A nurse is teaching a client about advance directives. Which of the following statements by the client indicates an understanding of the teaching?

Rationale:

A. "I don't think you will benefit from reviewing your therapist's notes right now.": This statement dismisses the client’s request without addressing legal and policy guidelines regarding access to records. It also inappropriately assumes the client’s capacity to benefit from the information.

B. "Are you not happy with your treatment?": This redirects the conversation away from the request and implies dissatisfaction, which can create defensiveness. It does not provide the client with accurate information about their right to access medical records.

C. "Why are you interested in seeing your therapist's notes?": Asking “why” can sound confrontational and does not answer the client’s question. The focus should be on explaining what parts of the record can be shared, according to policy and law.

D. "We can provide a copy of your records, but the therapist's notes are not included.": Psychotherapy notes are excluded from standard medical record disclosures under HIPAA, as they are kept separate to protect sensitive details.

Rationale:

A. Being honest with the parents of a child about the need to report suspected abuse: This reflects the ethical principle of veracity, which involves truth-telling and providing accurate information, rather than distributive justice.

B. Accepting the decision of an older adult client to live alone in her home: This action demonstrates respect for autonomy, which is honoring a client’s right to make decisions about their own life and care, not distributive justice.

C. Keeping a promise to visit with a client who is housebound after the delivery of care: This is an example of fidelity, the ethical obligation to keep commitments and follow through on promises made to clients.

D. Ensuring that a homeless client receives preventive medical care: Distributive justice focuses on fair and equitable allocation of resources and services, particularly for vulnerable or underserved populations. Providing preventive care to a homeless client exemplifies this principle.