The Safe & Effective Care
Environment: The
Management of Care Practice
Questions
1. You are caring for a client at the end of life. The client tells
you that they are grateful for having considered and decided
upon some end of life decisions and the appointments of
those who they wish to make decisions for them when they
are no longer able to do so. During this discussion with the
client and the client’s wife, the client states that “my wife
and I are legally married so I am so glad that she can
automatically make all healthcare decisions on my behalf
without a legal durable power of attorney when I am no
longer able to do so myself” and the wife responds to this
statement with, “that is not completely true. I can only make
decisions for you and on your behalf when these decisions
are not already documented on your advance directive.” How
should you, as the nurse, respond to and address this
conversation between the husband and wife and the end of
life?
A. You should respond to the couple by stating that only unanticipated
treatments and procedures that are not included in the advance
directive can be made by the legally appointed durable power of
attorney for healthcare decisions.
B. You should be aware of the fact that the wife of the client has a knowledge
deficit relating to advance directives and durable powers of attorney for
, healthcare decisions and plan an educational activity to meet this learning
need.
C. You should be aware of the fact that the client has a knowledge deficit
relating to advance directives and durable powers of attorney for healthcare
decisions and plan an educational activity to meet this learning need.
D. You should reinforce the wife’s belief that legally married spouses
automatically serve for the other spouse’s durable power of attorney for
health care decisions and that others than the spouse cannot be legally
appointed while people are married
Correct Response: A
You should respond to the couple by stating that only unanticipated treatments
and procedures that are not included in the advance directive can be made by the
legally appointed durable power of attorney for healthcare decisions.
Both the client and the client’s spouse have knowledge deficits relating to advance
directives. Legally married spouses do not automatically serve for the other
spouse’s durable power of attorney for health care decisions; others than the
spouse can be legally appointed while people are married.
2. The Patient Self Determination Act of the United States
protects clients in terms of their rights to what? Select all that
apply.
A. Privacy and to have their medical information confidential unless the client
formally approves the sharing of this information with others such as family
members.
B. Make healthcare decisions and to have these decisions protected and
communicated to others when they are no longer competent to do so.
, C. Be fully informed about all treatments in term of their benefits, risks and
alternatives to them so the client can make a knowledgeable and informed
decision about whether or not to agree to having it
D. Make decisions about who their health care provider is without any
coercion or undue influence of others including healthcare providers.
Correct Response: B, D
The Patient Self Determination Act, which was passed by the US Congress in 1990,
gives Americans the right to make healthcare decisions and to have these decisions
protected and communicated to others when they are no longer competent to do
so. These decisions can also include rejections for future care and treatment and
these decisions are reflect in advance directives. This Act also supports the rights of
the client to be free of any coercion or any undue influence of others including
healthcare providers.
The Health Insurance Portability and Accountability Act (HIPAA) supports and
upholds the clients’ rights to confidentially and the privacy of their medical related
information regardless of its form. It covers hard copy and electronic medical
records unless the client has formally approved the sharing of this information with
others such as family members.
The elements of informed consent which includes information about possible
treatments and procedures in terms of their benefits, risks and alternatives to them
so the client can make a knowledgeable and informed decision about whether or
not to agree to having it may be part of these advanced directives, but the law that
protects these advance directives is the Patient Self Determination Act.
3. Your client is in the special care area of your hospital with
multiple trauma and severe bodily burns. This 45 year old
male client has an advance directive that states that the
client wants all life saving measures including
cardiopulmonary resuscitation and advance cardiac life
support, including mechanical ventilation. As you are caring
for the client, the client has a complete cardiac and
respiratory arrest. This client has little of no chance for
survival and they are facing imminent death according to
, your professional judgement, knowledge of pathophysiology
and your critical thinking. You believe that all life saving
measures for this client would be futile. What is the first thing
that you, as the nurse, should do?
A. Call the doctor and advise them that the client’s physical status has
significantly changed and that they have just had a cardiopulmonary arrest.
B. Begin cardiopulmonary resuscitation other emergency life saving
measures.
C. Notify the family of the client’s condition and ask them what they should be
done for the client.
D. Insure that the client is without any distressing signs and symptoms at the
end of life.
Correct Response: B
You must immediately begin cardiopulmonary resuscitation and all life saving
measures as requested.by the client in their advance directive despite the nurse’s
own beliefs and professional opinions. Nurses must uphold the client’s right to
accept, choose and reject any and all of treatments, as stated in the client’s advance
directive.
You would not call the doctor first; your priority is the sustaining of the client’s life;
you would also not immediately notify the family for the same reason and, when
you do communicate with the family at a later time, you would not ask them what
should or should not be done for the client when they wishes are already contained
in the client’s advance directive.
Finally, you would also insure that the client is without pain and all other distressing
signs and symptoms at the end of life, but the priority and the first thing that you
would do is immediately begin cardiopulmonary resuscitation and all life saving
measures as requested by the client in their advance directive, according to the
ABCs and Maslow’s Hierarchy of Needs.
4. You are caring for a high risk pregnant client who is in a life
threatening situation. The fetus is also at high risk for death.
