Title: Usmle Step 1 MCQ’s # 39
Subject: Behavioral Science
Q NO 39: A nurse on an inpatient internal medicine ward comes to see the attending physician. While drawing blood for routine laboratory tests ordered by the medical staff, the nurse inadvertently stuck herself with a hypodermic needle, in which were several drops of the patients blood. The nurse is anxious, and wants the physician to order that the patient’s existing blood sample be tested for HIV. The physician is aware that the patient has a history of homosexual encounters, although neither the physician nor the nurse are aware of the patient’s HIV status. At this point, the physician should do which of the following?
A. Assure the nurse that the probability of contracting HIV by this method is relatively low, but that she should be more careful in the future.
B. Convene a meeting of the nursing staff and ask it anyone on the ward is aware of the patient’s HIV status.
C. Order the test, as the nurse requests.
D. Review the patient’s chart and medical histor’ for clinical signs consistent with HIV infection.
E. Talk to the patient and order the test only if the patient gives his permission.
F. Tell the nurse that you will order the test if she can obtain the patient’s permission.
Explanation:
The correct answer is C. The general rule is that patient’s conl9dentialitv is to be respected at all times. This means that no medical procedure, including laboratory tests, can be run on a patient without his or her consent. There is one exception: threat of harm to self or others. The guidelines of the American Medical Association explicitly state that the exception applies in this case. The nurse may be at risk. If the patient is HIV-positive, treating her quickly greatly reduces the chance of becoming HIV-positive and increases her life span should she become HIV-positive.
The nurse has aright to treatment and the right to know if she needs treatment. She needs more than reassurances (choice A). She needs the test performed to know the patient’s HIV status.
This is an escalation that breaks the confidentiality of both the patient and the nurse. Simply running the screening test constitutes much less of a breach than initiating a general discussion with in the hospital staff (choice B)
Knowing that the patient is homosexual already places him in one of the high-risk groups. It is unlikely that reviewing the medical chart (choice D) will produce information that would obviate the need for HIV testing.
Because of the threat of harm clause the patient’s permission is not required (choices E and F).
Source: http://www.usmleworldwide.com/blog/?p=769
Subject: Behavioral Science
Q NO 39: A nurse on an inpatient internal medicine ward comes to see the attending physician. While drawing blood for routine laboratory tests ordered by the medical staff, the nurse inadvertently stuck herself with a hypodermic needle, in which were several drops of the patients blood. The nurse is anxious, and wants the physician to order that the patient’s existing blood sample be tested for HIV. The physician is aware that the patient has a history of homosexual encounters, although neither the physician nor the nurse are aware of the patient’s HIV status. At this point, the physician should do which of the following?
A. Assure the nurse that the probability of contracting HIV by this method is relatively low, but that she should be more careful in the future.
B. Convene a meeting of the nursing staff and ask it anyone on the ward is aware of the patient’s HIV status.
C. Order the test, as the nurse requests.
D. Review the patient’s chart and medical histor’ for clinical signs consistent with HIV infection.
E. Talk to the patient and order the test only if the patient gives his permission.
F. Tell the nurse that you will order the test if she can obtain the patient’s permission.
Explanation:
The correct answer is C. The general rule is that patient’s conl9dentialitv is to be respected at all times. This means that no medical procedure, including laboratory tests, can be run on a patient without his or her consent. There is one exception: threat of harm to self or others. The guidelines of the American Medical Association explicitly state that the exception applies in this case. The nurse may be at risk. If the patient is HIV-positive, treating her quickly greatly reduces the chance of becoming HIV-positive and increases her life span should she become HIV-positive.
The nurse has aright to treatment and the right to know if she needs treatment. She needs more than reassurances (choice A). She needs the test performed to know the patient’s HIV status.
This is an escalation that breaks the confidentiality of both the patient and the nurse. Simply running the screening test constitutes much less of a breach than initiating a general discussion with in the hospital staff (choice B)
Knowing that the patient is homosexual already places him in one of the high-risk groups. It is unlikely that reviewing the medical chart (choice D) will produce information that would obviate the need for HIV testing.
Because of the threat of harm clause the patient’s permission is not required (choices E and F).
Source: http://www.usmleworldwide.com/blog/?p=769
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