I wrote an alternative answer to a question from Potter and Perry to try and clarify and help me to understand the principle of the living will:
The nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline the nurse will follow?
answer
: A living will is invoked only when the patient has a terminal
condition or is in a persistent vegetative state.
A living will is invoked only when the patient has a terminal condition and is no longer cognitively capable to direct their care (e.g. is in a persistent vegetative state).
Does the second answer make more sense? It seems like the first answer creates the possibility of a patient's document coming into conflict with their conscious desires.
And the clear cut is terminally ill or not capable to make the decision.
However, terminally ill patient has the right to refuse fluid and food and it has to be stated in the living will.
Potter and perry are the authors of fundamentals of nursing(8th edition)
No, that's not true at all. A terminally ill patient who does not have a living will can refuse food and fluid. Again, terminally ill does NOT equal unable to make decisions for oneself. When the time comes to make the decision as to whether artificial nutrition or hydration is necessary, the living will is NOT consulted unless the patient is unable to make decisions for himself. If he is, the MD approaches the patient and says "Mr. Jones, do you want a feeding tube?" And if he says no, that's that. The MD will probably encourage him to put that in a living will so his family knows his wishes in the event that he becomes unable to make decisions for himself but it does not HAVE to be stated in the living will for the terminally ill but cognizant patient to refuse it.
Well I know thats true but nlcex/Nursing school stuff is different from the real world nursing.
In other for students to get the grades they deserve, they have to know the textbook content but believe me I know for a fact that it has to be both not just either or.
Again, these are some of the people that create nclex questions
The second answer states both. The first answer states either or. Sometimes books have bad questions and answers. People complain about it all the time on here. One book says one thing and another book contradicts it. Luckily the NCLEX is not created by Saunders or Potter and Perry. The questions are clearcut and well written.
Yes, of course some books have bad questions and rationale.
if the same question shows up on any of my exams, I will pick either or but on nclex I will pick both. my school really goes by the book and 2 point difference can change a grade to B or A
Well I know thats true but nlcex/Nursing school stuff is different from the real world nursing.
In other for students to get the grades they deserve, they have to know the textbook content but believe me I know for a fact that it has to be both not just either or.
Again, these are some of the people that create nclex questions
I think you missed the point of this thread. The OP wrote an alternate answer to the question posed by Potter and Perry because the answer they give is factually untrue/poorly written and had her confused on the nature of Advanced Directives/Living Wills.
Given the choices provided in the OP, the correct answer is that a living will applies when a patient is terminally ill AND unable to make decisions for himself, not or.
Potter and Perry don't write NCLEX. Given this question on NCLEX or a scenario based off of it, you would be wrong if you stated that living wills applied in the instance of terminal illness OR incapacitation.
For example- Mrs. Smith is a 73 yr old woman with stage IV pancreatic cancer. She has a living will which names her daughter, Jane, as her health care proxy and states that she does not wish for interventions such as dialysis, intubation, artificial nutrition/hydration, central venous access, etc. Mrs. Smith is admitted to the Oncology Floor with acute dehydration related to chemotherapy induced nausea/vomiting. Mrs Smith is alert and oriented. She has poor venous access and the MD states that he would like to insert a PICC line to give her IV fluid and antiemetics. The nurse knows which of the following to be true:
A) Mrs. Smith's living will applies because she is terminally ill and she has already stated that she does not want artificial hydration or central access
B) The MD should ask Mrs. Smith's daughter her opinion because she is the health care proxy.
C) The living will does not apply yet because Mrs. Smith, though terminally ill, is still cognizant and she may wish for interventions in the interim to ease her comfort so her wishes should be discussed.
The only answer that is correct is C. If you said A or B, you would be wrong. Mrs. Smith may have stated that she does not want central access done in the event that she takes a turn for the worse and death is imminent but that's not the case here.
KelRN215, BSN, RN
1 Article; 7,349 Posts
No, that's not true at all. A terminally ill patient who does not have a living will can refuse food and fluid. Again, terminally ill does NOT equal unable to make decisions for oneself. When the time comes to make the decision as to whether artificial nutrition or hydration is necessary, the living will is NOT consulted unless the patient is unable to make decisions for himself. If he is, the MD approaches the patient and says "Mr. Jones, do you want a feeding tube?" And if he says no, that's that. The MD will probably encourage him to put that in a living will so his family knows his wishes in the event that he becomes unable to make decisions for himself but it does not HAVE to be stated in the living will for the terminally ill but cognizant patient to refuse it.
It is not either or. Both must apply.