Chp 9 Legal & Ethical concerns
Durable Power of Attorney
surrogate health care decision maker/ health care proxy, to represent the person during any time of incapacity, must be initiated when the older adult is competent
Two staff nurses from different care areas are having lunch while discussing a difficult client care situation. Which comment demonstrates a violation in client confidentiality?
"He's worried what the results of the HIV test will be."
An 81-year-old adult suffered an ischemic stroke 6 days ago. The client has failed to regain consciousness since the event. The care team has approached the client's family to obtain their views on inserting a feeding tube. Which of the following documents will allow the family to make a decision on the parent's behalf?
A durable power of attorney for health care
An older woman of Filipino heritage has been having rectal bleeding for several months. Her physician has told the woman and her daughters that she has advanced colon cancer. Her daughters want to obtain hospice services but the client is reluctant and does not want to discuss what she feels is "beyond her control." Which of the following concerns is this client most likely experiencing?
Cultural taboo to discuss death
The nurse correctly demonstrates understanding of the difference between guardianship and durable power of attorney when making which statement?
Guardians are usually court-appointed to make decisions for a client.
In which of the following situations would a living will provide clear direction to the care and treatment of the individual involved?
Mr. Jimenez, age 84, has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive.
A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, "I feel quite well and do not wish to undergo another round of chemotherapy. " The client's children are adamantly opposed to their parent's decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action?
The client's autonomy
A client wants to stop all hemodialysis treatments and understands that this decision will hasten death. The nurse discusses the client's wishes with the healthcare provider and all treatments are cancelled. Which ethical principle did the nurse support for this client?
autonomy
An 80-year-old female must undergo surgery for a hip fracture repair. The surgeon asks the unit secretary to get the client's daughter on the phone so he can obtain telephone consent from the daughter. The nurse informs the surgeon that the client is competent and can sign her own consent form. Which ethical principle is the nurse applying in this situation?
autonomy
The family of an older client wants everything done for an acute problem however the client is "tired" and wants to "let nature take its course." What should the nurse do?
encourage the client to talk with the family about personal desires
Advanced medical directives
legal documents that allow competent older adults to document medical care they would or would not want to receive
Physician Orders for Life-Sustaining Treatment Directives (POLST)
medical directives effective for ensuring that patient preferences are known and honored in all health care settings and situations
Health care proxy
person responsible for communication of person's wishes if they become unable or incompetent to communicate decisions of care
A 76-year-old Hispanic woman has been admitted to the hospital. There are no advance directives in the chart. Which of the following questions will best prepare the nurse to begin a dialogue with this client about advance directives?
"With whom do you talk to about your health care decisions?"
A nurse discusses advance medical directives with a group of older adults at the senior citizens' center. Which of the following statements made by a member of the group indicates a need for further teaching about medical directives?
"A durable power of attorney cannot be initiated before a person is incapacitated."
A nurse in the long-term care facility plans a meeting to assist an older adult and family discuss end-of-life care options. Which of the following interventions is appropriate for the nurse to include in preparation for this event? (Select all that apply.)
- Assist the older adult to his or her wear hearing aid. - Assure that the older adult is well rested. - Obtain a private meeting room
Five Wishes
- Who you want to make care decisions for you when you cannot make them - What kind of medical treatment you want or do not want - The level of comfort you want - How you want people to treat you - What you want your loved ones to know
A group of nurses working on a medical unit are discussing ethical dilemmas that they experienced and identifying strategies to address them. Which statement about ethical decision making by the group would be most appropriate?
"Instead of making ethical decisions in isolation we should enlist the help of people like ethics committees and clergy."
An older client who is competent has signed a medical order for DNR status. The client's family strongly objects to the DNR order and asks that the order be nullified. What is the nurse's first action?
Advocate compliance with the client's wishes.
A nurse manager of a nursing care facility reviews potential health and safety interventions and outcomes with the nursing staff. Which of the following interventions places emphasis on quality of life with the best possible health and safety outcomes?
Allowing the resident with a history of falls to walk with the help of an assistant
Which is the best example of an ethical dilemma?
Nurse is forced to decide between losing her job and breaking a regulation.
An older adult client with urosepsis has become nonresponsive. The nurse is to identify the appropriate person to sign the consent forms for an invasive medical procedure. Which of the following actions by the nurse is appropriate?
Review the chart for a health care power of attorney.
A nurse plans discharge for an older woman from China who is living with her son. Which of the following should be included in this plan to indicate that the nurse understands cultural influences?
Review the discharge plans with the client and her son.
An older adult with heart failure and mild dementia states the intent to refuse low sodium diet and diuretics, stating: "It's important to me to live free, without restrictions on what I eat." The family is supportive. Which action, by the nurse, should be done first?
Assure that the client understands the consequences of this decision.
The nursing staff at an assisted living facility are learning how to safeguard themselves legally. After participating in an in-service about safeguards, which situation would indicate that the staff needs additional education?
Avoid the admission of residents who have living wills or advance directives
A gerontological nurse is reviewing a journal article describing the factors that have contributed to increasing the number and complexity of ethical dilemmas that nurses face. Which situation would the nurse identify as an important social change factor?
Greater numbers of older adults
The children of a resident of a nursing home have approached the nurse because they believe their parent is being manipulated by a person who also lives in the facility. Their parent has a diagnosis of early-stage Alzheimer disease and various comorbidities that affect mobility and function. How should the care team appraise the parent's decision-making capacity?
Her decision-making capacity should be determined according to objective criteria.
A series of transient ischemic attacks have caused an older adult to become dysphagic. Despite failing a swallowing assessment, the client is opposed to eating a minced and pureed diet and wishes to eat a regular diet. How should the care team respond to this request?
Provide the client's requested diet after ensuring the client understands the risks.
An 87-year-old woman has a history of depression and hypothyroidism. She was recently diagnosed as having breast cancer. Her daughter tells her health care provider that her mother cannot participate in decision making about her care because she is too old. Which of the following statements is true about decision-making capacity?
The older adult needs to understand the issues involved in decision making and communicate about them.
A nurse discusses the future with an older adult who has had surgery for a fractured hip and is also diagnosed as having depression. The client wavers between wanting to give up and going to rehabilitation. Which of the following questions should the nurse ask to assist the client toward values clarification?
What goals do you have for the next year?
