A nurse is assisting in the care of a client. Nurses' Notes

2000:

The client presents to the emergency department and states, "I have been assaulted." The client was immediately placed in a treatment

room. 2015:

"The client states they were out with friends this evening and had "a little too much to drink." The client states that they fell asleep at their friend's house and when they woke up all of their clothes were off and their genitals were sore. The client states, "I think someone had sex with me, but I don't remember anything." The client reports a history of depression. The client is a full-time college student who lives with roommates. The client admits to drinking socially but denies illicit drug use and tobacco use.

Which of the following interventions should the nurse plan to implement? Select all that apply.

Ensure that the client has given informed consent.

Obtaining informed consent is a critical step before any medical procedure. It ensures that the client understands the nature of the procedure, its risks, benefits, and alternatives, and voluntarily consents to it. It is essential to ensure that the client has given their informed consent before proceeding with the EGD.

The other options do not directly pertain to the EGD procedure:

- Administering an oral contrast solution is typically not part of the preparation for an EGD.

- Informing the client about the duration of the procedure is important for the client's understanding, but it is not the primary action for the nurse to take.

- Ensuring that the client's bladder is full is not a standard preparation for an EGD.

1. "Your health care surrogate will make decisions on your behalf if you are unable": This statement is correct. A health care surrogate, also known as a health care proxy or durable power of attorney for health care, is an individual designated by the client to make medical decisions on their behalf if they become unable to make decisions for themselves. It is important for the client to choose someone they trust and who understands their values and wishes.
2. "You should appoint a family member as your health care surrogate": This statement is a subjective recommendation and may not be applicable to all individuals. The decision of whom to appoint as a health care surrogate should be based on the client's personal preferences and the individual's ability to make informed decisions according to the client's wishes. While a family member is often chosen, it is not a requirement, and the client may choose a close friend, partner, or anyone else they trust to fulfill this role.
   1. "You will need an attorney to appoint a health care surrogate": This statement is not necessarily true. While involving an attorney can be helpful, it is not always required to appoint a health care surrogate. In many jurisdictions, a legally valid healthcare surrogate designation can be made through a simple document or form provided by the hospital or a local government office. It is important to check the specific legal requirements in the client's jurisdiction.

"Your health care surrogate will make decisions on your behalf if you are unable": This statement is correct. A health care surrogate, also known as a health care proxy or durable power of attorney for health care, is an individual designated by the client to make medical decisions on their behalf if they become unable to make decisions for themselves. It is important for the client to choose someone they trust and who understands their values and wishes.
"You will need an attorney to appoint a health care surrogate": This statement is not necessarily true. While involving an attorney can be helpful, it is not always required to appoint a health care surrogate. In many jurisdictions, a legally valid healthcare surrogate designation can be made through a simple document or form provided by the hospital or a local government office. It is important to check the specific legal requirements in the client's jurisdiction.
"You should appoint a family member as your health care surrogate": This statement is a subjective recommendation and may not be applicable to all individuals. The decision of whom to appoint as a health care surrogate should be based on the client's personal preferences and the individual's ability to make informed decisions according to the client's wishes. While a family member is often chosen, it is not a requirement, and the client may choose a close friend, partner, or anyone else they trust to fulfill this role.
"Once you have completed a living will, it cannot be changed": This statement is incorrect. A living will, which is a type of advanced directive, can be changed or revoked at any time by the client as long as they are competent to do so. It is important for the client to review and update their living will periodically to ensure that it reflects their current wishes regarding medical care and treatment.