Chapter·SurgeryPre-operative evaluation

Informed consent processDownloads

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1

A 16-year-old girl comes to the physician for a regular health visit. She feels healthy. She lives with her parents at home. She says that the relationship with her parents has been strained lately because they ""do not approve"" of her new boyfriend. She recently became sexually active with her boyfriend and requests a prescription for an oral contraception. She does not want her parents to know. She smokes half-a-pack of cigarettes per day and does not drink alcohol. She appears well-nourished. Physical examination shows no abnormalities. Urine pregnancy test is negative. Which of the following is the most appropriate next step in management?

ARecommend an oral contraceptive pill

BDiscuss all effective contraceptive options

CConduct HIV screening

DInform patient that her smoking history disqualifies her for oral contraceptives

EAsk patient to obtain parental consent before discussing any contraceptive options

2

A 29-year-old man is admitted to the emergency department following a motorcycle accident. The patient is severely injured and requires life support after splenectomy and evacuation of a subdural hematoma. Past medical history is unremarkable. The patient’s family members, including wife, parents, siblings, and grandparents, are informed about the patient’s condition. The patient has no living will and there is no durable power of attorney. The patient must be put in an induced coma for an undetermined period of time. Which of the following is responsible for making medical decisions for the incapacitated patient?

AThe spouse

BAn older sibling

CPhysician

DLegal guardian

EThe parents

3

A 15-year-old teenager presents to the emergency department via emergency medical service (EMS) after a motor vehicle accident. The patient is in critical condition and is hemodynamically unstable. It becomes apparent that the patient may require a blood transfusion, and the parents are approached for consent. They are Jehovah’s Witnesses and deny the blood transfusion, saying it is against their beliefs. However, the patient insists that she wants the transfusion if it will save her life. Despite the patient’s wishes, the parents remain steadfast in their refusal to allow the transfusion. Which of the following is the most appropriate course of action?

AObtain a court order to give blood products.

BGive the patient the blood transfusion.

CGive intravenous fluids to attempt to stabilize the patient.

DDo not give blood transfusion due to the parents’ refusal.

EConsult the hospital ethics committee.

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