A nurse in a long-term care facility is assessing a client who has returned from an acute care facility following a brief illness. The nurse observes that the client is confused and agitated. Which of the following actions should the nurse take first?

Choice A Reason:
"I will have a nurse witness the signing of my living will." This statement is incorrect. While having a witness present during the signing of a living will is important for validity in some jurisdictions, the statement alone does not demonstrate an understanding of advance directives. It's essential to ensure that the client comprehends the purpose and content of the document, not just the procedural aspect.
Choice B Reason:
"I can make changes to my living will even after I sign it." This statement is correct. Understanding that living wills can be revised or updated as needed reflects comprehension of the flexibility and control that advance directives provide. It's crucial for clients to know that they can make changes to their directives if their preferences or circumstances change.
Choice C Reason:
"I should choose a family member as my health care proxy." This statement is incorrect. While selecting a family member as a health care proxy is a common choice, it may not necessarily indicate an understanding of advance directives. The key aspect is that the client understands the role of the health care proxy and chooses someone who can make decisions aligned with their wishes.
Choice D Reason:
"I need to have my attorney review my advance directives." This statement is incorrect. While it can be beneficial to have an attorney review advance directives for legal clarity and compliance with state laws, it is not a requirement for their validity. The statement alone does not demonstrate understanding of advance directives.

Choice A Reason:
"The nurse verbalizes their understanding of the plan," is important, verbalizing understanding does not necessarily guarantee successful implementation of the plan. Action is required to demonstrate competence and improvement.
Choice B Reason:
The nurse performs all tasks as specified is correct. The effectiveness of a performance improvement plan is best determined by observing whether the nurse successfully implements the specified tasks and achieves the desired improvements in their performance. Therefore, option B, "The nurse performs all tasks as specified," is the most appropriate outcome to indicate the effectiveness of the plan.
Choice C Reason:
"The nurse attends a critical thinking class," may be a component of the performance improvement plan, but attending a class alone does not necessarily indicate whether the nurse's performance has improved.
Choice D Reason:
"The nurse shares their performance plan with another nurse," is not a direct measure of the effectiveness of the plan. Sharing the plan with another nurse may demonstrate openness and willingness to seek support, but it does not necessarily indicate whether the nurse has successfully improved their performance as a result of the plan.