You are seeing patients in clinic when two men in dark suits and dark glasses come in and show you badges marking them as members of a federal law enforcement agency. The identification is legitimate. These 'men in black' inform you that they are making a 'minor investigation' of one of your patients. They ask to look at the patient's chart for a few minutes, saying, 'You wouldn't want to interfere with a federal investigation, would you?' What should you do?

Correct Answer: C

Rationale: You cannot release a patient's medical records unless there is a clear, signed release from the patient or there is a court order. This is true no matter who is asking. If the federal agents have a court order for the records then they have a right to the information. A court order, warrant, or subpoena can be used by the judicial system to violate confidentiality if the judicial system sanctions the violation. Although the medical record as a physical object is the property of the physician or health-care facility, the information is the property of the patient. In a sense, the information is like a person's house. No one has the right to enter your home without either your permission or a court order allowing the investigation. This is also true even if the people requesting it are law enforcement agents. We all have a constitutional right against illegal search and seizure of our property.

Correct Answer: B

Rationale: You must obtain informed consent by specific procedure. Consent for another procedure or clear medical necessity cannot infer consent for another procedure. Neither the medical necessity of the procedure, the seriousness of the condition, nor the assumption that any reasonable person would consent is sufficient to assume that consent is given. The patient is not aware of his surroundings and condition because of the sedation. You cannot have an 'informed consent' without waking up and informing the patient. Another example would be a blood transfusion in a Jehovah's Witness. If, during a procedure, a clear but unexpected necessity for blood transfusion arises, you must wake the patient up and ask about the patient's wishes to have or not have blood. The consent or refusal must be informed. You cannot say that because of the necessity or sedation, that you should just give the blood. On the other hand, just because a patient is a Jehovah's Witness, you cannot assume that he will refuse the blood. A refusal must be informed as well. The patient could, after all, be a Jehovah's Witness who does not agree with that religion's teaching on blood. Each procedure must undergo an individual consent process.

Correct Answer: C

Rationale: Sending medications in pharmacy packaging with the MAR ensures continuity of care and accurate administration during the visit.

Correct Answer: C

Rationale: Only the RN trainer or physician can authorize changes to medication orders, requiring clarification.

Correct Answer: C

Rationale: Systemic medications affect the whole body via the bloodstream, unlike local medications.