# An adult who lacks decision-making capacity has an advance directive naming the spouse as health care agent. An adult child asks the nurse to ignore the spouse and make a different plan. No immediate emergency is present. Complete the management-of-care statement.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393390&lang=en  
> language: en  
> subject: Advance Directives  
> category: MOC

## Question

An adult who lacks decision-making capacity has an advance directive naming the spouse as health care agent. An adult child asks the nurse to ignore the spouse and make a different plan. No immediate emergency is present. Complete the management-of-care statement.

The nurse should first ::선택::ask the family to vote on who should decideverify the directive, the capacity determination, and the named agent's authority under policy and lawremove the directive from the record until the family agreesaccept the adult child's request because the child is biologically related. Decisions should then ::선택::base the plan on whichever relative arrives firstreplace the client's prior wishes with the nurse's view of the best outcomework with the authorized agent using the client's documented wishes, values, and best interestsask unlicensed personnel to resolve the disagreement. If the conflict remains unresolved, the nurse should ::선택::continue current safe care, document objective facts, and escalate to the provider, leadership, and ethics or legal resources according to policystop all care until every relative agreespromise the child that the directive will not be followeddelay reporting the conflict until discharge.

## Explanation

The nurse first verifies the advance directive, the documented loss of decision-making capacity, and the identity and authority of the named health care agent under applicable law and policy. Decisions should be discussed with the authorized representative using the client's expressed wishes, values, and best interests rather than family hierarchy or staff preference. If conflict persists, the nurse maintains current safe care, communicates the dispute to the provider and nursing leadership, documents objective facts, and obtains ethics, legal, or risk-management support according to policy. The nurse should not conceal the directive, choose a surrogate independently, or allow a nonurgent family dispute to bypass the established process.

## In-depth explanation

Correct Answer
Verify the directive and the named agent's authority, center decisions on the client's documented wishes and values, and escalate an unresolved conflict through the provider, nursing leadership, and ethics or legal resources according to policy.

Why It Fits
An advance directive is part of the plan of care when the client lacks capacity. The nurse protects the client's voice by confirming the legal and clinical facts before treating any relative's preference as controlling.

Clinical Picture
There is time to verify the document and obtain the appropriate team review. Current safe care continues while the nonurgent dispute is resolved through an authorized process.

Memory Link
Verify the document, identify the agent, follow the client's voice, escalate the conflict.

NCLEX Rule
The nurse integrates advance directives into care but does not independently make legal determinations or let family pressure erase documented client preferences.

Why the Alternatives Fail
Choosing the loudest relative ignores the established representative. Hiding the directive blocks informed team review. Stopping all care without an applicable decision or order can harm the client, while waiting silently leaves the conflict unresolved.

Source
1CMS Hospital Patients' Rights to Representatives
22026 NCLEX-RN Test Plan

## Clinical scenario

The directive is available in the record, but the team has not yet confirmed that it applies to the current decision. The nurse follows applicable law and facility policy, preserves the client's known values, and does not personally decide which family member should prevail.

## Key concepts

- **Decision-making capacity** — A clinical determination of whether a person can understand relevant information, appreciate consequences, reason about options, and communicate a choice for a specific decision.
- **Health care agent** — A person designated through an applicable legal process to make health care decisions when the client cannot do so.
- **Advance directive** — A document or instruction that communicates future health care preferences or identifies a representative, interpreted under applicable law and policy.

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