A nurse is contacting an occupational therapist for a client who had a stroke with right-sided weakness and has difficulty eating. Which of the following roles should the nurse expect the occupational therapist to perform?

A. "You will need an attorney to appoint a health care surrogate": It is not necessary to involve an attorney to designate a health care surrogate. Most states allow clients to complete the form themselves using standardized documents, making it accessible without legal assistance.

B. "You should appoint a family member as your health care surrogate": The surrogate does not have to be a family member; the client may choose any competent adult they trust to make health care decisions on their behalf. Emphasizing family only limits the client’s autonomy in selecting a trusted decision-maker.

C. "Once you have completed a living will it cannot be changed": Advanced directives, including living wills, can be updated or revoked at any time as long as the client has decision-making capacity. This flexibility allows clients to adjust their wishes as circumstances or preferences change.

D. "Your health care surrogate will make decisions on your behalf if you are unable": The primary role of a health care surrogate is to make medical decisions for the client when they lack the capacity to do so. This ensures that the client’s preferences and best interests are respected in situations where they cannot communicate their wishes.

Rationale for correct choices:
• malabsorption: A positive sweat chloride test confirms cystic fibrosis, which leads to thick secretions obstructing pancreatic ducts. This reduces pancreatic enzyme delivery to the intestine, impairing fat and protein digestion and contributing to weight loss despite increased appetite.

• chronic respiratory infections: Cystic fibrosis causes thick, sticky mucus in the airways that traps bacteria and interferes with normal mucociliary clearance. This environment promotes recurrent and chronic respiratory infections, explaining the persistent cough and wheezing noted on assessment.

Rationale for incorrect choices:
• bone marrow failure: Cystic fibrosis does not directly affect bone marrow function or blood cell production. Findings such as anemia, leukopenia, or thrombocytopenia would suggest an alternative hematologic disorder rather than this condition.

• excessive weight gain: Children with cystic fibrosis typically experience poor weight gain or weight loss due to malabsorption and increased metabolic demands. Excessive weight gain would be inconsistent with the disease process and the child’s current presentation.

• hypernatremia: Although cystic fibrosis involves increased sodium and chloride loss in sweat, this does not typically result in hypernatremia under normal conditions. Electrolyte imbalances are more commonly related to dehydration rather than sustained elevated serum sodium levels.