The Safe & Effective Care Environment: The Management of Care Practice Question

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: AYou 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