Nclexrn Quiz: Advance Directives And Surrogate Decision Making
20 questions · exam conditions
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Advance Directives And Surrogate Decision MakingQuestion 1 of 20

A 57-year-old client is found unresponsive at home and is admitted with an intracranial hemorrhage. The client has a wallet card stating a health care proxy, but the proxy cannot be reached; the client's neighbor arrives and offers to make decisions. Current assessment: blood pressure 176/96 mm Hg, heart rate 62/min, irregular respirations, Glasgow Coma Scale score 6. How should the nurse proceed if the surrogate decision-maker is unavailable?

Accept the neighbor as the surrogate because they are present and willing
Ask the neighbor to sign consent for neurosurgery to prevent delays
Stop all interventions until the proxy is reached to avoid violating autonomy
Continue urgent stabilization measures as ordered and follow facility policy to identify an appropriate decision-maker while attempting to reach the proxy
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Nclexrn Quiz: Advance Directives And Surrogate Decision Making

Practice Advance Directives And Surrogate Decision Making in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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This quiz focuses on Advance Directives And Surrogate Decision Making, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

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Question 1

A 57-year-old client is found unresponsive at home and is admitted with an intracranial hemorrhage. The client has a wallet card stating a health care proxy, but the proxy cannot be reached; the client's neighbor arrives and offers to make decisions. Current assessment: blood pressure 176/96 mm Hg, heart rate 62/min, irregular respirations, Glasgow Coma Scale score 6. How should the nurse proceed if the surrogate decision-maker is unavailable?

  1. Accept the neighbor as the surrogate because they are present and willing
  2. Ask the neighbor to sign consent for neurosurgery to prevent delays
  3. Stop all interventions until the proxy is reached to avoid violating autonomy
  4. Continue urgent stabilization measures as ordered and follow facility policy to identify an appropriate decision-maker while attempting to reach the proxy (correct answer)
Explanation: This question tests understanding of advance directives and surrogate decision-making when non-designated individuals offer help. The priority concern is respecting client autonomy and legal guidelines by seeking the named proxy. Continuing stabilization and following policy to identify a decision-maker aligns with these principles by adhering to legal designations. Accepting the neighbor lacks authority; stopping interventions risks harm; asking the neighbor to sign is invalid. The decision-making principle is to honor specified proxies in incapacitation. This prevents unauthorized decisions. A transferable strategy is to use chain of command for locating surrogates in nursing practice.

Question 2

A 79-year-old client with advanced dementia is admitted with aspiration pneumonia. The client's advance directive requests no antibiotics and comfort-focused care; the client's son states, "Give antibiotics; Mom would want to live." Current assessment: temperature 38.6°C (101.5°F), blood pressure 102/60 mm Hg, heart rate 110/min, nonverbal and does not follow commands. What should the nurse do FIRST when the family member disagrees with the advance directive?

  1. Administer antibiotics now to avoid delay, then discuss the directive later
  2. Review the documented advance directive and notify the provider that the client requested no antibiotics, while supporting the son emotionally (correct answer)
  3. Ask the son to bring proof that he is the legal next of kin before care continues
  4. Tell the son the nurse cannot discuss the plan of care and to speak only with the provider
Explanation: This question tests understanding of advance directives and surrogate decision-making in antibiotic refusal conflicts. The priority concern is respecting client autonomy and legal guidelines by upholding the no-antibiotics request. Reviewing the directive and notifying the provider while supporting the son aligns with these principles by honoring documented wishes compassionately. Administering antibiotics ignores the directive; asking for proof escalates; refusing discussion avoids advocacy. The decision-making principle is that directives guide palliative care preferences. Nurses balance enforcement with empathy. A transferable strategy is to involve social work for family support in ethical conflicts in nursing practice.

Question 3

A 58-year-old client with terminal heart failure is receiving home hospice services and is completing paperwork to appoint a surrogate decision-maker. The client is alert and states, "I want my friend to speak for me if I can't." Current assessment: blood pressure 104/62 mm Hg, heart rate 110/min, dyspnea with minimal activity, oxygen saturation 93% on 2 L/min nasal cannula. Which nursing action is MOST appropriate when educating the client about appointing a surrogate decision-maker?

