A 67-year-old woman is diagnosed with breast cancer. She is fully alert and very specifically both verbally and in writing tells you that she does not want to have surgery on her breast to remove the tumor. She fully understands her condition and treatment options. This is a decision her husband and son both disagree with. Over the next several weeks the patient becomes confused and loses the capacity to understand the details of her medical care. The husband and son now approach you to perform the surgery. Which of the following is most appropriate?

Correct Answer: A

Rationale: The patient in this question gave a clear advance directive while she still had decision-making capacity. This must be followed. This case is especially clear because it states there is both a clear verbal as well as written advance directive. Cases in which there is no clear advance directive are much harder. It does not matter if the family's request is in writing. The case would be considered too straightforward to warrant the intervention of an ethics committee. Even if the ethics committee for some reason recommended the surgery, you would still have to refuse because your duty is to follow the patient's wishes, no one else's. You cannot refuse a decision made while competent simply because the patient later becomes incompetent. If this were not so, then all wills would be invalid. A person's will is a form of advance directive for their property after they become unable to speak for themselves directly.

Correct Answer: B

Rationale: Staff must be trained specifically for each individual's medications to ensure competency, per regulations.

Correct Answer: C

Rationale: Initials like SR (sustained release) indicate formulations that release slowly and cannot be crushed, affecting administration.

Correct Answer: D

Rationale: Antacids neutralize stomach acid to treat inflammation and ulcers.

Correct Answer: B

Rationale: Slow position changes prevent orthostatic hypotension, a common antihypertensive side effect.