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

Choice A rationale

A sliding hiatal hernia occurs when the gastroesophageal junction and a portion of the stomach slide up into the chest through the diaphragm's esophageal hiatus. This displacement disrupts the lower esophageal sphincter's function, causing gastric acid to reflux into the esophagus and resulting in heartburn.

Choice B rationale

Abdominal cramping is typically associated with conditions affecting the intestines, such as irritable bowel syndrome, inflammatory bowel disease, or bowel obstruction. It is not a direct symptom of a sliding hiatal hernia, which primarily affects the stomach and esophagus.

Choice C rationale

Breathlessness or dyspnea can be a symptom of a very large hiatal hernia that compresses the lungs. However, for a standard sliding hiatal hernia, it is not a primary or expected finding. The most common manifestation is related to acid reflux.

Choice D rationale

Constipation is a condition of the large intestine and is characterized by infrequent bowel movements. It is not directly caused by a sliding hiatal hernia, as the hernia’s primary impact is on the stomach and esophagus, causing upper gastrointestinal symptoms. *.

Choice A rationale

Informed consent is a dynamic and ongoing process, not a one-time event. A client has the autonomous right to refuse a procedure at any point, even after having previously signed a consent form. This right is based on the principle of client autonomy, which states that competent individuals have the right to make decisions about their own healthcare, including the right to withdraw consent at any time. The signed form simply documents that the discussion occurred; it does not nullify the client's right to change their mind.

Choice B rationale

The ability to write is not a prerequisite for providing informed consent. A client who is unable to write can still provide verbal consent, and this is typically documented by a witness. The key components of informed consent are the client's understanding of the procedure and their voluntary agreement. As long as the client can comprehend the information and communicate their decision, they are considered capable of providing consent. A mark or a signature from a witnessed verbal consent can be used to formalize the documentation process.

Choice C rationale

A client who is blind is fully capable of providing informed consent as long as they can understand the information being presented. The nurse or healthcare provider must ensure that the information is communicated in a manner the client can comprehend, which may include reading the consent form aloud and answering any questions. The visual impairment does not compromise the client's cognitive ability to make decisions about their own healthcare, and therefore, a guardian is not required for this reason.

Choice D rationale

While a nurse can and often does clarify information, the primary responsibility for explaining surgical risks and benefits to a client lies with the surgeon or the healthcare provider performing the procedure. The physician must provide a comprehensive explanation of the procedure, including all potential risks, benefits, and alternatives, to ensure the client is fully informed. The nurse's role is to act as a witness to the signature and to ensure the client has had their questions answered, and to notify the provider if they have new questions or concerns. *.