A nurse is caring for a client who is seeking information about end-of-life decisions. According to the Patient Self-Determination Act, which of the following applies to medical decisions that can be made within organizations that receive Medicare and Medicaid reimbursements?
The person holding financial power of attorney will make health care decisions based on the client's advance directives.
The client has the right to refuse medical treatment, even if health care providers recommend it.
The client's eldest adult child has the right to change advance directives in an end-of-life situation.
If the client's advance directives are in writing and notarized, the client cannot change it in the future.
The Correct Answer is B
Rationale:
A. The person holding financial power of attorney will make health care decisions based on the client's advance directives: A financial power of attorney manages financial matters, not health care decisions. A separate designation such as a health care proxy or medical power of attorney is needed for making medical decisions.
B. The client has the right to refuse medical treatment, even if health care providers recommend it: Under the Patient Self-Determination Act (PSDA), clients have the legal right to make autonomous decisions about their care, including the right to refuse or discontinue treatment, regardless of medical advice.
C. The client's eldest adult child has the right to change advance directives in an end-of-life situation: Advance directives reflect the client’s own decisions. No family member, regardless of birth order, has the legal authority to change them unless specifically authorized as a health care proxy and even then, only if the client is incapacitated.
D. If the client's advance directives are in writing and notarized, the client cannot change it in the future: Clients can revise or revoke advance directives at any time, as long as they remain mentally competent. Notarization does not make the document legally fixed or unchangeable.
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Related Questions
Correct Answer is C
Explanation
Rationale:
A. "I should take this medication on an empty stomach.": Amitriptyline does not require administration on an empty stomach. It can be taken with or without food, although taking it with food may help reduce gastrointestinal discomfort in some individuals.
B. "I can continue to take St. John's wort while taking this medication.": St. John's wort can increase the risk of serotonin syndrome and reduce the effectiveness of amitriptyline due to drug interactions. Clients should avoid combining herbal supplements with antidepressants.
C. "I know it will be a couple of weeks before the medication helps me feel better.": Tricyclic antidepressants like amitriptyline take 2 to 4 weeks to show noticeable improvement in mood. Recognizing the delayed onset helps set realistic expectations and supports adherence.
D. "I expect this medication to raise my blood pressure.": Amitriptyline more commonly causes orthostatic hypotension, especially when therapy is initiated. Clients should be taught to change positions slowly to reduce the risk of dizziness and falls.
Correct Answer is B
Explanation
Rationale:
A. "I will avoid strenuous exercise.": Physical activity, including regular moderate exercise like walking, actually helps stimulate bowel function. Avoiding exercise may worsen constipation rather than prevent it.
B. "I will increase my intake of high-fiber foods.": A high-fiber diet supports regular bowel movements by increasing stool bulk and promoting peristalsis. This is a key strategy for preventing opioid-induced constipation.
C. "I will take a bulk-forming laxative every day.": Bulk-forming laxatives can be helpful, but daily use should be discussed with a provider, as they can worsen constipation if fluid intake is insufficient. Dietary changes are usually the first recommended step.
D. "I will limit my fluid intake to 1 liter per day.": Limiting fluid intake can lead to dehydration and hard stools, worsening constipation. Adequate hydration is essential to help fiber work effectively and support regular bowel function.
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