A health care provider asks the nurse about an older adult client's durable power of attorney (POA) because consent is needed for a medically necessary invasive procedure. The client has end-stage disease, is intubated, and is on mechanical ventilation. Which steps should the nurse implement?
Assist with obtaining informed consent from the client.
Refer to the client's advance directive for a name.
Determine the client's inability to make reasonable decisions.
Use the oral trail-making test to measure cognitive function.
The Correct Answer is C
A. Assist with obtaining informed consent from the client.
Explanation: Informed consent is a critical aspect of healthcare procedures, but it requires the patient to have the capacity to understand and make decisions. In this scenario, the client is intubated and on mechanical ventilation, which might compromise their ability to communicate effectively. If the client lacks capacity, obtaining consent from the durable power of attorney (POA) is more appropriate.
B. Refer to the client's advance directive for a name.
Explanation: Advance directives, including the durable POA, provide guidance on a person's wishes for healthcare decisions when they are unable to communicate. However, the advance directive may not always specify a particular person's name for decisions related to specific medical interventions. The key consideration in this situation is to determine the current decision-making capacity and involve the appropriate decision-maker if needed.
C. Determine the client's inability to make reasonable decisions.
Explanation: This is the correct answer. In this scenario, the nurse should assess the client's capacity to make decisions. If the client lacks capacity, the durable POA can be activated to make healthcare decisions on behalf of the client. Capacity involves the ability to understand relevant information, appreciate the consequences of decisions, and communicate a choice.
D. Use the oral trail-making test to measure cognitive function.
Explanation: The oral trail-making test is a cognitive screening tool, but it may not be suitable in this critical care scenario with an intubated and mechanically ventilated patient. Moreover, the primary concern in this situation is determining the capacity to make healthcare decisions, which requires a more comprehensive evaluation than a specific cognitive function test. The focus should be on decision-making capacity rather than a cognitive assessment.
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Related Questions
Correct Answer is ["C","D","E"]
Explanation
A. Participants in PACE programs must be able to perform their own ADLs independently.
Explanation: This statement is generally not true. PACE programs are designed to provide comprehensive and coordinated care for individuals who are frail and meet the criteria for nursing home admission. The emphasis is on maintaining participants in their homes and communities. Participants in PACE programs often have limitations in Activities of Daily Living (ADLs), and the program is designed to support them in these activities.
B. Participants in PACE programs must have been residents in a nursing home prior to enrollment in the PACE program.
Explanation: This statement is generally not true. PACE programs aim to keep individuals out of nursing homes by providing comprehensive healthcare services in a community setting. Participants in PACE programs are often those at risk of nursing home placement due to their health and functional status.
C. Participants in PACE programs must be eligible for either Medicare or Medicaid.
Explanation: This statement is generally true. PACE programs are funded through Medicare and Medicaid. Participants must be eligible for both Medicare and Medicaid to enroll in a PACE program. Medicaid eligibility may vary by state.
D. PACE programs only provide service to individuals who are age 55 and over.
Explanation: This statement is generally true. PACE programs typically serve individuals who are 55 years of age or older. However, the specific age eligibility may vary by state.
E. PACE programs provide services to individuals who meet the criteria for nursing home admission.
Explanation: This statement is generally true. PACE programs are designed for individuals who are at risk of nursing home placement due to their health and functional status. Participants must meet the criteria for nursing home admission to be eligible for PACE services.
Correct Answer is D
Explanation
A. "As the health care proxy, you are the one who makes the decisions. Let's call your mom's doctor."
Explanation: This response inaccurately suggests that the health care proxy has the authority to make decisions even when the client has decision-making capacity. The focus should be on the client's autonomy.
B. "I understand why you are so upset. I don't think she is doing the right thing either. Let us think together how we can change her mind."
Explanation: This response is inappropriate as it involves the nurse expressing a personal opinion and attempting to influence the client's decision. The nurse's role is to support the client's autonomy and facilitate communication between the client and their family.
C. "You will need to go to court and be declared a guardian."
Explanation: Involving the court and seeking guardianship is not warranted when the client has decision-making capacity. This option is not aligned with the principles of respecting the client's autonomy and decision-making capacity.
D. "Health care proxies only come into play when the individual can no longer make their own decisions. Your mother is able to make her own decisions. I suggest you talk with her."
Explanation: In this scenario, the client is cognitively intact and has decision-making capacity. As long as the older adult is able to make their own decisions, the health care proxy's role is not activated. The nurse appropriately advises the daughter to communicate directly with her mother about her concerns and decisions. This respects the autonomy of the client, who has the right to make decisions about their own healthcare as long as they have the capacity to do so.
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