  1. Explain that the surrogate should make decisions based on the client's stated values and wishes (correct answer)
  2. Tell the client the surrogate can decide whatever is best, even if it differs from the client's preferences
  3. Instruct the client to name multiple surrogates who can all vote on decisions
  4. Advise the client to wait until the client loses capacity to select a surrogate
Explanation: This question tests understanding of advance directives and surrogate decision-making in educating about surrogate roles. The priority concern is respecting client autonomy and legal guidelines by ensuring surrogates act on client wishes. Explaining that the surrogate should base decisions on the client's values aligns with these principles by guiding proper surrogate function. Allowing surrogates to decide freely risks overriding wishes; instructing multiple surrogates complicates matters; advising delay is irresponsible. The decision-making principle is substituted judgment, where surrogates approximate client preferences. This maintains autonomy when clients cannot speak. A transferable strategy is to include role education in advance care planning discussions in nursing practice.

Question 4

A 70-year-old client with end-stage renal disease is hospitalized with fluid overload. The client is alert, has no advance directive, and says, "My kids will handle it if something happens." Current assessment: blood pressure 168/92 mm Hg, heart rate 92/min, crackles at lung bases, 2+ edema. Which action is MOST appropriate for the nurse when discussing advance directives with the client?

  1. Provide information about naming a surrogate decision-maker and encourage the client to share wishes with family (correct answer)
  2. Tell the client that the hospital will automatically choose a surrogate if the client becomes incapacitated
  3. Ask the client's adult children to complete the paperwork on the client's behalf
  4. Document that the client refused advance directives and end the conversation
Explanation: This question tests understanding of advance directives and surrogate decision-making for a client relying on family without formal designation. The priority concern is respecting client autonomy and legal guidelines by encouraging formal documentation. Providing information about naming a surrogate and encouraging sharing wishes aligns with these principles by promoting proactive planning. Telling the client the hospital chooses automatically is inaccurate; asking children to complete paperwork violates autonomy; documenting refusal ends education prematurely. The decision-making principle is that clients should designate surrogates to ensure wishes are honored. Nurses educate to facilitate this process. A transferable strategy is to assess readiness and provide tailored education for legal planning in nursing practice.

Question 5

A 67-year-old client with severe chronic obstructive pulmonary disease is admitted to the intensive care unit after respiratory failure and is now intubated and unresponsive. A valid do-not-resuscitate order and living will are on file stating the client does not want cardiopulmonary resuscitation or re-intubation if extubated. Current assessment: blood pressure 98/56 mm Hg, heart rate 112/min, oxygen saturation 92% on the ventilator; the client's adult son insists the team "do everything" if the client's heart stops. What should the nurse do FIRST when the family member disagrees with the advance directive?

  1. Ask the son to sign the hospital's revocation form so the do-not-resuscitate order is removed from the chart and resuscitation can proceed if needed.
  2. Notify the provider of the son's request for full resuscitation and ask for new orders to override the advance directive.
  3. Confirm the advance directive is in the medical record and communicate the client's documented wishes to the health care team. (correct answer)
  4. Call the hospital attorney to determine whether the son's verbal request can override the living will before making a care decision.
Explanation: The best first action is to confirm that the client's advance directive is in the medical record and then communicate the client's documented wishes to the health care team. Because the do-not-resuscitate order and living will are valid, they speak for the client now; the son's disagreement does not change their legal authority. The choice asking the son to sign a revocation form is incorrect because a family member cannot revoke a valid advance directive by signing a hospital form, and it would place the son's preference over the client's autonomy. The choice asking the provider for new orders to override the advance directive is also incorrect: a valid directive cannot be set aside simply because the family requests full resuscitation. The choice calling the hospital attorney is not the first nursing action and is unnecessary when the directive has already been verified as valid; it delays bedside advocacy. After confirming and communicating the documented wishes, the nurse can support the son and, if needed, involve an ethics committee.

Question 6

A 77-year-old client with moderate dementia is admitted from a long-term care facility for aspiration pneumonia. Assessment: confused, intermittently follows commands, temperature 101.3°F (38.5°C), heart rate 110/min, blood pressure 100/58 mm Hg, oxygen saturation 90% on 2 L/min nasal cannula. The client has an advance directive requesting comfort-focused care only, but the client's son insists on transfer to the intensive care unit and "all possible treatments." What should the nurse do FIRST when the family member disagrees with the advance directive?

