A nurse is providing teaching about advance directives to a middle adult client. Which of the following client responses indicates an understanding of the teaching?
"I can designate my partner as my health care surrogate."
"I am only 40 years old, so I don't need to worry about this yet."
“I will need a lawyer's help to draw up the documents."
“I understand that my family can alter my advance directives if I become incapacitated."
The Correct Answer is A
"I can designate my partner as my health care surrogate."
- A. Correct. Designating a health care surrogate is one of the components of an advance directive, which allows the client to appoint someone who can make medical decisions on their behalf if they are unable to do so themselves.
- B. Incorrect. Age is not a factor that determines the need for an advance directive, as anyone can become incapacitated at any time due to illness or injury.
- C. Incorrect. A lawyer's help is not necessary to draw up an advance directive, as there are standardized forms available that can be filled out by the client and witnessed by two adults. - D. Incorrect. The family cannot alter or override the advance directives of the client unless they have been designated as their health care surrogate or have obtained a court order to do so.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
A blood lead level of 18 mcg/dL in a 9-month-old infant is elevated. The Centers for Disease Control and Prevention (CDC) considers a blood lead level of 5 mcg/dL or higher in children to be concerning. Lead exposure can lead to developmental delays and cognitive impairments. Therefore, this result needs to be reported to the healthcare provider promptly.
Choice B rationale:
Hemoglobin level of 12 g/dL is within the normal range for a 9-month-old infant (11-15 g/dL) There is no need to report this result to the provider.
Choice C rationale:
Iron level of 74 mcg/dL is within the normal range for a 9-month-old infant (50-120 mcg/dL) There is no need to report this result to the provider.
Choice D rationale:
Hematocrit level of 35% is within the normal range for a 9-month-old infant (29-41%) There is no need to report this result to the provider.
Correct Answer is B
Explanation
- A. Incorrect. Withholding pain medications for 24 hr after the old patch is removed is a harmful action that could cause severe withdrawal symptoms and uncontrolled pain for the client. The nurse should respect the client's right to refuse treatment and explore the reasons for their decision.
- B. Correct. Asking another nurse to witness the disposal of the new patch is a safe and legal action that follows the policies and procedures for handling controlled substances. The nurse should document the disposal of the new patch and report it to the appropriate authority.
- C. Incorrect. Sealing the patches in a plastic bag and placing them in the client's trash basket is an unsafe and illegal action that could lead to diversion, misuse, or accidental exposure of fentanyl to others. The nurse should dispose of the patches in a secure and designated container that prevents access by unauthorized persons.
- D. Incorrect. Sticking the two patches to each other and placing them in the sharps bin is an unsafe and improper action that could cause contamination, injury, or infection to others who handle or dispose of sharps waste. The nurse should dispose of the patches separately and carefully, avoiding contact with their adhesive surfaces.
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