A nurse is teaching a client about advance directives. Which of the following statements by the client indicates an understanding of the teaching?
"I will have a nurse witness the signing of my living will."
"I can make changes to my living will even after I sign it."
"I should choose a family member as my health care proxy."
"I need to have my attorney review my advance directives."
The Correct Answer is B
Choice A Reason:
"I will have a nurse witness the signing of my living will." This statement is incorrect. While having a witness present during the signing of a living will is important for validity in some jurisdictions, the statement alone does not demonstrate an understanding of advance directives. It's essential to ensure that the client comprehends the purpose and content of the document, not just the procedural aspect.
Choice B Reason:
"I can make changes to my living will even after I sign it." This statement is correct. Understanding that living wills can be revised or updated as needed reflects comprehension of the flexibility and control that advance directives provide. It's crucial for clients to know that they can make changes to their directives if their preferences or circumstances change.
Choice C Reason:
"I should choose a family member as my health care proxy." This statement is incorrect. While selecting a family member as a health care proxy is a common choice, it may not necessarily indicate an understanding of advance directives. The key aspect is that the client understands the role of the health care proxy and chooses someone who can make decisions aligned with their wishes.
Choice D Reason:
"I need to have my attorney review my advance directives." This statement is incorrect. While it can be beneficial to have an attorney review advance directives for legal clarity and compliance with state laws, it is not a requirement for their validity. The statement alone does not demonstrate understanding of advance directives.
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Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Completing an incident report is inappropriate. While completing an incident report is important for documenting any errors or deviations from the standard of care, it should not be the first action taken. Assessing the client's condition takes precedence to ensure their immediate safety and well-being.
Choice B Reason:
Notifying the provider is inappropriate. Notifying the provider may be necessary, but it should not be the first action taken. Initially, the nurse should assess the client's condition to determine if any adverse effects have occurred as a result of the additional medication dose.
Choice C Reason:
Informing the nursing supervisor is inappropriate. Informing the nursing supervisor may be appropriate, especially if further actions or investigations are needed. However, the immediate priority is to assess the client's condition to ensure their safety.
Choice D Reason:
Observing the client's condition is appropriate. The nurse should first assess the client's condition to determine if any adverse effects have occurred due to the additional medication dose. This assessment helps identify any immediate concerns that require intervention. Based on the client's condition, further actions such as notifying the provider or completing an incident report may be warranted. However, observing the client's condition is the initial and most immediate action to take.
Correct Answer is A
Explanation
Choice A Reason:
A client who is at risk for pressure ulcers and has an albumin level of 4.2 g/dL is correct. This client has multiple risk factors for developing pressure ulcers, including a low albumin level. An interdisciplinary conference would be beneficial to involve various healthcare professionals, such as wound care specialists, dietitians, and physical therapists, to develop a comprehensive plan of care to prevent and manage pressure ulcers.
Choice B Reason:
A client who has Type 1 diabetes and uses an insulin pump is incorrect. While managing Type 1 diabetes requires coordination among healthcare providers, the use of an insulin pump alone may not necessitate an interdisciplinary conference unless there are specific concerns or issues that require input from multiple disciplines.
Choice C Reason:
A client who is receiving heparin and has an aPTT of 34 seconds is incorrect. Monitoring heparin therapy and adjusting doses based on laboratory values such as activated partial thromboplastin time (aPTT) is typically within the purview of the nursing and medical team. An interdisciplinary conference may not be necessary unless there are complications or concerns that require input from other healthcare professionals.
Choice D Reason:
A client who has orthostatic hypotension and is receiving IV fluids is incorrect. Orthostatic hypotension and IV fluid management are often managed primarily by the nursing and medical team. While input from other disciplines may be valuable in certain cases, it may not warrant scheduling an interdisciplinary conference unless there are specific complexities or challenges that require input from multiple disciplines.
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