  1. Explain to the son that the advance directive guides care and notify the provider of the disagreement (correct answer)
  2. Begin preparing the client for transfer to the intensive care unit because the son is family and may direct care
  3. Tell the son to obtain a court order to change the advance directive before treatment decisions are made
  4. Ask the nurse assistant to obtain the son's written consent for aggressive treatment and prepare the transfer paperwork
Explanation: The client's advance directive requests comfort-focused care, and this documented wish continues to guide treatment even when a family member disagrees. The nurse's first action is to explain that to the son and notify the provider so the conflict can be addressed in a timely, coordinated way, such as a family conference or ethics consultation. Preparing the client for ICU transfer is wrong because it treats the son's request as overriding the advance directive; a surrogate's authority is limited by the client's documented wishes. Telling the son to obtain a court order is not the nurse's appropriate first step and wrongly suggests that a family member can change an advance directive through the courts. Asking the nurse assistant to obtain the son's signature is also incorrect: informed consent cannot be delegated to assistive personnel, and consent for aggressive treatment would contradict the comfort-focused directive. The nurse should uphold the directive, keep the son informed, and involve the provider early while continuing to provide comfort measures.

Question 7

A 70-year-old client with advanced chronic obstructive pulmonary disease is admitted with worsening respiratory distress. Assessment: anxious, using accessory muscles, oxygen saturation 86% on 4 L/min nasal cannula, heart rate 118/min, blood pressure 156/88 mm Hg. The client has a do-not-resuscitate (DNR) order in the chart but also has an advance directive that is difficult to interpret regarding intubation. The client is now too short of breath to speak in full sentences. What is the PRIORITY nursing action when a client's advance directive is unclear?

  1. Clarify the client's current wishes if possible and promptly notify the provider to review goals of care before initiating non-emergent interventions (correct answer)
  2. Assume the client would refuse intubation because the DNR order represents a clear preference to limit aggressive treatment, even though the advance directive itself is unclear
  3. Ask the respiratory therapist to determine whether intubation aligns with the advance directive and to communicate that decision to the health care team
  4. Wait until the client's family arrives to interpret the advance directive together and then ask the family to authorize intubation if it becomes necessary
Explanation: When an advance directive is unclear and the client is too breathless to speak in full sentences, the nurse should first try to clarify the client's current wishes if possible and promptly notify the provider so goals of care can be reviewed before any non-emergent intervention. This protects autonomy while avoiding dangerous delay. The option that assumes a DNR means the client would refuse intubation is wrong because a DNR order applies only to cardiopulmonary resuscitation and does not by itself establish a preference about intubation. Asking the respiratory therapist to decide whether intubation aligns with the directive is also wrong: interpreting an advance directive and setting goals of care is not within the respiratory therapist's scope, and the provider must be involved. Waiting until family arrives and asking family to authorize intubation is wrong because it delays care in acute respiratory distress; the provider needs to be notified now, and family members may not be the legal surrogate or may not know the client's values.

Question 8

A 63-year-old client with a massive stroke is unresponsive in the intensive care unit. A durable power of attorney for health care is on file naming the client's partner as surrogate; the client's adult child states, "I'm the next of kin, so I decide." Current assessment: blood pressure 154/84 mm Hg, heart rate 78/min, irregular respirations, no gag reflex. What should the nurse do FIRST when the family member disagrees with the advance directive?

  1. Follow the decisions of the adult child as next of kin in order to prevent conflict with the family.
  2. Verify the surrogate document in the chart and reinforce that the named surrogate is the decision-maker. (correct answer)
  3. Ask the provider to obtain consent from both the partner and the adult child before the next treatment decision.
  4. Ask the ethics committee whether the adult child can overrule the durable power of attorney before the plan of care continues.
Explanation: The durable power of attorney for health care is already on file and names the client's partner as the surrogate, so the adult child's next-of-kin claim does not override it. The nurse's first action is to verify that document in the chart and reinforce that the named partner is the legal decision-maker. Following the adult child's choice to prevent family conflict substitutes a family claim for the client's documented choice. Asking the provider for consent from both the partner and the adult child incorrectly gives the child an equal legal role the directive does not create. Asking the ethics committee whether the adult child can overrule the durable power of attorney treats a valid directive as an open question and delays the legally authorized process. The named surrogate remains the patient's voice for health care decisions.

