# The nurse reviews the admission record. Which findings require follow-up? Highlight the findings that conflict with the client's decision-making rights or plan of care. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=556760&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question The nurse reviews the admission record. Which findings require follow-up? Highlight the findings that conflict with the client's decision-making rights or plan of care. Nurses' Notes 1430: The client with metastatic pancreatic cancer is admitted for symptom management of a partial bowel obstruction. The client is awake, names the hospital and date, and explains the expected benefits and burdens of the available treatments. The record includes a signed directive declining cardiopulmonary resuscitation and endotracheal intubation. The client says, "I still want medicine for pain and a tube if it helps the nausea". The electronic admission banner lists the client as Full Code even though no later revocation is documented. The daughter asks the team to "do everything" because she believes the client will change their mind. The nurse asks the daughter to sign treatment consent while the client continues to answer questions coherently. The client requests nasogastric decompression for comfort and asks to discuss home hospice after symptoms improve. The medication record shows the client accepted the prescribed opioid after the nurse reviewed expected effects. A palliative care consultation has been requested for this afternoon. The blood pressure is 118/70 mm Hg, and the client speaks without respiratory distress. A clinician entry states that no capacity assessment is needed because metastatic cancer makes the client unable to decide. The social worker documents that the daughter is the named health-care representative if the client loses capacity. The nurse pauses the admission process to compare the client's current wishes, directive, and active orders. ## Explanation A capable client directs current care, and the active code order must match the client's wishes. An incorrect Full Code order, improper surrogate consent, and dismissal of capacity because of diagnosis all require correction. ## In-depth explanation Quick answer Follow up on the Full Code banner, the request for the daughter to consent for a capable client, and the note that assumes incapacity from diagnosis alone. These entries can override or misrepresent the client's own choices. Why this is correct Decision-making capacity is task-specific and must be assessed rather than presumed absent because a person has serious cancer.[1] A capable client may accept comfort treatment while refusing CPR or intubation. A representative makes decisions when the client cannot do so, not merely because family disagrees.[2] Easy analogy or mental picture Think of the client as the driver and the advance directive as a route saved for a time when the driver cannot speak. A family member is a backup navigator, not a second steering wheel while the client can decide. Memory hook Capacity present: ask the client. Capacity absent: follow the valid directive and representative. NCLEX decision rule When the client's wishes, active code status, and family requests conflict, think autonomy first; verify current capacity, clarify the client's choice, and reconcile orders before asking a surrogate to decide. Why the other choices are wrong Understanding the options, requesting comfort-focused decompression, accepting analgesia, requesting palliative consultation, and documenting that the representative acts only after capacity is lost all support rather than violate the client's plan.References - [1]CMS: Advance Care PlanningCenters for Medicare & Medicaid Services - [2]CMS: Hospital Patients' Rights to Delegate DecisionsCenters for Medicare & Medicaid Services - [3]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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