Nclexrn Quiz: Advance Directives And Surrogate Decision Making

What this quiz covers

This quiz focuses on Advance Directives And Surrogate Decision Making, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Accept the neighbor as the surrogate because they are present and willing
2. Ask the neighbor to sign consent for neurosurgery to prevent delays
3. Stop all interventions until the proxy is reached to avoid violating autonomy
4. Continue urgent stabilization measures as ordered and follow facility policy to identify an appropriate decision-maker while attempting to reach the proxy (correct answer)

Explanation: This question tests understanding of advance directives and surrogate decision-making when non-designated individuals offer help. The priority concern is respecting client autonomy and legal guidelines by seeking the named proxy. Continuing stabilization and following policy to identify a decision-maker aligns with these principles by adhering to legal designations. Accepting the neighbor lacks authority; stopping interventions risks harm; asking the neighbor to sign is invalid. The decision-making principle is to honor specified proxies in incapacitation. This prevents unauthorized decisions. A transferable strategy is to use chain of command for locating surrogates in nursing practice.

Question 2

1. Administer antibiotics now to avoid delay, then discuss the directive later
2. Review the documented advance directive and notify the provider that the client requested no antibiotics, while supporting the son emotionally (correct answer)
3. Ask the son to bring proof that he is the legal next of kin before care continues
4. Tell the son the nurse cannot discuss the plan of care and to speak only with the provider

Explanation: This question tests understanding of advance directives and surrogate decision-making in antibiotic refusal conflicts. The priority concern is respecting client autonomy and legal guidelines by upholding the no-antibiotics request. Reviewing the directive and notifying the provider while supporting the son aligns with these principles by honoring documented wishes compassionately. Administering antibiotics ignores the directive; asking for proof escalates; refusing discussion avoids advocacy. The decision-making principle is that directives guide palliative care preferences. Nurses balance enforcement with empathy. A transferable strategy is to involve social work for family support in ethical conflicts in nursing practice.

Question 3

1. Explain that the surrogate should make decisions based on the client's stated values and wishes (correct answer)
2. Tell the client the surrogate can decide whatever is best, even if it differs from the client's preferences
3. Instruct the client to name multiple surrogates who can all vote on decisions
4. Advise the client to wait until the client loses capacity to select a surrogate

Explanation: This question tests understanding of advance directives and surrogate decision-making in educating about surrogate roles. The priority concern is respecting client autonomy and legal guidelines by ensuring surrogates act on client wishes. Explaining that the surrogate should base decisions on the client's values aligns with these principles by guiding proper surrogate function. Allowing surrogates to decide freely risks overriding wishes; instructing multiple surrogates complicates matters; advising delay is irresponsible. The decision-making principle is substituted judgment, where surrogates approximate client preferences. This maintains autonomy when clients cannot speak. A transferable strategy is to include role education in advance care planning discussions in nursing practice.

Question 4

1. Ask the son to sign a form requesting that the do-not-resuscitate order be revoked
2. Notify the provider that the family is demanding full resuscitation and request new orders
3. Confirm the advance directive is in the medical record and communicate the client's documented wishes to the health care team (correct answer)
4. Call the hospital attorney to determine whether the son can override the living will

Explanation: This question tests understanding of advance directives and surrogate decision-making in a critical care setting. The priority concern is respecting client autonomy and legal guidelines by honoring a valid do-not-resuscitate order and living will. Confirming the advance directive in the medical record and communicating the client's documented wishes to the health care team aligns with these principles by ensuring the client's preferences guide care despite family disagreement. Asking the son to sign a revocation form is incorrect as it bypasses verification; notifying the provider for new orders ignores the directive; calling the attorney delays action and is unnecessary if the directive is valid. The decision-making principle is that advance directives legally represent the client's wishes when they cannot communicate. Nurses must advocate for these wishes while supporting families emotionally. A transferable strategy is to always verify legal documents promptly and involve ethics committees for conflicts in nursing practice.

Question 5

1. Follow the decisions of the adult child as next of kin to prevent conflict
2. Verify the surrogate document in the chart and reinforce that the named surrogate is the decision-maker (correct answer)
3. Ask the provider to obtain consent from both the partner and the adult child
4. Contact the police to remove the adult child from the unit

Explanation: This question tests understanding of advance directives and surrogate decision-making in family disputes over authority. The priority concern is respecting client autonomy and legal guidelines by honoring the named surrogate. Verifying the surrogate document and reinforcing their role aligns with these principles by upholding the legal designation despite next-of-kin claims. Following the adult child's decisions ignores the document; obtaining dual consent is unnecessary; contacting police escalates inappropriately. The decision-making principle is that durable power of attorney designates authority explicitly. Nurses must enforce this to protect client wishes. A transferable strategy is to de-escalate conflicts by explaining legal hierarchies in nursing practice.