Question 9

A 68-year-old client is admitted for acute heart failure exacerbation and is alert and oriented. The client has no advance directive and says, "I don't want to think about that." Current assessment: blood pressure 160/88 mm Hg, heart rate 96/min, shortness of breath on exertion, oxygen saturation 94% on 2 L/min nasal cannula. Which action is MOST appropriate for the nurse when discussing advance directives with the client?

  1. Document the client's refusal of care, note that advance directives were declined, and avoid further discussion during this admission period
  2. Insist that the client complete the advance directive forms before receiving any further treatment for the heart failure exacerbation
  3. Ask the client's spouse to decide on the client's code status now, despite the client being alert and oriented
  4. Acknowledge the client's feelings, explain that completing an advance directive is voluntary, and offer to revisit the topic later (correct answer)
Explanation: The client is alert and oriented and has not made an advance directive. When the client declines to discuss it, the nurse must respect that choice while keeping the door open. The correct action is to acknowledge the client's feelings, explain that advance directives are voluntary, and offer to revisit the topic later. This approach honors patient autonomy and avoids coercion. The other options are incorrect. Documenting that the client is refusing care because they declined the advance directive discussion misrepresents the situation; the client only refused that discussion, not all care. Insisting that the client complete the forms before further treatment is coercive and violates voluntariness. Asking the spouse to decide when the client is alert and oriented disregards the client's own decision-making capacity. Therefore, the nurse should respect the client's current preference and provide an opportunity to discuss it later.

Question 10

A 77-year-old client with chronic kidney disease is admitted with hyperkalemia and is intermittently confused. The client has an advance directive, but the document is difficult to interpret and does not clearly address dialysis decisions; the spouse states, "He never wanted machines," while the adult daughter states, "He wanted dialysis." Current assessment: blood pressure 138/74 mm Hg, heart rate 56/min, peaked T waves on telemetry, oriented to person only. What is the PRIORITY nursing action when a client's advance directive is unclear?

  1. Delay interventions until the family reaches agreement about dialysis despite the current ECG changes and low heart rate
  2. Ask the spouse to make the final decision immediately because the spouse is present and can interpret the client's earlier statements
  3. Assume the client refused dialysis because the spouse mentioned "machines" when describing the advance directive rather than the daughter's account of wanting dialysis
  4. Notify the provider of the urgent clinical findings and request clarification of goals of care while treating the hyperkalemia per protocol (correct answer)
Explanation: In this emergency, the client has bradycardia and peaked T waves, so hyperkalemia is immediately life-threatening. Because the advance directive is unclear and family members disagree about dialysis, the nurse's first duty is to address the unstable clinical status while getting direction from the provider about goals of care. Notifying the provider of the findings and treating hyperkalemia per protocol simultaneously satisfies both obligations. Delaying care until the whole family agrees is unsafe because waiting can worsen arrhythmias; family consensus is not required before emergency treatment. Asking the spouse to make a final decision is flawed because the spouse's authority as surrogate is not established and the daughter's account conflicts with the spouse's, so a unilateral family decision does not resolve the ambiguity. Assuming the client refused dialysis based on the spouse's word "machines" ignores the unclear document and the opposing account; a nurse cannot infer wishes from a single phrase. Thus, the priority is to stabilize the client and obtain provider clarification rather than act on an ambiguous family statement.

Question 11

A 69-year-old client with advanced amyotrophic lateral sclerosis is hospitalized for aspiration pneumonia and is now minimally responsive. The client's advance directive requests no feeding tube; the client's spouse pleads for a feeding tube placement "so they don't starve." Current assessment: blood pressure 122/68 mm Hg, heart rate 102/min, respiratory rate 24/min, oxygen saturation 90% on 4 L/min nasal cannula. What should the nurse do FIRST when the family member disagrees with the advance directive?

  1. Explain that the advance directive should be followed and communicate the client's documented refusal of a feeding tube to the provider. (correct answer)
  2. Ask the spouse to sign consent for feeding tube placement to prevent further decline and discuss the client's caloric needs with the provider.
  3. Request a court order to determine whether the spouse can override the directive before the health care provider proceeds with a feeding tube.
  4. Delay addressing the spouse's concerns until after the feeding tube is placed, then clarify the client's values in a family meeting.
Explanation: The client's advance directive is a legal expression of the client's own treatment wishes, and it remains controlling when the client cannot speak for themselves. The directive says no feeding tube, so the spouse's emotional objection does not override the client's documented decision. The nurse should explain that the directive must be followed and inform the provider so the no-feeding-tube order is honored. Asking the spouse to sign consent, even while discussing caloric needs, treats the spouse as the decision-maker and bypasses the client's stated choice. Requesting a court order is premature and unnecessary; the valid advance directive already controls and does not require a court review. Delaying discussion until after the feeding tube has been placed allows the refused treatment to precede the conversation, leaving no meaningful chance to honor the client's wish. The correct first action is to uphold the advance directive and communicate it to the health care team.

