# A 68-year-old client with newly diagnosed metastatic cancer is admitted to the medical-surgical unit. The client is alert, oriented, and fully decisional. During the admission process, the client asks the nurse to explain advance directive documents before signing them. Which explanations by the nurse are accurate? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=558421&lang=en > language: en > subject: Advance Directives > category: MOC ## Question A 68-year-old client with newly diagnosed metastatic cancer is admitted to the medical-surgical unit. The client is alert, oriented, and fully decisional. During the admission process, the client asks the nurse to explain advance directive documents before signing them. Which explanations by the nurse are accurate? Select all that apply. 1 A health care proxy may use the client's known values to address a treatment situation the living will did not specifically anticipate. 2 A living will documents the client's treatment preferences for a time when the client cannot communicate or make decisions. 3 A proxy may co-sign treatment decisions with a client who has decisional capacity to make those decisions legally effective. 4 Keeping the only signed copy in the hospital record is sufficient because clinicians in other settings can retrieve it when needed. 5 The client may revise or revoke the advance directive while decisional capacity remains intact. 6 A general financial power of attorney automatically gives that person authority to make the client's health care decisions. ## Explanation The nurse should explain that a health care proxy can use the client's known values when a living will does not anticipate a specific situation (Choice 1), that a living will records treatment preferences for periods of incapacity (Choice 2), and that a client with decisional capacity may revise or revoke the directive (Choice 5). A capable client does not need a proxy to co-sign treatment decisions (Choice 3). The only signed copy should not be confined to one hospital record (Choice 4), and financial power of attorney does not automatically include health care authority (Choice 6). ## In-depth explanation Correct Answer Choices 1, 2, 5 Clinical Reasoning The nurse should explain that a health care proxy can use the client's known values when a living will does not anticipate a specific situation (Choice 1), that a living will records treatment preferences for periods of incapacity (Choice 2), and that a client with decisional capacity may revise or revoke the directive (Choice 5). A capable client does not need a proxy to co-sign treatment decisions (Choice 3). The only signed copy should not be confined to one hospital record (Choice 4), and financial power of attorney does not automatically include health care authority (Choice 6). Option Review - Correct — A designated health care proxy can apply the client's known goals and values when an unanticipated clinical decision is not specifically addressed in the living will. - Correct — A living will records treatment preferences for circumstances in which the client cannot communicate or make decisions. - Incorrect — A client who has decisional capacity makes and authorizes the client's own treatment decisions; proxy co-signature is not required to make them effective. - Incorrect — Copies should be available to the proxy, relevant clinicians, and others identified by the client so the directive can be accessed across care settings; one hospital copy is not sufficient. - Correct — A client with decisional capacity may revise or revoke an advance directive according to applicable law and facility procedure. - Incorrect — Financial and health care powers of attorney grant different authority. A financial appointment does not automatically authorize health care decisions. Sources 12026 NCLEX-RN Test Plan 2NIA: Advance care planning and advance directives ## Clinical scenario A 68-year-old client with newly diagnosed metastatic cancer is admitted to the medical-surgical unit and asks the nurse to explain advance directive documents before signing them. ## Related questions - [A home hospice RN is leading care for a 72-year-old patient with end-stage heart failure. …](https://mymerci.kr/pages/nclex_q.php?qn_id=372731&lang=en) - [A nurse is part of an emergency response team using START (Simple Triage and Rapid Treatme…](https://mymerci.kr/pages/nclex_q.php?qn_id=372756&lang=en) - [An adult who lacks decision-making capacity has an advance directive naming the spouse as …](https://mymerci.kr/pages/nclex_q.php?qn_id=393390&lang=en) - [A client's family member asks the nurse whether the client has HIV. 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