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A nurse is providing information to a client about durable power of attorney. The nurse should include that durable power of attorney is enforceable under which of the following conditions?

A.

The client is incapable of providing self-care.

B.

The client is terminally ill.

C.

The client is unable to express their wishes.

D.

The client has refused treatment.

Answer and Explanation

The Correct Answer is C

Choice A Reason:

 

The condition that the client is incapable of providing self-care does not necessarily make a durable power of attorney enforceable. While incapacity can be a factor, the key aspect is the client’s ability to make decisions. A durable power of attorney becomes effective when the client is unable to make their own decisions, not merely when they are unable to provide self-care.

 

Choice B Reason:

 

Being terminally ill does not automatically make a durable power of attorney enforceable. The enforceability of a durable power of attorney is based on the client’s decision-making capacity. While terminal illness might lead to incapacity, it is the inability to make decisions that triggers the use of the durable power of attorney.

 

Choice C Reason:

 

A durable power of attorney is specifically designed to be enforceable when the client is unable to express their wishes. This legal document allows the designated agent to make decisions on behalf of the client when they are incapacitated and unable to communicate their preferences. This ensures that the client’s affairs are managed according to their wishes, even when they cannot express them.

 

Choice D Reason:

 

The refusal of treatment by the client does not make a durable power of attorney enforceable. The enforceability is related to the client’s capacity to make decisions. If a client is still capable of making informed decisions, even if they refuse treatment, the durable power of attorney does not come into effect.


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View Related questions

Correct Answer is A

Explanation

Choice A Reason

Waiting 5 minutes between the administration of each medication is the most appropriate action. This allows each medication to be absorbed properly without being washed away by the subsequent drops. Adequate absorption ensures that each medication can exert its therapeutic effect effectively.

Choice B Reason

Asking the client to close their eyes tightly after instilling each medication is not recommended. This action can force the medication out of the eye, reducing its effectiveness. Instead, clients should be advised to close their eyes gently to allow the medication to spread evenly across the eye surface.

Choice C Reason

Holding the dropper 3 cm (1.2 in) away from the client’s eye is too far. The recommended distance is about 1 to 2 cm (0.4 to 0.8 in) to ensure that the drops are accurately placed in the conjunctival sac without touching the eye or eyelashes, which could cause contamination.

Choice D Reason

Massaging the client’s eyelids for 20 seconds after instillation is not a standard practice for administering ophthalmic drops. This action could potentially irritate the eye or cause discomfort. Instead, gentle pressure can be applied to the inner corner of the eye (nasolacrimal duct) for a few seconds to prevent the medication from draining into the tear duct.

Correct Answer is D

Explanation

Choice A reason:

“Use a size 20 French catheter for catheterization.” This statement is incorrect. Using a larger catheter size, such as 20 French, can increase the risk of trauma and infection. It is generally recommended to use the smallest catheter size possible to minimize the risk of catheter-associated urinary tract infections (CAUTIs) and other complications.

Choice B reason:

“Allow the drainage bag to fill completely before emptying.” This statement is incorrect. Allowing the drainage bag to fill completely can increase the risk of infection and cause backflow of urine into the bladder. It is recommended to empty the drainage bag when it is two-thirds full to prevent these issues.

Choice C reason:

“Disconnect the drainage tube if the catheter requires irrigation.” This statement is incorrect. Disconnecting the drainage tube can break the closed system and increase the risk of infection. If irrigation is necessary, it should be done using a closed system to maintain sterility and reduce the risk of CAUTIs.

Choice D reason:

“Keep the collection bag below bladder level.” This statement is correct. Keeping the collection bag below bladder level helps prevent backflow of urine into the bladder, which can reduce the risk of infection. This practice is a key component of preventing CAUTIs and is recommended in clinical guidelines.

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