A nurse is outlining the various levels of health care services to a group of newly licensed nurses. Which of the following examples of care or care settings should the nurse identify as tertiary care? (Select all that apply.)

Choice A reason: A living will is a legally binding document that outlines a client's preferences regarding lifesaving and end-of-life medical interventions. It becomes effective when the client is incapacitated or unconscious and unable to communicate their wishes. The nurse should affirm that the living will reflects the client’s predetermined decisions and must be respected by healthcare providers and family members.

Choice B reason: The durable power of attorney for health care (DPOA-HC) is authorized to make decisions only within the scope allowed by the living will. They cannot override or cancel the living will unless the document itself grants them that authority. Most living wills do not permit cancellation by the DPOA-HC once the client is incapacitated.

Choice C reason: The Patient Self-Determination Act (PSDA) mandates that healthcare institutions inform patients of their rights to make advance directives. However, it does not grant family members the right to change lifesaving measures once a living will is in effect. This statement misrepresents the PSDA’s role.

Choice D reason: A case manager does not have legal authority to alter a client’s living will. Their role is to coordinate care and resources, not to make or change medical decisions outlined in legal documents.

Choice A reason: Monitoring evidence-based practice is typically the responsibility of professional organizations and healthcare institutions that develop clinical guidelines. State licensing boards do not directly oversee clinical practice protocols for specific diagnoses.

Choice B reason: Accreditation standards for healthcare facilities are set by independent accrediting bodies such as The Joint Commission or the Commission on Accreditation of Rehabilitation Facilities (CARF), not state licensing boards.

Choice C reason: State licensing boards are responsible for ensuring that healthcare providers comply with state regulations, including licensure requirements, scope of practice, and disciplinary actions. They protect public safety by enforcing professional standards.

Choice D reason: Determining medication safety is the responsibility of federal agencies such as the Food and Drug Administration (FDA), not state licensing boards. The FDA evaluates drug efficacy and safety before approval for public use.