Answer to Question 1
Answer: A, C, D
The nurse should explain that if a decision is made on an advance directive, the decision can be changed. Clients should be instructed to provide a copy of their advance directives to their next of kin. The nurse needs to assess whether the client has an accurate understanding of life-sustaining measures and provide teaching on these measures if necessary. An advance directive does not mean that the client does not need to make any future decisions about health care. An individual to be responsible for care decisions is a durable power of attorney for health care and may or may not be included when creating an advance directive.
Answer to Question 2
Answer: D
Keeping the environment tidy and free of clutter will go a long way in preventing falls. The call button should always be within reach of the client, but is not the best way to prevent falls. Electrical cords should be used only if necessary, and the maintenance department can help if any of them present a hazard. Reading label directions will prevent the wrong use of substances given to the client but would not directly prevent falls.