Question 6

1. Provide information about naming a surrogate decision-maker and encourage the client to share wishes with family (correct answer)
2. Tell the client that the hospital will automatically choose a surrogate if the client becomes incapacitated
3. Ask the client's adult children to complete the paperwork on the client's behalf
4. Document that the client refused advance directives and end the conversation

Explanation: This question tests understanding of advance directives and surrogate decision-making for a client relying on family without formal designation. The priority concern is respecting client autonomy and legal guidelines by encouraging formal documentation. Providing information about naming a surrogate and encouraging sharing wishes aligns with these principles by promoting proactive planning. Telling the client the hospital chooses automatically is inaccurate; asking children to complete paperwork violates autonomy; documenting refusal ends education prematurely. The decision-making principle is that clients should designate surrogates to ensure wishes are honored. Nurses educate to facilitate this process. A transferable strategy is to assess readiness and provide tailored education for legal planning in nursing practice.

Question 7

1. Withhold all non-emergency treatments until the sister arrives to provide consent
2. Provide comfort measures and notify the provider while continuing attempts to reach the named surrogate (correct answer)
3. Ask the nearest available family member on the unit to make decisions immediately
4. Request that the unit clerk contact the court to appoint a temporary guardian

Explanation: This question tests understanding of advance directives and surrogate decision-making when a surrogate is temporarily unreachable. The priority concern is respecting client autonomy and legal guidelines while providing necessary care. Providing comfort measures and notifying the provider while attempting to reach the surrogate aligns with these principles by balancing urgent needs with efforts to involve the proxy. Withholding treatments delays care; asking another family member overrides the named surrogate; requesting a guardian is premature without exhaustion of efforts. The decision-making principle is to continue essential care in emergencies while seeking the designated decision-maker. This ensures continuity without violating autonomy. A transferable strategy is to document all contact attempts and collaborate with the team for ethical dilemmas in nursing practice.

Question 8

1. Wait to administer oxygen until the family agrees on the plan of care
2. Ask the loudest family member to decide to quickly end the disagreement
3. Assume the directive is invalid and disregard it permanently
4. Treat the client's respiratory distress and notify the provider while obtaining a complete, valid copy of the advance directive per policy (correct answer)

Explanation: This question tests understanding of advance directives and surrogate decision-making with incomplete documents. The priority concern is respecting client autonomy and legal guidelines by validating directives properly. Treating distress and obtaining a complete copy per policy aligns with these principles by ensuring accurate implementation. Asking a family member decides prematurely; assuming invalidity disregards intent; delaying oxygen harms. The decision-making principle is to verify document integrity before application. This upholds ethical standards. A transferable strategy is to collaborate with administration for document issues in nursing practice.

Question 9

1. Explain that the client's advance directive guides care and notify the provider of the documented wishes (correct answer)
2. Arrange an immediate family meeting and ask the daughter to persuade other relatives to agree
3. Begin preparing the client for intensive care unit transfer to reduce delays in treatment
4. Call risk management to determine whether the directive can be ignored during sepsis

Explanation: This question tests understanding of advance directives and surrogate decision-making in conflicts with family wishes. The priority concern is respecting client autonomy and legal guidelines by upholding a valid directive for comfort care. Explaining that the advance directive guides care and notifying the provider aligns with these principles by prioritizing the client's documented preferences over family demands. Arranging a family meeting delays action; preparing for ICU transfer ignores the directive; calling risk management is unnecessary if the directive is clear. The decision-making principle is that advance directives supersede family opinions when explicit. Nurses must communicate this compassionately to de-escalate conflicts. A transferable strategy is to reference policies and involve palliative care for end-of-life ethical issues in nursing practice.

Question 10

1. Tell the client to wait until discharge to complete any advance directive paperwork
2. Encourage the client to name a trusted surrogate decision-maker and offer resources to document wishes according to facility policy (correct answer)
3. Recommend the client choose the oldest child as surrogate because it avoids conflict
4. Explain that the nurse can serve as the client's surrogate decision-maker if needed

Explanation: This question tests understanding of advance directives and surrogate decision-making, specifically helping clients designate surrogate decision-makers. The priority concern is respecting client autonomy by facilitating their ability to choose and document a trusted surrogate. Option B is correct because it empowers the client to select their own surrogate and provides resources for proper documentation according to facility requirements. Option A inappropriately delays important planning; Option C makes assumptions about family dynamics; Option D violates professional boundaries as nurses cannot serve as client surrogates. The principle is that clients should be encouraged to choose surrogates based on trust and shared values, not assumptions about family hierarchy. When clients express interest in naming surrogates, nurses should provide education about the surrogate's role, offer resources for documentation, and facilitate completion according to facility policy without influencing the choice.

