
d.	1, 2, 3, and 4

ANS: D

All of the above are considered economic loss in a negligence lawsuit.

DIF: Application REF: p. 94 OBJ: 6

41.What are the most effective tools in preventing malpractice litigations?

1. active risk management practices

2. appropriate guest relations policies

3. continuing education and certifications for facility maintenance staff

4. having supervisors on every shift

a.	1 , 2 and 3
b.	1 and 3
c.	1, 2, and 4
d.	1 and 2

ANS: D

Active risk management practices and appropriate guest relations policies are two of the most effective tools in preventing malpractice litigation.

DIF: Application REF: p. 95-96 OBJ: 7

42.What is the role of the corporate compliance officer (CCO) in a health care setting?

a.	to oversee the hospital`s business practices and make sure that they conform to the law.
b.	to ensure the hospital staff is working within the annual budgets
c.	to enforce the hospital’s recycling policies
d.	to ensure a high level of performance by the CFO

ANS: A

CCO are appointed by the board of directors, oversee the hospital`s business practices and make sure that they conform to the law. They are freely available to discuss legal or ethical issues arising in the course of care.

DIF: Recall REF: p. 97 OBJ: 11

43.What does The National Labor Relations Act (NLRA) do for each individual health care worker?

a.	It provides protections to hospital workers whether they are organized into a union or not.
b.	It oversees the hospital`s business practices.
c.	It provides legal aid only for those in a organized union.
d.	It provides legal aid only for those NOT in a organized union.

ANS: A

The National Labor Relations Act: (NLRA) provides protections to hospital workers whether they are organized into a union or not.

DIF: Recall REF: p. 99 OBJ: 12