A nurse on a medical-surgical unit is caring for a client who asks about advance directives and states that he wants to appoint a health care proxy. Which of the following responses should the nurse make?
"You must choose a member of your family to serve as your health care proxy."
"A health care proxy can make decisions for you when you are unable to do so."
"You should appoint a health care proxy before undergoing an invasive procedure."
"It is necessary for an attorney to approve your health care proxy."
The Correct Answer is B
A. It's not mandatory for a health care proxy to be a member of the client's family; the most important aspect is appointing someone the client trusts to make decisions on their behalf.
B. A health care proxy is someone designated by the client to make medical decisions when the client is unable to do so, based on the client's preferences and wishes.
C. While it's advisable to have an advance directive in place before procedures or when facing serious illnesses, the timing of appointing a health care proxy should not be confined to only these situations.
D. It is not necessary for an attorney to approve the appointment of a health care proxy; the client can designate someone they trust without legal counsel's approval.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. A client receiving an operation on the wrong side of the body is a serious medical error but might not inherently involve an ethical dilemma unless the decision-making process and accountability are in question.
B. A parent wanting a 14-year-old adolescent to receive radiation treatment against his will involves conflicting values of autonomy, beneficence, and parental rights,
constituting an ethical dilemma.
C. A visitor experiencing a minor burn is an incident but doesn't inherently pose an ethical dilemma.
D. A nurse witnessing another nurse administering an incorrect medication is a patient safety issue but might not inherently involve an ethical dilemma unless there are questions about reporting or intervening in the situation.
Correct Answer is B
Explanation
A. A client who has peripheral vascular disease and has an absent pedal pulse in the right foot is not the highest priority because this is a chronic condition that does not pose an
immediate threat to the client's health. The nurse should monitor the client's circulation, provide education on foot care, and encourage smoking cessation if applicable.
B. This client is at risk for urinary retention, which can lead to bladder distension,
infection, and renal damage. The nurse should assess the client's bladder, perform a
bladder scan, and notify the provider if indicated. This is the most urgent situation that requires immediate intervention.
C. A client who is newly diagnosed with pancreatic cancer and is scheduled to begin IV chemotherapy is not the highest priority because this is a planned procedure that does not require immediate action. The nurse should prepare the client for chemotherapy, provide emotional support, and teach the client about potential side effects and complications.
D. A client who has methicillin-resistant Staphylococcus aureus (MRSA) and has an
axillary temperature of 38° C (101° F) is not the highest priority because this is a sign of infection that can be managed with antibiotics and infection control measures. The nurse should administer the prescribed antibiotics, monitor the client's vital signs, and
implement contact precautions.
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