Examkin

Question

Difficulty: HardEthical Practice

An alert and oriented 78-year-old client with end-stage heart failure is admitted to the progressive care unit. The client explicitly requests a "Do Not Resuscitate" (DNR) status and refuses any future mechanical ventilation. The client's adult child, who is the legally designated healthcare proxy, arrives and demands that the healthcare team "do everything possible," including intubation if necessary. Which of the following ethical nursing actions should the nurse take? Select all that apply.

  1. Communicate the client's explicit end-of-life wishes to the primary healthcare provider.Answer
  2. Explain to the adult child that the healthcare proxy designation is only active if the client loses decision-making capacity.Answer
  3. Reassure the client that their right to refuse medical treatment will be respected by the healthcare team.Answer
  4. D
    Encourage the client to compromise with their child to maintain healthy family dynamics.
  5. E
    Delay processing the resuscitation status change until a hospital ethics committee can formally review the disagreement.
  6. F
    Interpret the client's refusal of life-sustaining treatment as age-related cognitive decline and defer to the proxy.

Answer

The correct actions are to communicate the client's wishes to the provider, explain the limitations of the healthcare proxy to the adult child, and reassure the client that their autonomous decisions will be respected.
The core ethical principle of autonomy guarantees a competent client the right to make their own healthcare decisions, including the refusal of life-sustaining treatment. A healthcare proxy (durable power of attorney for healthcare) only holds decision-making authority when the client is deemed legally or clinically incompetent. Therefore, the nurse must advocate for the client by ensuring their wishes are immediately communicated to the provider for formal orders, educating the family on these legal boundaries, and validating the client's autonomous choices.

Step-by-Step Solution

1
Assess the client's current competency and decision-making capacity.
The client is alert, oriented, and competent to make healthcare decisions.
Competency determines who holds the legal right to dictate the plan of care.
2
Identify the ethical conflict between the client's autonomy and the family member's demands.
The client's right to refuse treatment supersedes the adult child's wishes, as a healthcare proxy is only enacted when the client is incapacitated.
Ethical practice requires prioritizing the competent client's autonomy over surrogate demands.
3
Select interventions that advocate for the client's rights.
The nurse must notify the provider to obtain the DNR order, educate the family on legal boundaries, and support the client emotionally.
These actions directly uphold the principles of autonomy, veracity, and advocacy without causing harm or unnecessary delay.

Key Concept

Client Autonomy and Healthcare Proxy Activation
Rate this question

Topics

Ethical Practice

More questions from this topic