A nurse is reviewing the medical record of a client who has end-stage renal disease and is receiving palliative care. The nurse notes that the client has an advance directive that states that they do not want dialysis or any other form of renal replacement therapy.

However, the nurse also notes that the client's spouse is the designated surrogate decision-maker and has consented to start dialysis for the client.

Which of the following actions should the nurse take?

Advance care planning can be revised or updated at any time by the client or their designated surrogate, as long as they have decision-making capacity and communicate their wishes clearly. This allows for flexibility and adaptation to changing circumstances or preferences.

Answer A is incorrect because advance care planning is recommended for all adults, regardless of their health status or prognosis, as it can help them prepare for future situations and ensure that their values and goals are respected.

Answer B is incorrect because advance care planning involves more than just making decisions about life-sustaining treatments and organ donation; it also includes expressing one's values, beliefs, preferences, fears, hopes, and expectations for end-of-life care, as well as identifying a surrogate decision-maker and communicating with one's family and health care team.

Answer C is incorrect because advance care planning does not require a written document, although it is advisable to have one; it can also be done verbally or through other means, such as videos or audio recordings.

The nurse should inform the health care provider of the discrepancy between the client's advance directive and the spouse's consent, and request clarification on how to proceed. The health care provider should then discuss the situation with the spouse and explain their role and responsibilities as a surrogate decision-maker, as well as the benefits and burdens of dialysis for the client. The health care provider should also try to resolve any conflicts or misunderstandings that may exist between the client's wishes and the spouse's beliefs or values.

Answer A is incorrect because it does not respect the client's advance directive or their right to self-determination, and it may cause harm or suffering to the client.

Answer B is incorrect because it may delay or complicate the decision-making process, and it may not be necessary unless there is a serious ethical dilemma or legal dispute that cannot be resolved by other means.

Answer C is incorrect because it is not within the nurse's scope of practice to educate or persuade the spouse about the client's advance directive or its implications; this should be done by the health care provider or another qualified professional.