Question 11

1. Explain to the son that the advance directive guides care and notify the provider of the disagreement (correct answer)
2. Begin preparing the client for intensive care unit transfer to respect the son's request
3. Tell the son he must contact the court to change the advance directive
4. Ask the nurse assistant to obtain the son's signature for consent to aggressive treatment

Explanation: This question tests understanding of advance directives and surrogate decision-making when family requests conflict with comfort-focused care directives. The priority concern is respecting the client's documented wishes for comfort care while addressing family concerns compassionately. Option A is correct because it acknowledges the advance directive's authority and ensures provider notification to address the family's disagreement professionally. Option B incorrectly prioritizes family wishes over the client's directive; Option C is inappropriate as families cannot legally change advance directives through courts; Option D improperly delegates a nursing responsibility. The principle is that advance directives requesting comfort care must be honored even when family members disagree or request aggressive interventions. When families disagree with comfort-focused directives, nurses should explain the legal obligation to follow documented wishes, notify providers for family meetings, and ensure comfort measures are implemented while supporting grieving families.

Question 12

1. Arrange a family meeting with the provider and case management to explain the advance directive
2. Notify the charge nurse and follow facility policy to ensure the client's documented wishes are communicated and honored (correct answer)
3. Ask the brother to bring proof that he is the legal decision-maker
4. Tell the brother that the nurse will follow the family's wishes to avoid conflict

Explanation: This question tests understanding of advance directives and surrogate decision-making when family members threaten legal action against following documented wishes. The priority concern is respecting client autonomy while following facility policies and maintaining professional boundaries despite threats. Option B is correct because it ensures proper communication channels and policy adherence, protecting both client wishes and staff from liability. Option A addresses communication but doesn't emphasize following facility policy; Option C is incorrect as the brother cannot legally change another's advance directive; Option D inappropriately suggests overriding the directive. The principle is that valid advance directives legally guide care regardless of family disagreement or threats, and facility policies provide protection for following documented wishes. When facing threats or conflicts about advance directives, nurses should follow facility policy, ensure proper documentation, involve appropriate leadership, and maintain professional communication while upholding client autonomy.

Question 13

1. Ask the spouse to leave the room so the team can proceed without interference
2. Inform the provider of the documented wishes and advocate to follow the client's directive while providing comfort measures (correct answer)
3. Intubate the client to stabilize first and discuss the advance directive later
4. Request security and document the spouse's refusal to comply with the plan of care

Explanation: This question tests understanding of advance directives and surrogate decision-making during emergency situations when family members emotionally oppose documented wishes. The priority concern is respecting client autonomy while providing compassionate care during a crisis. Option B is correct because it advocates for following the client's documented wishes while ensuring comfort measures, balancing legal obligations with compassionate family support. Option A is inappropriate and potentially harmful to remove grieving family; Option C violates the client's explicit wishes; Option D escalates the situation unnecessarily. The principle is that even in emergencies, valid advance directives must be followed while supporting distressed family members with comfort measures and compassionate communication. During emotional crises when families oppose advance directives, nurses should advocate for client wishes, ensure comfort measures are maximized, provide emotional support to family, and involve appropriate team members for family support.

Question 14

1. Explain that completing an advance directive is required for admission and must be done today
2. Provide information about advance directives and offer to contact social work to help the client complete forms if desired (correct answer)
3. Ask the son to decide now whether the client would want cardiopulmonary resuscitation
4. Tell the client that only the provider can discuss advance directives and end-of-life options

Explanation: This question tests understanding of advance directives and surrogate decision-making, particularly the nurse's role in educating clients about advance care planning. The priority concern is respecting client autonomy while providing appropriate information and resources. Option B is correct because it offers education and support without coercion, respecting the client's right to choose whether to complete advance directives. Option A is incorrect because advance directives are not mandatory for admission; Option C inappropriately pressures the son to make immediate decisions; Option D incorrectly limits the nurse's role in advance directive education. The principle is that nurses should provide information about advance directives and facilitate completion if desired, but never pressure or mandate participation. When discussing advance directives, nurses should offer resources, respect client readiness, and involve appropriate team members like social work for assistance.

Question 15

1. Ask the unlicensed assistive personnel to call the spouse and obtain consent by phone
2. Refuse to administer blood products until the spouse signs a refusal form
3. Proceed with transfusion because the do-not-resuscitate order implies refusal of all treatments
4. Clarify the client's current wishes when possible and notify the provider of the conflict and missing details (correct answer)

Explanation: This question tests understanding of advance directives and surrogate decision-making when directives lack specificity. The priority concern is respecting client autonomy and legal guidelines by addressing ambiguities promptly. Clarifying the client's current wishes and notifying the provider aligns with these principles by resolving conflicts with available information. Refusing transfusions delays care; proceeding assumes refusal incorrectly; delegating to unlicensed personnel is inappropriate. The decision-making principle is to seek client input when possible for unclear directives. This ensures decisions reflect current values. A transferable strategy is to involve ethics teams for directive ambiguities in nursing practice.

