NCLEX Review – 43 pages

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NCLEX Review – 43 pages

 Part I: Subject Area Review Chapters

3. An advance directive is written and notarized according to law in the state of Colorado. This document is legal

and binding:

1. internationally.

2. in the state of Colorado only.

3. in the continental United States.

4. in the county of origination only.

(2) Choices 1, 3, and 4 are incorrect; advance directive protocols and documents are defined by each state.

4. The authority conveyed to a Power of Attorney is revocable by:

1. a primary care physician.

2. a court proceeding.

3. the family if all members agree.

4. the person who originally delegated the authority following proper documentation procedures.

(4) Only the person who delegates authority has the legal right to revoke the authority. Choices 1, 2, and 3, therefore,

are incorrect.

5. Copies of advance care directives should be:

1. kept in a safe or safe deposit box only.

2. given to the attorney responsible for preparing the documents.

3. provided to each healthcare institution upon entry for services.

4. kept as private and confidential documents.

(3) Each healthcare facility is required to have advance directives on file. Choices 1, 2, and 4 are incorrect as advance

directives are not considered confidential information. They are to be shared information in order to ensure their direction

will be followed.

6. The legal age for expressing one’s wishes through an advance directive is:

1. 21 years.

2. 18 years.

3. 65 years.

4. Any age.

(2) Eighteen years of age is the minimum legal age for establishing advance directives.

7. A patient is “competent” when he/she is:

1. able to understand risks and benefits of treatment options and manipulate the information rationally.

2. able to sign a consent form.

3. is oriented to person, place, and time.

4. is able to physically take care of him/herself.

(1) 2, 3, and 4 are incorrect. An individual can sign his name on a form without higher level comprehension of what he

is signing, it’s appropriateness, and so on. Orientation is one aspect of cognitive function that does not support decision

making, concrete thinking, and problem solving. An individual may be able to perform basic activities of daily living

(ADLs) but still have impaired thought processes, judgment, and decision making, which are also important factors in

competency determination.

8. The night before an elective surgery, a client asks the nurse why he was asked to complete an advance directive

on admission. The nurse’s best response is:

1. “It’s just a formality.”

2. “This form helps the care team understand your wishes so we won’t be sued.”

3. “It is a legal requirement that all clients entering the hospital have the opportunity to express their wishes

through an advance directive.”

4. “Are you worried that you might not live through your surgery?”

(3) All patients entering the hospital for any reason are asked to complete advance directives according to JCAHO

standards. Choices 1, 2, and 4 are incorrect. Advance directives are more than a formality as they give guidance to

treatment based on the individual’s wishes. The guiding ethical principle is patient autonomy, not liability protection

for the healthcare providers. Choice 4 is an inappropriate response by the nurse as it reflects that she did not understand

or interpret the patient’s original question.

9. As the nurse caring for Mrs. Peet, you discover during her admission assessment that she does not have advance

directives. She asks whether there are any specific rules about naming a Durable Power of Attorney for

Healthcare (DPOAHC) or document requirements. You accurately answer:

1. “A person designated DPOAHC must be a family member.”

2. “A DPOAHC must be a lawyer.”

3. “The DPAOHC document must include the name, address, and contact information of the party named.”

4. “The individual named as DPOAHC must agree with the designee’s decisions.”

(3) The document records contact information of the party named. Choice 1, 2, and 4 are incorrect. A person named as a

DPOAHC can be anyone of choice. That person does not have to be any personal or professional relation. The DPOAHC

does not have to agree with the designee’s decisions but be willing and able to speak for them should decisions regarding

care be needed.

10. For individuals who are no longer capable of speaking for themselves, the order of surrogacy for their healthcare

decision making is:

1. guardian, DPOAHC, spouse, adult children of patient, parents of patient, adult brothers and sisters of patient.

2. spouse, DPOAHC, parents of patient, adult children of patient.

3. DPOAHC, spouse, adult children of patient, adult brothers and sisters of the patient.

4. spouse, guardian, adult children of patient, DPOAHC.

(1) Choices 2, 3, and 4 are incorrect according to state law definitions.

11. In the relationship between DNR orders and advance directives (AD), all of the following are true except:

1. an AD may help a physician decide whether a DNR order is the “right” decision for a particular patient.

2. it can be assumed that a patient with an AD is a DNR.

3. an AD is not necessary in order for a physician to write a DNR order (with the exception of New York State).

4. a hospital-based DNR order should not require the patient’s or family’s signature but does require the

physician’s signature.

(2) It is NOT a correct assumption that a patient with an AD is a DNR. Choices 1, 3, and 4 are true as written.

12. Patient self-determination is the primary focus of:

1. malpractice insurance.

2. nursing’s advocacy for patients.

3. confidentiality.

4. healthcare.

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NCLEX Review – 43 pages