A health care provider asks the nurse about an older male adult's durable power of attor-ney because consent is needed for a medically necessary invasive procedure; the patient has end-stage disease, is intubated, and on mechanical ventilation

Question

Which of the following steps should the nurse implement? a. Refer to the patient's advance directive for a name.
b. Assist with obtaining informed consent from the patient.
c. Use the oral Trailmaking Test to measure cognitive function.
d. Apply the Confusion Assessment Method for critical care.

Answer 1

D

Feedback
A Incorrect. If the patient has an advance directive, the attorney-in-fact named in the power of attorney should be on that document. However, because the patient has the right to make his own decisions about care, his cognitive status should be established first.
B Incorrect. Before informed consent can be given, the patient's cognitive status must be determined.
C Incorrect. The patient is unable to perform an oral test while he is intubated.
D Correct. The health care provider assumes the intubated older adult lacks the cognitive skill to give consent for treatment. Before the search begins for the power of attorney and to help determine the patient's cognitive status, the nurse assesses the patient for delirium using the Confusion Assessment Method for the Intensive Care Unit. The nurse implements this valid and reliable tool because, as the patient's advocate, the nurse wants to give the patient every opportunity to participate in the plan of care and make his own determinations.