A nurse is teaching a client who is to undergo placement of a nontunneled percutaneous central venous access device. Which of the following statements should the nurse include in the teaching?

Choice A reason: Financial power of attorney manages monetary decisions, not health care, unless specified as a health care surrogate. Advance directives guide health decisions, but this role is distinct, making this statement incorrect under the Patient Self-Determination Act’s provisions.
Choice B reason: The Patient Self-Determination Act ensures clients’ rights to refuse treatment, even against provider recommendations, promoting autonomy through advance directives. This legal protection applies in Medicare/Medicaid facilities, making it the correct principle for end-of-life decision-making in this context.
Choice C reason: Advance directives can be changed by a competent client, even if notarized, as the Act supports ongoing autonomy. Stating they cannot be altered is incorrect, as flexibility is a core feature, making this an inaccurate representation of the law.
Choice D reason: The eldest adult child cannot change advance directives unless designated as a surrogate. The Act prioritizes the client’s documented wishes or appointed decision-maker, not family hierarchy, making this statement incorrect and misaligned with legal requirements.

Choice A reason: Clients with borderline personality disorder (BPD) typically exhibit an unstable sense of self and tumultuous relationships, not stability. Their identity disturbances and fear of abandonment lead to chaotic interpersonal dynamics, making this statement incorrect as it misrepresents core BPD characteristics.
Choice B reason: Self-harming behaviors, such as cutting or suicidal gestures, are common in BPD due to emotional dysregulation and impulsivity. These actions serve as maladaptive coping mechanisms for intense emotions, aligning with DSM-5 criteria for BPD, making this the correct information to include.
Choice C reason: While group therapy can be beneficial, dialectical behavior therapy (DBT), an individual and skills-based approach, is the primary evidence-based treatment for BPD. Group therapy alone is not the standard, as it may not address individual emotional regulation needs, making this statement inaccurate.
Choice D reason: Clients with BPD frequently experience mood swings and emotional instability, a hallmark of the disorder due to affective dysregulation. This contradicts the statement, as BPD involves rapid mood shifts, not stability, making this information incorrect for describing BPD characteristics.