Nclexrn Flashcards: Advance Directives And Surrogate Decision Making

What this deck covers

This deck focuses on Advance Directives And Surrogate Decision Making, giving you a quick way to review the definitions, rules, and examples that matter most for Nclexrn.

How to use these flashcards

Work through these flashcards in short sessions. Try to answer each prompt before flipping the card, then revisit any cards you miss until the explanation feels automatic.

Flashcard 1: Which standard is used when the patient's wishes are unknown and cannot be inferred?

Answer: Best-interest standard. Without known wishes, the best-interest standard provides an objective framework to evaluate benefits, burdens, and quality of life for decision-making.

Flashcard 2: What is the best evidence of a patient's wishes: current competent choice or an older directive?

Answer: The patient's current competent choice overrides prior directives. Current competent decisions reflect the most up-to-date expression of autonomy, superseding outdated directives that may no longer align with wishes.

Flashcard 3: Which principle guides care when a valid advance directive exists and applies?

Answer: Honor the patient's stated wishes (autonomy). The ethical principle of autonomy prioritizes respecting the patient's expressed wishes in advance directives to guide end-of-life care.

Flashcard 4: What is a POLST/MOLST form used for?

Answer: Portable medical orders reflecting current goals for serious illness. POLST/MOLST translates patient goals into transferable orders, facilitating consistent care across settings for those with advanced illnesses.

Flashcard 5: Which standard is preferred when the patient's known values and prior wishes are clear?

Answer: Substituted judgment. Substituted judgment is prioritized as it most closely honors patient autonomy by approximating what the individual would decide if able.

Flashcard 6: What does "allow natural death" (AND) indicate in practice?

Answer: Focus on comfort; do not initiate CPR during arrest. AND emphasizes palliative care and natural progression, explicitly excluding CPR to honor patient wishes for comfort-oriented end-of-life management.

Flashcard 7: Identify the best action when an unconscious patient arrives without known directives.

Answer: Provide emergency stabilization while seeking surrogate/documentation. Emergency protocols prioritize stabilization to preserve life while simultaneously pursuing legal surrogates or documents to guide ongoing care.

Flashcard 8: What is the primary purpose of a durable power of attorney for health care?

Answer: To name a health care agent to make decisions if incapacitated. This document upholds patient autonomy by designating a trusted individual to make health care decisions aligned with the patient's values when incapacitated.

Flashcard 9: Which document names a surrogate decision-maker: living will or durable power of attorney?

Answer: Durable power of attorney for health care. Unlike a living will, which specifies treatment preferences, a durable power of attorney legally appoints a proxy to interpret and apply the patient's wishes.

Flashcard 10: Which clinician action is required to implement a DNR: family request or provider order?

Answer: A provider order (per facility and state policy). Legal and facility protocols mandate a provider's order to implement DNR, ensuring it reflects informed discussions rather than family requests alone.

Flashcard 11: What is an advance directive in nursing care?

Answer: A legal document stating future health care wishes if incapacitated. Advance directives empower patients to maintain autonomy by specifying preferences for medical treatment when they lack decision-making capacity.

Flashcard 12: What is the nurse's first action when a patient mentions having an advance directive?

Answer: Assess for the document and ensure it is in the medical record. Nursing standards require verifying and documenting advance directives to ensure they are accessible and can guide care decisions appropriately.

Flashcard 13: What is the nurse's role if the health care agent's decision appears inconsistent with the patient's wishes?

Answer: Advocate for the patient and consult provider/ethics per policy. Nurses act as patient advocates by identifying potential misalignments and involving interdisciplinary teams to ensure decisions reflect patient values.

Flashcard 14: What is the nurse's best response when a patient asks to create an advance directive?

Answer: Provide information and refer to appropriate resources; do not give legal advice. Nurses support patient autonomy by offering education and referrals while avoiding legal advice, which falls outside their scope of practice.

Flashcard 15: What is substituted judgment in surrogate decision-making?

Answer: Surrogate chooses based on what the patient would have wanted. This standard requires surrogates to base decisions on the patient's known values and preferences, promoting authenticity in representation.

Flashcard 16: What must be verified before following an advance directive in an acute change in status?

Answer: That it is valid, available, and applicable to the current situation. Verification ensures the directive is legally sound, readily accessible, and relevant to the patient's current clinical circumstances before implementation.

Flashcard 17: Identify the correct action if a family member demands CPR but the chart shows a valid DNR order.

Answer: Do not initiate CPR; follow the DNR and notify the provider immediately. Valid DNR orders must be followed to respect patient autonomy, with immediate provider notification to address family concerns ethically.

Flashcard 18: What is a DNR order?

Answer: A medical order to withhold CPR if cardiac or respiratory arrest occurs. DNR orders prevent unwanted resuscitation attempts, aligning with patient autonomy in end-of-life care preferences.

Flashcard 19: What is the nurse's priority if there is conflict between family wishes and a valid directive?

Answer: Follow the patient's directive and notify the provider/ethics as needed. Prioritizing the valid directive upholds patient autonomy, with escalation to ethics or providers resolving conflicts ethically and legally.

Flashcard 20: What is the best-interest standard in surrogate decision-making?

Answer: Surrogate chooses the option that best promotes the patient's welfare. When wishes are unclear, this standard guides surrogates to select options that objectively maximize the patient's overall well-being and quality of life.

Flashcard 21: Which treatments can still be provided under a DNR order?

Answer: All appropriate care except CPR during arrest. DNR specifically limits CPR but allows other interventions to manage symptoms and maintain quality of life unless otherwise specified.

Flashcard 22: What is implied consent and when is it used?

Answer: Presumed consent for emergency care when the patient cannot consent. Implied consent protects patients in urgent situations by assuming they would want life-saving interventions when unable to provide explicit consent.

Flashcard 23: Identify the correct action if a patient with decision-making capacity refuses treatment.

Answer: Respect the refusal after ensuring informed decision-making. Respecting informed refusal upholds patient autonomy and ethical standards, provided the patient understands the risks and benefits.

Flashcard 24: Which takes priority for immediate care: a valid POLST/MOLST or a general living will?

Answer: POLST/MOLST (it is a set of actionable medical orders). As medical orders, POLST/MOLST provide specific, immediate directives that supersede broader living wills in guiding acute care decisions.

Flashcard 25: What is the primary purpose of a living will?

Answer: To document desired or refused life-sustaining treatments. A living will ensures patient autonomy by clearly outlining specific medical interventions to be administered or withheld in terminal conditions.