Question 12

A 59-year-old client with metastatic lung cancer is admitted for uncontrolled pain and worsening shortness of breath. The client is alert, states, "My sister is my health care proxy," but the document is not yet in the chart; the sister cannot be reached by phone. Current assessment: blood pressure 118/70 mm Hg, heart rate 104/min, respiratory rate 26/min, oxygen saturation 88% on room air. How should the nurse proceed if the surrogate decision-maker is unavailable?

  1. Withhold all non-emergency treatments until the sister arrives to provide consent
  2. Provide comfort measures and notify the provider while continuing attempts to reach the named surrogate (correct answer)
  3. Ask the nearest available family member on the unit to make decisions immediately
  4. Request that the unit clerk contact the court to appoint a temporary guardian
Explanation: This question tests understanding of advance directives and surrogate decision-making when a surrogate is temporarily unreachable. The priority concern is respecting client autonomy and legal guidelines while providing necessary care. Providing comfort measures and notifying the provider while attempting to reach the surrogate aligns with these principles by balancing urgent needs with efforts to involve the proxy. Withholding treatments delays care; asking another family member overrides the named surrogate; requesting a guardian is premature without exhaustion of efforts. The decision-making principle is to continue essential care in emergencies while seeking the designated decision-maker. This ensures continuity without violating autonomy. A transferable strategy is to document all contact attempts and collaborate with the team for ethical dilemmas in nursing practice.

Question 13

A 72-year-old client with chronic heart failure is admitted with worsening dyspnea. The client has an advance directive but the copy in the chart is missing the final page with signatures; the family is arguing about what the client would want. Current assessment: blood pressure 106/64 mm Hg, heart rate 112/min, respiratory rate 28/min, oxygen saturation 89% on room air. What is the PRIORITY nursing action when a client's advance directive is unclear?

  1. Wait to administer oxygen until the family agrees on the plan of care
  2. Ask the loudest family member to decide to quickly end the disagreement
  3. Assume the directive is invalid and disregard it permanently
  4. Treat the client's respiratory distress and notify the provider while obtaining a complete, valid copy of the advance directive per policy (correct answer)
Explanation: This question tests understanding of advance directives and surrogate decision-making with incomplete documents. The priority concern is respecting client autonomy and legal guidelines by validating directives properly. Treating distress and obtaining a complete copy per policy aligns with these principles by ensuring accurate implementation. Asking a family member decides prematurely; assuming invalidity disregards intent; delaying oxygen harms. The decision-making principle is to verify document integrity before application. This upholds ethical standards. A transferable strategy is to collaborate with administration for document issues in nursing practice.

Question 14

A 74-year-old client with advanced dementia is admitted from a long-term care facility with sepsis. The client has a written advance directive requesting comfort-focused care only, but the client's daughter demands transfer to the intensive care unit and aggressive treatment. Current assessment: temperature 39.1°C (102.4°F), blood pressure 86/50 mm Hg, heart rate 124/min, lethargic and nonverbal. What should the nurse do FIRST when the family's wishes conflict with the client's advance directive?

  1. Explain that the client's advance directive guides care and notify the provider of the documented wishes (correct answer)
  2. Arrange an immediate family meeting and ask the daughter to persuade other relatives to agree
  3. Begin preparing the client for intensive care unit transfer to reduce delays in treatment
  4. Call risk management to determine whether the directive can be ignored during sepsis
Explanation: This question tests understanding of advance directives and surrogate decision-making in conflicts with family wishes. The priority concern is respecting client autonomy and legal guidelines by upholding a valid directive for comfort care. Explaining that the advance directive guides care and notifying the provider aligns with these principles by prioritizing the client's documented preferences over family demands. Arranging a family meeting delays action; preparing for ICU transfer ignores the directive; calling risk management is unnecessary if the directive is clear. The decision-making principle is that advance directives supersede family opinions when explicit. Nurses must communicate this compassionately to de-escalate conflicts. A transferable strategy is to reference policies and involve palliative care for end-of-life ethical issues in nursing practice.

