A nurse is caring for a client who has end-stage kidney disease and refuses further hemodialysis treatments. The client has advance directives that indicate no life-sustaining treatments. Which of the following actions should the nurse take?

Choice A reason: Informed consent does not prevent a client from refusing the procedure, as they retain the right to withdraw consent at any time before or during the process. This statement is incorrect, as it misrepresents the client’s autonomy and legal rights under informed consent principles.
Choice B reason: The nurse’s role in witnessing consent is to verify the client’s voluntary agreement, not to explain the procedure in detail. The surgeon or provider is responsible for detailed explanations, making this action outside the nurse’s scope in this context and incorrect.
Choice C reason: Explaining risks and benefits is the surgeon’s responsibility, not the nurse’s when witnessing consent. The nurse ensures the client understands and agrees voluntarily but does not provide the explanation, making this an incorrect description of the nurse’s role in the process.
Choice D reason: The client’s voluntary agreement is a core legal requirement of informed consent, which the nurse verifies as a witness. This ensures the client understands the procedure, risks, and benefits and consents without coercion, aligning with ethical and legal standards, making it correct.

Choice A reason: Nurses can witness advance directives in many settings, depending on state laws, so stating they cannot is inaccurate. This response dismisses the client’s request without providing guidance, making it incorrect and unhelpful for addressing their wishes.
Choice B reason: Including the client’s desire for advance directives in the medical record ensures their wishes are documented and respected. This aligns with the Patient Self-Determination Act, facilitating care planning, making it the correct and supportive response.
Choice C reason: Stating the client’s name can be removed from advance directives is confusing, as directives are personal and revocable, not about name removal. This response is inaccurate and irrelevant to the client’s request, making it incorrect.
Choice D reason: There is no universal age requirement of 21 for advance directives; competent adults (typically 18+) can create them. This statement is incorrect and restrictive, misinforming the client about their rights, making it inappropriate.