Editing Management of Care – RN Practice Questions (section)

==Question 9==
A client is admitted unresponsive with a valid living will stating that mechanical ventilation is not desired. The client's adult daughter, who is not the named health care proxy, insists that the client be intubated. Which action should the registered nurse take?
# Honor the daughter's request, since the client is unable to speak.
# Notify the provider, contact the named health care proxy, and review the advance directive with the care team.
# Inform the daughter that the directive cannot be discussed and end the conversation.
# Ask the daughter to sign a consent form for intubation.

'''Answer:''' 2. Notify the provider, contact the named health care proxy, and review the advance directive with the care team.

''Rationale:'' A valid advance directive takes effect when the client loses decision-making capacity and expresses that client's own autonomous choice. The named health care proxy, not the most vocal family member, is the authorized decision maker. The nurse advocates for the client by ensuring the directive is known to the team, involving the proxy and the provider, and requesting an ethics consultation if conflict persists. Option 1 substitutes an unauthorized surrogate's wishes for the client's documented wishes. Option 3 abandons a grieving family member who needs support and information. Option 4 seeks consent from a person without authority to give it.