Question 15

A 79-year-old client is admitted to a telemetry unit after a syncopal episode. Assessment: alert and oriented, heart rate 58/min, blood pressure 110/66 mm Hg, oxygen saturation 96% on room air; the client says, "I don't want my kids making decisions for me if I can't speak." The client has no advance directive on file and asks what to do. Which action is MOST appropriate for the nurse when discussing advance directives with a client?

  1. Tell the client to wait until discharge to complete any advance directive paperwork
  2. Encourage the client to name a trusted surrogate decision-maker and offer resources to document wishes according to facility policy (correct answer)
  3. Recommend the client choose the oldest child as surrogate because it avoids conflict
  4. Explain that the nurse can serve as the client's surrogate decision-maker if needed
Explanation: This question tests understanding of advance directives and surrogate decision-making, specifically helping clients designate surrogate decision-makers. The priority concern is respecting client autonomy by facilitating their ability to choose and document a trusted surrogate. Option B is correct because it empowers the client to select their own surrogate and provides resources for proper documentation according to facility requirements. Option A inappropriately delays important planning; Option C makes assumptions about family dynamics; Option D violates professional boundaries as nurses cannot serve as client surrogates. The principle is that clients should be encouraged to choose surrogates based on trust and shared values, not assumptions about family hierarchy. When clients express interest in naming surrogates, nurses should provide education about the surrogate's role, offer resources for documentation, and facilitate completion according to facility policy without influencing the choice.

Question 16

A 67-year-old client is in a coma after a motor vehicle crash and is receiving mechanical ventilation in the intensive care unit. Vital signs: temperature 99.1°F (37.3°C), heart rate 88/min, blood pressure 124/70 mm Hg, oxygen saturation 97% on the ventilator. The client's advance directive on file states they do not want cardiopulmonary resuscitation or prolonged life support if permanently unconscious. The client's brother demands full resuscitation "no matter what" and threatens to sue staff. What should the nurse do FIRST when a family member disagrees with the advance directive?

  1. Arrange a family meeting with the provider and case management to discuss the advance directive and answer the brother's concerns.
  2. Notify the charge nurse and follow facility policy to ensure the client's documented wishes are communicated and honored. (correct answer)
  3. Ask the brother to bring proof that he is the legal decision-maker before the nurse acts on his demands.
  4. Tell the brother that the nurse will follow the family's wishes to avoid conflict and document the request in the medical record.
Explanation: Notify the charge nurse and follow facility policy is the first action because a valid advance directive on file controls the client's care, even when a family member threatens legal action. The nurse must activate the chain of communication and policy so the client's documented wishes are honored. Arranging a family meeting with the provider and case management is not wrong as a later step, but it is not the immediate first step and it implies that discussion may alter a document that already reflects the client's choices. Asking the brother to bring proof that he is the legal decision-maker misdirects attention; the client's directive is already on file, and a surrogate cannot override the client's stated wishes. Telling the brother that the nurse will follow the family's wishes to avoid conflict, even while documenting the request, violates the client's autonomy and the legal protections of advance directives. The only option that protects the client, follows policy, and begins the proper chain of communication is to notify the charge nurse and follow facility policy.

Question 17

A 73-year-old client with advanced heart failure is in the emergency department with severe shortness of breath. Assessment: cannot speak full sentences, oxygen saturation 82% on nonrebreather mask, heart rate 132/min, blood pressure 168/92 mm Hg. The client has a documented DNR order and an advance directive requesting no intubation, but the client's spouse is crying and demands intubation immediately. What should the nurse do FIRST when a family member disagrees with the advance directive?

  1. Ask the spouse to leave the room so the team can proceed without interference
  2. Inform the provider of the documented wishes and advocate to follow the client's directive while providing comfort measures (correct answer)
  3. Intubate the client to stabilize first and discuss the advance directive later
  4. Request security and document the spouse's refusal to comply with the plan of care
Explanation: This question tests understanding of advance directives and surrogate decision-making during emergency situations when family members emotionally oppose documented wishes. The priority concern is respecting client autonomy while providing compassionate care during a crisis. Option B is correct because it advocates for following the client's documented wishes while ensuring comfort measures, balancing legal obligations with compassionate family support. Option A is inappropriate and potentially harmful to remove grieving family; Option C violates the client's explicit wishes; Option D escalates the situation unnecessarily. The principle is that even in emergencies, valid advance directives must be followed while supporting distressed family members with comfort measures and compassionate communication. During emotional crises when families oppose advance directives, nurses should advocate for client wishes, ensure comfort measures are maximized, provide emotional support to family, and involve appropriate team members for family support.

