The Safe & Effective Care Environment: The

Management of Care Practice Questions 1

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. Clinical decisions are being made that concern you
because some of these treatments and life saving measures
promote the pregnant woman’s life at the same time that
they significantly jeopardize the fetus’ life and viability and
other decisions can preserve the fetus’s life at the expense of
the pregnant woman’s life. Which role of the nurse is the
priority at this time?

A. Case manager
B. Collaborator
C. Coordinator of care
D. Advocacy

Correct Response: D
The priority role of the nurse is advocacy. The nurse must serve as the
advocate for both the fetus and the mother at risk as the result of this
ethical dilemma where neither option is desirable. As an advocate, the
nurse would seek out resources and people, such as the facility’s
ethicist or the ethics committee, to resolve this ethical dilemma.

5. A nurse who organizes and establishes a political action

committee (PAC) in their local community to address issues
relating to the accessibility and affordability of healthcare
resources in the community is serving in which capacity and
role of the registered nurse?

A. Client advocate
B. Collaborator
C. Politician
D. Entrepreneur

Correct Response: A
A nurse who organizes and establishes a political action committee
(PAC) in their local community to address issues relating to the
accessibility and affordability of healthcare resources in the community
is serving as the client advocate. As you should know, the definition of
“client” includes not only individual clients, and families as a unit, but
also populations such as the members of the local community.
Although the nurse, as the organizer of this political action committee
(PAC), will have to collaborate with members of the community to
promote the accessibility and affordability of healthcare resources in
the community, this is a secondary role rather than the primary role.
Additionally, although the nurse is serving in a political advocacy
effort, the nurse is not necessarily a politician and there is no evidence
that this nurse is an entrepreneur.