You are a resident managing a private patient with cellulitis. The patient has a history of congestive heart failure and a normal EKG. The patient is on digoxin, an ACE inhibitor and a diuretic, but not a beta-blocker. You cannot find a contraindication to the use of beta-blockers either in the chart or in discussion with the patient. You ask the private attending why there is no beta-blocker and he looks at you as if you had anoxic encephalopathy. He says, 'I have been in practice for 40 years. Don't you think I know what I am doing? Beta-blockers are dangerous in congestive failure.' The patient looks proudly at the attending and says, 'I have the smartest doctor in the world.' What should you do about this disagreement?

You are a resident managing a private patient with cellulitis. The patient has a history of congestive heart failure and a normal EKG. The patient is on digoxin, an ACE inhibitor and a diuretic, but not a beta-blocker. You cannot find a contraindication to the use of beta-blockers either in the chart or in discussion with the patient. You ask the private attending why there is no beta-blocker and he looks at you as if you had anoxic encephalopathy. He says, 'I have been in practice for 40 years. Don't you think I know what I am doing? Beta-blockers are dangerous in congestive failure.' The patient looks proudly at the attending and says, 'I have the smartest doctor in the world.' What should you do about this disagreement?

Mrs. Franklin, an 81-year-old Alzheimer's patient hospitalized under your care has been asked to participate in a clinical trial testing a new drug designed to help improve memory. You were present when the clinical investigator obtained a signed informed consent from Mrs. Franklin a few days ago. However, when you visit Mrs. Franklin today and ask her if she is ready to begin the study tomorrow, she looks at you blankly and seems to have no idea what you are talking about. What should you do?

A 65-year-old heavy smoker with a lengthy history of chronic obstructive pulmonary disease comes to the office due to recent-onset hemoptysis. He reports 3-5 episodes of coughing up blood in the past month. He also reports a 9.1-kg (20-lb) weight loss in the past 2 months. Chest radiograph reveals a suspicious lesion, and a bronchoscopy followed by biopsy establishes the diagnosis of squamous cell carcinoma of the lung. When the patient is informed of his condition and the prognosis, he asks that no one in his family be told the news yet. He seems tearful but cognitively intact. His wife, who usually brings him to his visits and is also his health care proxy, calls the next day to inquire about the pathology report. She says she is deeply concerned because her husband is reluctant to discuss his condition. Which of the following is the most appropriate course of action?

A 28-year-old married woman who works with you in the clinic as a nurse privately comes to you because she 'missed a period' this month. An over-the-counter urine pregnancy test confirms that she is pregnant. First-trimester laboratory testing reveals that she is also HIV positive. When you inform the patient of her HIV status, she is devastated. She hesitantly reveals that she had unprotected sexual intercourse with a former boyfriend several months ago. You explain that her husband's HIV status must be evaluated. The patient is horrified and says 'No, I cannot tell him about this. He would never forgive me!' Which of the following is the most appropriate first step?

This type of law results from judicial decisions, is heard in court, and is the most common type of case a nurse is involved in.