Why is increasing the use of advanced practice nurses encouraged?

Correct Answer: A

Rationale: The correct answer is A because the 2010 Institute of Medicine report recommended that nurses practice to the full extent of their education, which includes utilizing advanced practice nurses. This supports the efficient delivery of healthcare services. Choice B is incorrect as it focuses on the relationship between advanced practice nurses and physicians rather than a reason for increasing their use. Choice C is not a direct reason for increasing the use of advanced practice nurses but rather a statement about the terminal degree for nurse practitioners. Choice D is incorrect as advanced practice nurses do possess the skills necessary to diagnose and provide advanced care.

Correct Answer: B

Rationale: Confidentiality is the ethical principle that requires healthcare professionals to protect patient information from unauthorized disclosure. In this scenario, the RN has a duty to safeguard the senator's medical details, even in casual conversations with friends. The Health Insurance Portability and Accountability Act (HIPAA) legally enforces this principle, prohibiting sharing identifiable health information without consent. The RN must avoid confirming the senator's hospitalization or disclosing any specifics about their condition, as doing so would violate professional and legal obligations to maintain patient privacy. **Fidelity** involves keeping promises and maintaining trust in professional relationships. While fidelity is important in nursing, it is not the central issue here. The RN did not make any explicit promises to the senator about secrecy, nor is this about upholding an agreement—rather, it is about the inherent duty to protect private health information. Fidelity applies more broadly to reliability and commitment to patient care, not specifically to confidentiality breaches. **Veracity** refers to truthfulness in communication. While the RN should not lie to friends, the situation does not demand a truthful disclosure about the senator’s condition—it demands silence. The ethical obligation is to withhold information, not to provide truthful or deceptive answers. Veracity would be more relevant if the RN were directly asked by the senator’s family or another healthcare provider in a professional context, where honesty is required. **Accountability** means taking responsibility for one’s actions and decisions. While the RN must account for any breaches of confidentiality, the question focuses on the immediate ethical principle guiding the response, not accountability after the fact. Accountability would come into play if the RN had already disclosed information and needed to answer for that mistake, but the scenario emphasizes preventing disclosure in the first place. Thus, confidentiality is the overarching principle, as it directly addresses the protection of patient information in all settings, including social interactions. The RN must recognize that personal curiosity does not override the legal and ethical duty to keep patient details private, regardless of the patient's public status. The other principles, while valuable, are either secondary or irrelevant to this specific situation.

Correct Answer: D

Rationale: A violation of the nurse practice act falls under the category of tort. Tort refers to civil wrongs that cause harm or loss to another person, and a violation of the nurse practice act can result in a civil lawsuit against the nurse for negligence or malpractice. Choices A, B, and C are incorrect because a violation of the nurse practice act does not fall under juvenile offenses, felonies, or misdemeanors, but rather under civil wrongs known as torts.

Correct Answer: C

Rationale: Let’s analyze each choice in detail to understand why **C** is correct and the others are not. **Choice C: A DNR order can be written after the health-care provider has discussed it with the client and family.** This is the correct answer because it accurately reflects the ethical and legal process of establishing a DNR order. A DNR (Do Not Resuscitate) order is a medical directive that prevents healthcare providers from performing CPR or other life-sustaining measures if the patient's heart stops or they stop breathing. The decision must involve **informed consent**, meaning the healthcare provider (physician, nurse practitioner, or other authorized professionals depending on jurisdiction) must discuss the implications, benefits, and risks with the patient (if competent) and/or their legal surrogate or family. This ensures the patient's autonomy and aligns with medical ethics, including respect for patient wishes and shared decision-making. **Why other choices are incorrect:** **Choice A: When a heart ceases to beat, the client is pronounced clinically dead.** This is incorrect because it misrepresents the definition of clinical death. Clinical death is determined by **irreversible cessation of circulatory and respiratory functions** *or* irreversible cessation of all brain activity (brain death). A stopped heartbeat alone does not always mean clinical death—CPR or defibrillation can sometimes restore circulation. Additionally, the question focuses on DNR discussions, not the criteria for declaring death. This choice is irrelevant to the client’s question about DNR orders. **Choice B: Physicians must write do not resuscitate (DNR) orders.** This is incorrect because it overgeneralizes who can write a DNR order. While physicians often write DNR orders, **other authorized healthcare providers** (such as nurse practitioners or physician assistants, depending on state or institutional policies) may also be legally permitted to do so. The key requirement is that the decision follows informed discussions with the patient/family, not strictly that a physician must be the one to document it. **Choice D: A DNR requires a court decision.** This is incorrect because DNR orders do not typically involve courts unless there is a **legal dispute** (e.g., family members disagreeing with the decision). Normally, DNR decisions are made by the healthcare team in collaboration with the patient or their legally designated decision-maker (e.g., healthcare proxy, next of kin). Courts only intervene in exceptional cases where conflicts arise or if the patient lacks decision-making capacity without a clear surrogate. Implying that a court must always be involved is misleading and could unnecessarily complicate the process for patients and families. **Summary:** The correct answer (**C**) emphasizes **patient-centered communication** and the legal-ethical process of DNR orders, while the incorrect choices either misrepresent medical definitions (A), oversimplify roles (B), or introduce unnecessary legal hurdles (D). Understanding these distinctions ensures accurate patient education and upholds ethical standards in end-of-life care.

Correct Answer: D

Rationale: Option D is correct because it accurately describes the primary purpose of an advance directive in a healthcare context. An advance directive is a legal document that allows individuals to specify their preferences for medical treatment and appoint a healthcare surrogate (also called a healthcare proxy or agent) to make decisions on their behalf if they become incapacitated. This surrogate is responsible for communicating and enforcing the patient’s documented wishes, ensuring autonomy is preserved even when the patient cannot speak for themselves. This aligns with ethical principles of patient-centered care and respects the individual’s right to self-determination in medical decisions. Option A is incorrect because it misrepresents the role of nurses under the Patient Self-Determination Act (PSDA). While the PSDA mandates that healthcare institutions (such as hospitals) inform patients of their right to create an advance directive upon admission, it does not place this responsibility solely on nurses. Nurses may facilitate these discussions, but the legal obligation lies with the institution. Additionally, the PSDA does not require nurses to directly educate clients about advance directives—it ensures that institutions provide written information, not individual providers. Option B is incorrect because it conflates advance directives with financial decision-making authority. Advance directives pertain exclusively to healthcare decisions, not financial or legal matters. Financial decisions for an incapacitated individual are typically handled through separate legal instruments, such as a durable power of attorney for finances or a conservatorship. Including this in a discussion with nurse graduates would create confusion about the scope of advance directives, which are strictly healthcare-related. Option C is incorrect because it inaccurately describes the function of a living will. A living will is a type of advance directive that outlines an individual’s preferences for specific medical treatments (e.g., life support, artificial nutrition) but does not designate a decision-maker. The confusion arises from mixing the concepts of a living will (which states wishes) and a healthcare surrogate designation (which appoints a person to make decisions). A living will is static, while a surrogate can adapt decisions to unanticipated circumstances, making this distinction critical for nurse graduates to understand. Clarity on these distinctions is essential for nurses, as they often serve as advocates and educators for patients navigating advance care planning. Misinformation could lead to legal or ethical breaches, such as failing to honor a patient’s true wishes or improperly guiding families during crises. The correct answer (D) emphasizes the surrogate’s role, which is central to the practical application of advance directives in clinical settings.