Question 16

1. Tell the daughter she will be the surrogate automatically because she is the oldest child
2. Explain that the surrogate can change the client's wishes at any time if the family disagrees
3. Advise the client to avoid naming family members as surrogates to prevent conflict
4. Teach that the surrogate should base decisions on the client's known wishes and values, not the surrogate's personal preferences (correct answer)

Explanation: This question tests understanding of advance directives and surrogate decision-making in clarifying surrogate responsibilities. The priority concern is respecting client autonomy and legal guidelines by educating on proper roles. Teaching that surrogates base decisions on client wishes aligns with these principles by preventing personal bias. Allowing changes if family disagrees undermines autonomy; advising against family surrogates is unhelpful; assuming automatic surrogacy is incorrect. The decision-making principle is substituted judgment to reflect client values. This ensures fidelity to autonomy. A transferable strategy is to correct misconceptions early in planning discussions in nursing practice.

Question 17

1. Tell the daughter the team will follow the client's documented wishes and notify the provider of the conflict (correct answer)
2. Ask the daughter to sign a consent form to continue full life-sustaining treatment
3. Call the hospital attorney to obtain a legal order to proceed
4. Delay any decisions until additional neurologic tests confirm prognosis

Explanation: This question tests understanding of advance directives and surrogate decision-making, specifically how to respond when family members disagree with documented wishes. The priority concern is respecting client autonomy and following legal guidelines while maintaining therapeutic relationships. Option A is correct because it acknowledges the client's documented wishes take precedence over family preferences and ensures proper provider notification for conflict resolution. Option B is incorrect because it would override the client's advance directive; Option C is premature as legal intervention is not the first step; Option D inappropriately delays following the client's wishes. The key principle is that valid advance directives legally guide care decisions when clients cannot speak for themselves. When faced with family disagreement about advance directives, nurses should first affirm the client's documented wishes, notify the provider, and facilitate communication while following facility policies.

Question 18

1. Clarify the client's current wishes if possible and promptly notify the provider to review goals of care before initiating non-emergent interventions (correct answer)
2. Assume the client would refuse intubation because a DNR is present
3. Ask the respiratory therapist to decide whether intubation aligns with the advance directive
4. Wait until the client's family arrives to interpret the advance directive together

Explanation: This question tests understanding of advance directives and surrogate decision-making when directive content is unclear. The priority concern is respecting client autonomy while ensuring appropriate urgent care in respiratory distress. Option A is correct because it attempts to clarify the client's current wishes if possible and involves the provider to interpret the directive and establish clear goals of care. Option B incorrectly assumes DNR means refusing all interventions; Option C inappropriately delegates interpretation to another discipline; Option D dangerously delays necessary care discussions. The principle is that unclear advance directives require immediate provider involvement to clarify goals of care based on the client's known values and current clinical situation. When advance directives are ambiguous, nurses should attempt to clarify with the client if possible, promptly notify providers, and ensure care decisions align with the client's overall documented wishes and values.

Question 19

1. Inform the spouse that the client's documented wishes should be honored and immediately notify the provider of the no-intubation directive (correct answer)
2. Prepare for intubation to prevent hypoxia while the team discusses the directive later
3. Tell the spouse to leave the hospital until they agree with the plan
4. Call a lawyer to determine whether the spouse's request overrides the directive

Explanation: This question tests understanding of advance directives and surrogate decision-making when surrogates contradict directives. The priority concern is respecting client autonomy and legal guidelines by following the no-intubation request. Informing the spouse that wishes should be honored and notifying the provider aligns with these principles by prioritizing the directive over surrogate demands. Preparing for intubation ignores it; telling the spouse to leave escalates; calling a lawyer delays. The decision-making principle is that directives limit surrogate authority. Nurses enforce this legally. A transferable strategy is to educate on directive precedence in conflicts in nursing practice.

Question 20

1. Respect the son's request and avoid discussing advance directives with the client
2. Assess the client's readiness and provide information privately, since the client is capable of making decisions (correct answer)
3. Ask the son to decide whether the client should have a do-not-resuscitate order
4. Wait until after surgery, because advance directives are only for terminal illness

Explanation: This question tests understanding of advance directives and surrogate decision-making when family restricts discussions. The priority concern is respecting client autonomy and legal guidelines by ensuring private access to information. Assessing readiness and providing information privately aligns with these principles by honoring the competent client's right to decide. Respecting the son's request violates autonomy; asking the son to decide shifts authority; waiting until after surgery misses preoperative opportunities. The decision-making principle is client self-determination for capable individuals. Nurses must facilitate confidential discussions. A transferable strategy is to prioritize privacy in ethical conversations in nursing practice.