1. The process of
informed consent involves that the patient or the patient’s
surrogate:
A.
Is/Are competent
B.
Have comprehensible information about the medical situation and treatment
C.
Have information about alternative treatments and their consequences, and
have an understanding of what they have learned
D.
All of the above
E.
Only A and B are true
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2.
Children who can make their own decisions and give consents for medical
treatment separate from their parents include:
A.
Children who are pregnant or are already parents
B.
Children who graduated from high school
C.
Children who have joined the armed forces
D.
Children who live separately and independent from their parents
E.
All of the above
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3.
Appropriate statements pertaining to the mature minor doctrine include
all of the following except:
A.
A minor (child) should have the opportunity to accept or decline life
sustaining treatment such as mechanical ventilation or dialysis
B.
The child may refuse a blood transfusion that might otherwise be
essential for appropriate medical care, if this is due to long-standing, well
thought beliefs such as those held by adolescents who are Jehovah’s witnesses
C.
The law does recognize that some children have legitimate independent
claims regarding their medical care that may differ from the expressed wishes of
their parents
D.
This legal entitlement means that the proposed decision maker is actually
competent
E.
Physicians must assess the decision making capacity of patients or their
surrogates
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4.
In order to give an informed consent, the patient or legal guardian must
possess a decision- making capacity. This
capacity has several features and elements which include all of the following
except:
A.
The patient or surrogate does not need to have the ability to manipulate
the information provided to them
B.
Capacity includes the ability to deliberate about alternative options
C.
Capacity to make medical decisions involves specific determinations for
each significant decision
D.
Capacity involves the ability to understand and communicate about the
medical situation
E.
Capacity involves the ability to make a choice among alternatives
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5.
You are involved in the treatment of a critically ill child with sepsis
and multiple organ dysfunction syndrome at a university children’s hospital.
In this situation, all of the following actions and statements are true
except:
A.
Parental religious beliefs should not prevent this child from receiving a
clearly beneficial therapy
B.
The best interest of the child should remain the guiding principle in
most cases where there is any dispute with the parents
C.
Treatment can go forward with permission from only one parent
D.
When parents refuse involvement of trainees in the care of their child,
the best course of action is to remind them that this is a teaching institution
and proceed with the care with your trainees
E.
Children may receive treatment by court approval over and against
parental wishes, when the therapy constitutes the standard of care
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6.
In order for a patient to succeed in a claim for damages, he/she must
prove:
A.
That the physician failed to meet the standard of care
B.
That the physician’s error led to legally recognized injuries
C.
That the physician’s error approximately caused the patient to suffer
legally recognizable damage
D.
All of the above
E.
A only
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7.
Regarding the doctor/patient relationship involved in a malpractice suit,
which of the following statements is true:
A. It is illegal to alter patient’s medical records at a later time even
when a reason for addition is indicated
B.
It can be hard to deny charges that inappropriate care was provided when
the medical record have little or no information
C.
When a physician treats a patient with a chronic medical problem, he/she
is liable for the entire problem even after one encounter
D.
Most jurisdictions state that the physician is responsible for the
patient’s non-compliance
E.
All of the above
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8.
In the US, a 14-year-old who is healthy without any significant past
medical history is most likely to die from:
A.
Suicide
B.
Homicide
C.
Leukemia
D.
Accident
E.
Brain tumor
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9.
“Baby Doe” regulations include that health care providers cannot
withhold medically beneficial treatment from a child on the basis of a handicap.
Exception(s) include:
A.
If the infant is imminently dying
B.
The treatment would be inhumane
C.
The infant is permanently comatose
D.
All of the above
E.
A and B only
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10.
You are called to the Pediatric ICU as soon as possible because the
parents of a 6-month-old child with Down’s syndrome and atrioventricular canal
defect in congestive heart failure are very angry at the staff, and are
expressing dissatisfaction with the care provided to their child.
Upon your arrival you notice the father is indeed very angry and is
asking to transfer his child to another institution.
All of the following would be appropriate responses except:
A.
