You are discussing the care of an elderly woman with her family. Although she is awake and alert, the patient is very ill and physically fragile. You are awaiting the results of a biopsy for what will likely be cancer, which has already metastasized throughout the body. The family asks that you inform them first about the results of the biopsy. They are very loving and caring and are constantly surrounding the patient. They do not want to depress the patient further, and because there will be no hope for a cure they see no reason to ruin her remaining life with this information. What should you tell them?

Correct Answer: D

Rationale: Your first duty is to keep the patient fully informed about her health care. Unless there is significant evidence of possible psychological harm to a patient, you have an absolute duty to the patient first, not the family. One of the only examples of possible psychological harm to a patient would be an actively suicidal person who was given significant bad news. The motives of the family members are irrelevant. Whether they are kind and loving or vindictive and evil makes no difference. This is true whether their request to withhold information is in writing or is from the hospital ethics committee. In this case, the ethics committee is not necessary because there is no substantive question of the right action to inform the patient first. The health-care proxy's opinion and participation are only mandated if the patient loses decision-making capacity. If the patient has decision-making capacity, the health-care proxy's opinion is not different from anyone else's.

Correct Answer: A

Rationale: The patient described is not able to give informed consent for the procedure nor is he able to make an informed refusal of the procedure. He does not have the capacity to understand his medical condition and the consequences of deferring the lumbar puncture or the antibiotics. There is no proxy or family member available to give consent for the procedure and to substitute for his own judgment. In other words, what would the patient want for himself should he be able to make decisions for himself. The co-worker does not count as a person who can give consent. A blood culture alone or an MRI is insufficient as a diagnostic test to manage meningitis adequately. You cannot wait for the family in a case like this. If a patient has an urgent, life-threatening, dangerous, or even severely painful medical condition, and the patient is not competent and has no family or proxy available, then the medical staff can do what they feel is necessary to protect the patient without a specific signed consent. You would be more at fault for withholding therapy in this patient than you would to do the lumbar puncture. Acting in his best interests outweighs a formal consent that you cannot immediately obtain.

Correct Answer: A

Rationale: Notifying the nurse allows for professional evaluation and adjustment of the PRN order, ensuring safety.

Correct Answer: C

Rationale: Monitoring blood sugar levels is essential for insulin therapy to adjust doses and prevent hypo/hyperglycemia.

Correct Answer: A

Rationale: Erythromycin is an antibiotic that combats bacterial infections.