Question 18

An 81-year-old client with heart failure is admitted to a medical-surgical unit for shortness of breath. Assessment: alert and oriented, oxygen saturation 92% on 2 L/min nasal cannula, heart rate 104/min, blood pressure 132/74 mm Hg; the client states, "I don't have any papers about end-of-life care." The client's son is at the bedside and asks what the hospital needs "to make decisions" if the client worsens. Which action is MOST appropriate for the nurse when discussing advance directives with a client?

  1. Explain that completing an advance directive is required for admission and must be done today
  2. Provide information about advance directives and offer to contact social work to help the client complete forms if desired (correct answer)
  3. Ask the son to decide now whether the client would want cardiopulmonary resuscitation
  4. Tell the client that only the provider can discuss advance directives and end-of-life options
Explanation: This question tests understanding of advance directives and surrogate decision-making, particularly the nurse's role in educating clients about advance care planning. The priority concern is respecting client autonomy while providing appropriate information and resources. Option B is correct because it offers education and support without coercion, respecting the client's right to choose whether to complete advance directives. Option A is incorrect because advance directives are not mandatory for admission; Option C inappropriately pressures the son to make immediate decisions; Option D incorrectly limits the nurse's role in advance directive education. The principle is that nurses should provide information about advance directives and facilitate completion if desired, but never pressure or mandate participation. When discussing advance directives, nurses should offer resources, respect client readiness, and involve appropriate team members like social work for assistance.

Question 19

A 76-year-old client is admitted with a gastrointestinal bleed and becomes confused after receiving sedation for an endoscopy. The client's chart includes a do-not-resuscitate order but does not address transfusions; the spouse says, "No blood products," but the client previously stated to staff, "Do whatever you can to help me recover." Current assessment: blood pressure 90/54 mm Hg, heart rate 118/min, pale, oriented to name only. What is the PRIORITY nursing action when a client's advance directive is unclear?

  1. Ask the unlicensed assistive personnel to call the spouse and obtain consent by phone
  2. Refuse to administer blood products until the spouse signs a refusal form
  3. Proceed with transfusion because the do-not-resuscitate order implies refusal of all treatments
  4. Clarify the client's current wishes when possible and notify the provider of the conflict and missing details (correct answer)
Explanation: This question tests understanding of advance directives and surrogate decision-making when directives lack specificity. The priority concern is respecting client autonomy and legal guidelines by addressing ambiguities promptly. Clarifying the client's current wishes and notifying the provider aligns with these principles by resolving conflicts with available information. Refusing transfusions delays care; proceeding assumes refusal incorrectly; delegating to unlicensed personnel is inappropriate. The decision-making principle is to seek client input when possible for unclear directives. This ensures decisions reflect current values. A transferable strategy is to involve ethics teams for directive ambiguities in nursing practice.

Question 20

A 64-year-old client with pancreatic cancer is alert and completing paperwork to appoint a surrogate decision-maker. The client's adult daughter says, "I'll decide based on what I want for Mom." Current assessment: blood pressure 110/66 mm Hg, heart rate 98/min, reports fatigue and poor appetite. Which nursing response is MOST appropriate regarding the surrogate decision-maker's role?

  1. Tell the daughter she will be the surrogate automatically because she is the oldest child
  2. Explain that the surrogate can change the client's wishes at any time if the family disagrees
  3. Advise the client to avoid naming family members as surrogates to prevent conflict
  4. Teach that the surrogate should base decisions on the client's known wishes and values, not the surrogate's personal preferences (correct answer)
Explanation: This question tests understanding of advance directives and surrogate decision-making in clarifying surrogate responsibilities. The priority concern is respecting client autonomy and legal guidelines by educating on proper roles. Teaching that surrogates base decisions on client wishes aligns with these principles by preventing personal bias. Allowing changes if family disagrees undermines autonomy; advising against family surrogates is unhelpful; assuming automatic surrogacy is incorrect. The decision-making principle is substituted judgment to reflect client values. This ensures fidelity to autonomy. A transferable strategy is to correct misconceptions early in planning discussions in nursing practice.