Listening to their concerns is one of the most effective interventions in
dealing with this family
B.
A team meeting with this family should be promptly convened
C.
You should remind the parents that you and the staff were up all night
taking care of this child, and at this point, everybody on the team is somewhat
tired and exhausted
D.
Accept the emotional outburst of the father calmly
E.
Assure the parents that their child is being appropriately cared for and
comforted
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11.
Measures that can be taken to prevent hostility among parents such as the
ones above include:
A.
Orientation to policies of the Pediatric ICU as soon as possible after
the admission of the child
B.
Introduction of the staff soon after admission
C.
If there is evidence that the parents are showing signs of
dissatisfaction with the care, a team meeting with the family should be promptly
convened
D.
Family education to alleviate any knowledge deficit
E.
All of the above
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12.
A 12-month-old baby of a single mother, who was apparently being watched
by the mother’s boyfriend, was admitted to your Pediatric ICU for persistent
seizures. Physical examination was
significant for the presence of multiple retinal hemorrhages and the CT scan
revealed intracerebral hemorrhage and a subdural hematoma.
Correct statements pertaining to this case include all of the following
except:
A.
A complete copy of the medical record is extremely helpful during the
initial investigation
B.
If you are asked to testify in court regarding this case, a monitory
compensation is expected
C.
Accidental injury other than a car accident rarely causes intracranial
injury in infants
D.
Remind your staff that the parents of this child should be treated in the
same professional and supportive manner that is employed with the parents of any
other critically injured child
E.
In discussing this case with one of your residents who will be testifying
in court, it is crucial to remember that most physicians are unprepared by
training and experience to go to court as expert witnesses
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Answers
1.
D
All of the above are involved in the process of “informed consent.” (Fuhrman BP, et al. Pediatric
Critical Care, 2nd Edition; pp 10-11)
2.
E
These children are referred to as emancipated minors. (Fuhrman BP, et al.
Pediatric Critical Care, 2nd Edition; pp 10-12)
3.
D
It does not assume that the patient or the surrogate is competent. This must be assessed by the physician as indicated in Answer
E. (Fuhrman BP, et al. Pediatric
Critical Care, 2nd Edition; pp 9-14)
4.
A
It does include the ability to manipulate the information and deliberate
about alternatives. (Fuhrman BP, et al. Pediatric
Critical Care, 2nd Edition; pp 9-14)
5.
D
The best course of action is direct inquiry into their fears and guilt
which is likely to provide the best resolution for all parties. (Fuhrman BP, et
al. Pediatric Critical Care, 2nd
Edition; pp 18-22)
6.
D
In order to succeed in a claim for damage, it must meet all the above
criteria. (Fuhrman BP, et al. Pediatric
Critical Care, 2nd Edition; pp 18-22)
7.
B
As long as the reason and the date are stated, adding to medical records
is not illegal. Jurisdictions vary
on the essence of compliance. (Fuhrman BP, et al.
Pediatric Critical Care, 2nd Edition; pp 20-22)
8.
D
Accidents and adverse effects are the most common causes of death in
children 13-15 years of age. (Fuhrman BP, et al.
Pediatric Critical Care, 2nd Edition; p 4)
9.
D
“Baby Doe” regulations (introduced in 1982 by the federal government)
prohibit withholding or withdrawing of beneficial medical treatment from any
infant on the basis of handicap or prognosis for quality of life.
The three exceptions are: 1)
infant is permanently comatose; 2) treatment is inhumane; and 3) infant is
immediately dying. (Fuhrman BP, et al. Pediatric
Critical Care, 2nd Edition; pp 34)
10-11.
C, E
It is more helpful in dealing with these families to have a caring
attitude rather than a defensive attitude. (Fuhrman BP, et al.
Pediatric Critical Care, 2nd Edition; pp 38-41)
12.
A
The complete record may be needed if the case goes to trial.
It is rarely helpful in the initial investigation because so much of the
record pertains to investigation. (Fuhrman BP, et al. Pediatric Critical Care, 2nd Edition; pp 18-23)