Environment: The
Management of Care Practice
Questions
1. You are caring for a client at the end of life. The client tells
you that they are grateful for having considered and decided
upon some end of life decisions and the appointments of
those who they wish to make decisions for them when they
are no longer able to do so. During this discussion with the
client and the client’s wife, the client states that “my wife
and I are legally married so I am so glad that she can
automatically make all healthcare decisions on my behalf
without a legal durable power of attorney when I am no
longer able to do so myself” and the wife responds to this
statement with, “that is not completely true. I can only make
decisions for you and on your behalf when these decisions
are not already documented on your advance directive.” How
should you, as the nurse, respond to and address this
conversation between the husband and wife and the end of
life?
A. You should respond to the couple by stating that only unanticipated
treatments and procedures that are not included in the advance
directive can be made by the legally appointed durable power of
attorney for healthcare decisions.
B. You should be aware of the fact that the wife of the client has a knowledge
deficit relating to advance directives and durable powers of attorney for
, healthcare decisions and plan an educational activity to meet this learning
need.
C. You should be aware of the fact that the client has a knowledge deficit
relating to advance directives and durable powers of attorney for healthcare
decisions and plan an educational activity to meet this learning need.
D. You should reinforce the wife’s belief that legally married spouses
automatically serve for the other spouse’s durable power of attorney for
health care decisions and that others than the spouse cannot be legally
appointed while people are married
Correct Response: A
You should respond to the couple by stating that only unanticipated treatments
and procedures that are not included in the advance directive can be made by the
legally appointed durable power of attorney for healthcare decisions.
Both the client and the client’s spouse have knowledge deficits relating to advance
directives. Legally married spouses do not automatically serve for the other
spouse’s durable power of attorney for health care decisions; others than the
spouse can be legally appointed while people are married.
2. The Patient Self Determination Act of the United States
protects clients in terms of their rights to what? Select all that
apply.
A. Privacy and to have their medical information confidential unless the client
formally approves the sharing of this information with others such as family
members.
B. Make healthcare decisions and to have these decisions protected and
communicated to others when they are no longer competent to do so.
, C. Be fully informed about all treatments in term of their benefits, risks and
alternatives to them so the client can make a knowledgeable and informed
decision about whether or not to agree to having it
D. Make decisions about who their health care provider is without any
coercion or undue influence of others including healthcare providers.
Correct Response: B, D
The Patient Self Determination Act, which was passed by the US Congress in 1990,
gives Americans the right to make healthcare decisions and to have these decisions
protected and communicated to others when they are no longer competent to do
so. These decisions can also include rejections for future care and treatment and
these decisions are reflect in advance directives. This Act also supports the rights of
the client to be free of any coercion or any undue influence of others including
healthcare providers.
The Health Insurance Portability and Accountability Act (HIPAA) supports and
upholds the clients’ rights to confidentially and the privacy of their medical related
information regardless of its form. It covers hard copy and electronic medical
records unless the client has formally approved the sharing of this information with
others such as family members.
The elements of informed consent which includes information about possible
treatments and procedures in terms of their benefits, risks and alternatives to them
so the client can make a knowledgeable and informed decision about whether or
not to agree to having it may be part of these advanced directives, but the law that
protects these advance directives is the Patient Self Determination Act.
3. Your client is in the special care area of your hospital with
multiple trauma and severe bodily burns. This 45 year old
male client has an advance directive that states that the
client wants all life saving measures including
cardiopulmonary resuscitation and advance cardiac life
support, including mechanical ventilation. As you are caring
for the client, the client has a complete cardiac and
respiratory arrest. This client has little of no chance for
survival and they are facing imminent death according to
, your professional judgement, knowledge of pathophysiology
and your critical thinking. You believe that all life saving
measures for this client would be futile. What is the first thing
that you, as the nurse, should do?
A. Call the doctor and advise them that the client’s physical status has
significantly changed and that they have just had a cardiopulmonary arrest.
B. Begin cardiopulmonary resuscitation other emergency life saving
measures.
C. Notify the family of the client’s condition and ask them what they should be
done for the client.
D. Insure that the client is without any distressing signs and symptoms at the
end of life.
Correct Response: B
You must immediately begin cardiopulmonary resuscitation and all life saving
measures as requested.by the client in their advance directive despite the nurse’s
own beliefs and professional opinions. Nurses must uphold the client’s right to
accept, choose and reject any and all of treatments, as stated in the client’s advance
directive.
You would not call the doctor first; your priority is the sustaining of the client’s life;
you would also not immediately notify the family for the same reason and, when
you do communicate with the family at a later time, you would not ask them what
should or should not be done for the client when they wishes are already contained
in the client’s advance directive.
Finally, you would also insure that the client is without pain and all other distressing
signs and symptoms at the end of life, but the priority and the first thing that you
would do is immediately begin cardiopulmonary resuscitation and all life saving
measures as requested by the client in their advance directive, according to the
ABCs and Maslow’s Hierarchy of Needs.
4. You are caring for a high risk pregnant client who is in a life
threatening situation. The fetus is also at high risk for death.
