A nurse is caring for an older adult client who has advanced dementia and needs a blood transfusion. The client previously designated her adult daughter on a durable power of attorney for health care form, and the daughter refuses the treatment. Which of the following actions should the nurse take?
Respect the daughter's decision to refuse the transfusion.
Encourage the daughter to let her mother have the transfusion.
Discuss taking guardianship of the client with the facility administration.
Ask the provider to give consent for the transfusion.
The Correct Answer is A
A. Respecting the daughter's decision to refuse the transfusion aligns with the principles of patient autonomy and the authority granted through the durable power of attorney for health care, meaning the daughter's wishes must be followed.
B. Encouraging the daughter to allow the transfusion would undermine her role as the decision-maker and may cause unnecessary conflict, making this option inappropriate.
C. Discussing guardianship is not necessary or appropriate in this context, as the daughter has already been designated as the decision-maker, which negates the need for additional legal intervention.
D. Asking the provider to give consent for the transfusion contradicts the authority granted to the daughter, as she is the legally recognized decision-maker and has already made her choice.
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Correct Answer is D
Explanation
A. Using only room numbers for client identification does not guarantee confidentiality, as room numbers can still be linked to specific individuals.
B. Logging assistive personnel into unit computers compromises security and violates confidentiality protocols. Each user should have a unique login.
C. Including a client’s name on a fax cover sheet is not recommended, as it exposes protected health information and can breach confidentiality.
D. Conducting change-of-shift report in a staff-only area protects client information from being overheard by unauthorized individuals, ensuring confidentiality.
Correct Answer is C
Explanation
A. While the nurse's notes may include observations about the client's condition, recording that an incident report was filed does not provide pertinent details regarding the client's care and is not appropriate.
B. Incident reports are confidential documents and should not be shared with the client's family, so providing a copy of the report is inappropriate.
C. Documenting the facts about the incident in the medical record is essential to provide a complete account of the client's care and any resulting changes or observations. This documentation is important for continuity of care and legal purposes.
D. Incident reports should not be placed in the medical record, as they are separate documents intended for internal review and quality assurance purposes.