A nurse is caring for a client who has named someone to serve as their health care proxy. The client states they need clarification about this part of the advance directive.
Which of the following statements by the client indicates that need for clarification?

Choice A rationale

Hypertension is a major modifiable risk factor for the progression of polycystic kidney disease (PKD) to end-stage renal disease (ESRD). Uncontrolled blood pressure exacerbates glomerular damage and accelerates the decline in renal function. Effective blood pressure control, often targeting specific parameters, significantly reduces the strain on kidneys, preserving nephron function and delaying ESRD.

Choice B rationale

While blood glucose control is crucial for clients with diabetes to prevent diabetic nephropathy, it is not the primary or most important intervention for slowing the progression of polycystic kidney disease (PKD). PKD is an inherited disorder characterized by cyst formation, and its progression is mainly driven by factors like hypertension.

Choice C rationale

Fluid restriction is generally not a primary intervention for slowing the progression of polycystic kidney disease (PKD). In fact, maintaining adequate hydration is often encouraged to prevent dehydration and reduce the risk of kidney stone formation, which can be a complication in PKD. Fluid management is individualized based on kidney function.

Choice D rationale

Pain management is important for comfort in clients with polycystic kidney disease (PKD) dueating to cyst enlargement or complications. However, managing pain does not directly slow the progression of the underlying disease process to end-stage renal disease (ESRD). The primary focus for slowing progression is on managing factors that directly impact renal function.

Choice A rationale

The statement "I can change who I designate as my health care proxy at any time" indicates a correct understanding. A health care proxy designation is a revocable document, meaning the individual can modify or revoke their chosen proxy at any point, provided they have the decisional capacity to do so, reflecting their evolving wishes.

Choice B rationale

The statement "The health care proxy does not go into effect until I am incapable of making decisions" indicates a correct understanding. A health care proxy's authority is activated only when the principal is deemed medically incapacitated and unable to communicate their own healthcare decisions, preserving patient autonomy while capable.

Choice C rationale

The statement "If I become incapacitated, end-of-life choices will be made by my proxy" indicates a correct understanding. The designated health care proxy is legally empowered to make medical decisions, including end-of-life choices, on behalf of the incapacitated individual, aligning with the patient's previously expressed wishes or acting in their best interest.

Choice D rationale

The statement "I have to choose a family member as my health care proxy" indicates a need for clarification. While many individuals choose a family member, the law does not restrict the choice of a health care proxy to family members only. A person can designate any trusted adult, such as a friend, as their proxy, as long as they are competent and willing to serve. .