The Safe & E¦ective 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.

SHARES

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.

SHARES

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.