A nurse is teaching a client who has an ileostomy about the care of their stoma. Which of the following statements by the client indicates an understanding of the teaching?

Choice A reason: Financial power of attorney manages monetary decisions, not health care, unless specified as a health care surrogate. Advance directives guide health decisions, but this role is distinct, making this statement incorrect under the Patient Self-Determination Act’s provisions.
Choice B reason: The Patient Self-Determination Act ensures clients’ rights to refuse treatment, even against provider recommendations, promoting autonomy through advance directives. This legal protection applies in Medicare/Medicaid facilities, making it the correct principle for end-of-life decision-making in this context.
Choice C reason: Advance directives can be changed by a competent client, even if notarized, as the Act supports ongoing autonomy. Stating they cannot be altered is incorrect, as flexibility is a core feature, making this an inaccurate representation of the law.
Choice D reason: The eldest adult child cannot change advance directives unless designated as a surrogate. The Act prioritizes the client’s documented wishes or appointed decision-maker, not family hierarchy, making this statement incorrect and misaligned with legal requirements.

Choice A reason: Maternal fever may cause fetal tachycardia, not bradycardia, as it increases metabolic demand. While fever can indicate infection, it does not directly lower FHR to 100/min, making it an incorrect cause for sustained fetal bradycardia in this scenario.
Choice B reason: Chorioamnionitis, an intrauterine infection, typically causes fetal tachycardia due to stress and inflammation, not bradycardia. While serious, it does not align with a sustained FHR of 100/min, making it incorrect for this fetal condition.
Choice C reason: Maternal hypoglycemia may cause fetal distress, but it is more likely to result in tachycardia or variable decelerations, not sustained bradycardia. Its impact on FHR is less direct, making it an incorrect primary cause for this finding.
Choice D reason: Fetal anemia reduces oxygen-carrying capacity, leading to sustained bradycardia (FHR <110/min) due to hypoxia. This condition, often from hemolytic disease or bleeding, directly causes low FHR, requiring urgent evaluation, making it the correct cause.