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?

Choice A reason: Performing ADLs independently is not a specific indicator of donepezil’s effectiveness, as it treats cognitive symptoms in Alzheimer’s, not physical function. While improved cognition may indirectly aid ADLs, this outcome is too broad and not directly tied to the medication’s primary action, making it incorrect.
Choice B reason: Increased food intake is not an expected outcome of donepezil, which targets acetylcholinesterase to improve cognitive function in Alzheimer’s. Appetite changes are unrelated to its mechanism, and this finding does not indicate effectiveness, making it an incorrect measure of the drug’s impact.
Choice C reason: Enhanced mood is not a primary effect of donepezil, which focuses on slowing cognitive decline. While mood may improve indirectly, it is not a direct indicator of efficacy. Other medications address mood in Alzheimer’s, making this finding less relevant and incorrect.
Choice D reason: Improved short-term memory is a key indicator of donepezil’s effectiveness, as it increases acetylcholine levels to slow cognitive decline in Alzheimer’s. Enhanced memory reflects the drug’s intended action, aligning with clinical expectations, making this the correct measure of therapeutic success.

Choice A reason: Percussion precedes palpation to assess abdominal resonance and organ size without altering bowel motility. Performing it last risks inaccurate findings, as palpation may stimulate peristalsis, changing resonance patterns. This sequence ensures reliable detection of abnormalities like organomegaly or fluid accumulation in the abdomen.
Choice B reason: Auscultation is done before palpation to capture natural bowel sounds. Manipulation during palpation can alter peristalsis, affecting auscultatory findings. Early auscultation ensures accurate detection of hypoactive or hyperactive bowel sounds, critical for diagnosing conditions like ileus or obstruction in abdominal assessments.
Choice C reason: Palpation is the final step, following inspection, auscultation, and percussion, to assess for tenderness or masses. This sequence prevents manipulation from altering earlier findings, ensuring accurate identification of abdominal abnormalities like peritonitis or organ enlargement, critical for a comprehensive physical examination.
Choice D reason: Inspection is the first step, providing a visual baseline of abdominal appearance, such as distension or scars. Performing it last misses initial cues guiding subsequent steps. Early inspection ensures no manipulation affects visual assessment, vital for identifying external signs of underlying abdominal pathology.