A nurse is caring for a client who has a terminal illness and wishes to discuss hospice care. Which of the following statements by the nurse demonstrates veracity?

A. "My attorney will need to notarize the document."

This statement indicates a misunderstanding of advance directives. Notarization by an attorney is not a requirement for advance directives. While legal advice may be helpful in completing advance directive documents, notarization by an attorney is not necessary for their validity.

B. "I have to choose a member of my family to be my health care surrogate."

This statement is incorrect. While a family member can serve as a health care surrogate if chosen by the individual, there is no requirement to select a family member. The individual can choose any competent adult to act as their health care surrogate, regardless of familial relationship.

C. "Once the form is notarized, it cannot be changed."

This statement is incorrect. Advance directive documents can be changed or revoked at any time by the individual as long as they are of sound mind and able to make decisions. Notarization does not prevent changes or revisions to the document.

D. "My health care surrogate can decide my treatment if I am unable to."

Correct. This statement demonstrates an understanding of advance directives. A health care surrogate, also known as a health care proxy or durable power of attorney for health care, is a person chosen by an individual to make medical decisions on their behalf if they become unable to do so. This includes decisions about medical treatment, procedures, and end-of-life care.

A) Administer PRN haloperidol IM to the client:

Administering haloperidol is not the first-line intervention for managing behavioral disturbances in clients with dementia, especially in response to acute agitation. While antipsychotic medications like haloperidol may be prescribed in some cases, they should be used judiciously due to the risk of adverse effects, particularly in elderly clients. Additionally, administering medication should not be the first action taken without attempting non-pharmacological interventions.

B) Engage the client in a repetitive activity as a distraction:

This is the most appropriate initial intervention when dealing with an agitated client with dementia. Engaging the client in a repetitive, calming activity can help redirect their focus and reduce agitation. Simple, familiar tasks or activities tailored to the client's preferences can be effective in providing comfort and reducing distress.

C) Apply wrist restraints to the client:

Using physical restraints should be avoided unless absolutely necessary for the safety of the client or others. Restraints can cause physical and psychological harm, increase agitation, and compromise the client's dignity and autonomy. Therefore, restraint use should be a last resort and implemented only after other interventions have been attempted and deemed ineffective or when there is an imminent risk of harm.

D) Place the client in a seclusion room:

Seclusion should not be used as an initial intervention for managing agitation in clients with dementia. Seclusion can exacerbate distress and increase feelings of isolation and fear, which may escalate agitation further. It should only be considered as a last resort for managing severe agitation or aggression when all other interventions have failed and there is a risk of harm to the client or others.