The client suffered cardiac arrest, was resuscitated and has now been on a ventilator for several days.
The client had a written advance directive which the spouse brought from home.
The primary care provider (PCP) is encouraging the spouse to consent for placement of a percutaneous endoscopic gastrostomy (PEG) tube, which is contrary to the client's advance directive.
After the PCP leaves, the spouse states, "I wish I knew what my spouse wanted.”. What is the best reply by the nurse?

"Didn't you ever discuss this possibility?"

"The PCP only wants what is best for your spouse.”.

"You will now have to make the decision.”.

"The spouse did tell you in the advance directive.”.

Answer and Explanation

The Correct Answer is D

Choice A rationale

While it might seem natural to inquire about prior discussions, this response could induce guilt or regret in the spouse and doesn't directly address the current emotional distress and uncertainty about the spouse's wishes as explicitly stated in the advance directive. It shifts the focus to the past rather than the present need for clarification regarding the existing directive.

Choice B rationale

Although the primary care provider may indeed have the client's best interests in mind, this statement dismisses the spouse's expressed uncertainty and relies on an assumption about the PCP's motivations. It doesn't help the spouse understand or feel confident about the content of the advance directive, which is the core of their concern.

Choice C rationale

This statement, while true, places the burden of decision-making solely on the spouse without acknowledging the existence of the advance directive, which is meant to guide such decisions. It overlooks the possibility that the directive already contains the spouse's wishes and could offer clarity, thereby increasing the spouse's anxiety.

Choice D rationale

This response directly addresses the spouse's statement by reminding them that their spouse's wishes are likely documented in the advance directive. It encourages the spouse to review the directive, which is the most direct way to understand what their spouse wanted regarding medical interventions like a PEG tube, thus providing immediate and relevant support.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A rationale

Self-evaluation skills involve the ability to reflect on one's performance, acknowledge strengths, and identify areas for improvement based on feedback. The graduate nurse's act of reflecting on the positive and negative feedback received from the nurse manager directly demonstrates self-evaluation.

Choice B rationale

Communication skills involve the ability to convey information effectively and respectfully. While the initial meeting with the manager likely involved communication, the scenario focuses on the nurse's internal reflection afterward, not the interaction itself.

Choice C rationale

Interpersonal skills relate to how a nurse interacts with others, building rapport and working collaboratively. The scenario doesn't provide information about the nurse's interactions with colleagues or patients, but rather her individual reflection.

Choice D rationale

Problem-solving skills involve identifying issues and finding solutions. The scenario doesn't describe a problem the nurse is actively trying to resolve, but rather her processing of feedback on her past performance. .

A. The client expresses remorse at how his failure to make lifestyle changes has adversely affected his health. B. The client is now able to explain how his choices have contributed to his renal failure. C. The client states he will now begin to check his blood glucose before each meal and at bedtime. D. The client expresses pride that he now has the knowledge and skills to take control of his diabetes management.

Correct Answer is D

Explanation

Choice A rationale

Expressing remorse indicates an awareness of the negative consequences of past actions, which aligns with the valuing process step of choosing, where the individual recognizes the value and impact of different choices. However, it doesn't fully demonstrate prizing, which involves cherishing and affirming the value.

Choice B rationale

Explaining how past choices contributed to the renal failure demonstrates understanding and cognitive processing of the situation, aligning with the choosing step of the valuing process, where the individual intellectually recognizes the value. However, it doesn't necessarily indicate an emotional investment or affirmation of new values.

Choice C rationale

Stating an intention to adopt new behaviors reflects the acting step of the valuing process, where the individual commits to and implements the chosen values in their actions. While important for change, it doesn't directly demonstrate the internal valuing or cherishing of these new actions.

Choice D rationale

Expressing pride in gaining knowledge and skills to manage diabetes signifies that the client now holds this self-management in high regard and finds personal worth in it. This aligns with the prizing step of the valuing process, where the individual emotionally embraces and values the new belief or behavior, leading to a sense of satisfaction and affirmation.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

Correct Answer is D

Explanation

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