Progressive Care Nursing Certification (PCCN) Practice Exam

The authority of a surrogate to speak for a patient is based on:

1. A family member's presence and experience

2. The family designating the surrogate as knowledgeable

3. The patient’s specific conveyed wishes to the surrogate

4. The patient's indication to nursing staff that the surrogate should speak for them

The correct answer is: The patient’s specific conveyed wishes to the surrogate

The authority of a surrogate to speak for a patient primarily stems from the specific wishes of the patient conveyed to the surrogate. When a patient clearly communicates their preferences and decisions regarding their care, that surrogate is empowered to act on behalf of the patient in alignment with those wishes. This principle underscores the importance of patient autonomy and informed consent within healthcare, highlighting that the surrogate's role is to honor and implement the patient's desires, rather than merely acting on assumptions or general beliefs about what solutions might be best. Other methods of establishing authority, such as the presence and experience of a family member or a designation of knowledge by the family, may not provide a solid legal or ethical basis for decision-making. Simply having a family member present does not automatically grant the authority to make decisions for the patient without explicit wishes being communicated. Additionally, while nursing staff can certainly acknowledge a surrogate's role if indicated by the patient, such communication does not replace or override the necessity for the patient to directly express their wishes for the surrogate’s authority to be fully recognized. Thus, the correct answer emphasizes the critical role of the patient's articulated preferences in guiding surrogate authority.