A client is scheduled to have heart surgery and informs the nurse that she does not want any life saving measures done should there be any complications. Which of the following responses by the nurse is appropriate?

You and your provider will need to discuss your desire for DNR/DNI designation, I will put a call out to him.

Have you discussed this with your family? I think that would be best.

You do not need to worry about anything because everyone does well after this type of heart surgery.

I think you should discuss your choices with the hospital chaplain considering you are contemplating life and death.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Direct communication between the patient and the physician is essential for establishing legal orders like Do Not Resuscitate or Do Not Intubate. These decisions must be documented in the medical record to be legally binding during surgical procedures. The nurse acts as a patient advocate by facilitating this crucial conversation, ensuring the client's autonomy and end of life preferences are respected according to informed consent and advanced directive protocols.

Choice B rationale

While family involvement is often helpful for emotional support, the client's legal right to self-determination does not depend on familial approval. Suggesting this as the primary action avoids the immediate need for clinical documentation and legal orders. In healthcare ethics, the patient's individual autonomy is the priority. Focusing solely on family discussion may delay the formalization of the client's specific wishes before they undergo a high risk surgical intervention.

Choice C rationale

Providing false reassurance is non-therapeutic and dismisses the client's valid concerns and legal rights. Heart surgery carries inherent risks including myocardial infarction, stroke, or hemorrhage, making the patient's request highly relevant. Dismissing these concerns blocks further communication and violates the principle of veracity. The nurse must provide an environment where the client feels heard rather than patronized with unrealistic promises of a guaranteed positive outcome regardless of the surgical complexity.

Choice D rationale

Referring the client to a chaplain assumes the request is based on spiritual distress rather than a logical preference for medical care limitations. While spiritual support is a component of holistic care, it does not address the immediate clinical and legal requirement for a DNR order. This response deflects the nurse's responsibility to facilitate medical decision making. The priority is ensuring the surgical team is aware of the client's specific instructions for life saving measures.

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Free Nursing Study Resources

Correct Answer is ["A","B","D","E"]

Explanation

Choice A rationale:

Hypertension increases vascular resistance and damages arterial walls, promoting atherosclerosis and elevating risk for coronary artery disease and other cardiovascular complications.

Choice B rationale:

Smoking accelerates endothelial injury, promotes plaque formation, and increases oxidative stress, significantly raising risk for heart disease and vascular complications.

Choice C rationale:

Daily exercise improves cardiovascular health, lowers blood pressure, and reduces lipid levels, serving as a protective factor rather than a risk for heart disease.

Choice D rationale:

Rheumatoid arthritis involves chronic systemic inflammation, which accelerates atherosclerosis and increases cardiovascular risk independent of traditional factors.

Choice E rationale:

Cholesterol level of 275 mg/dL is markedly elevated, promoting plaque deposition in arteries and increasing risk for coronary artery disease.

Choice F rationale:

Fasting glucose of 90 mg/dL is within normal range, showing no evidence of diabetes or metabolic syndrome, so it does not increase heart disease risk.

A. Prevent the nurse from saying the wrong thing. B. Prompt the client to talk when he or she is ready. C. Determine if the client would prefer to talk with another person. D. Allow time for the client to drift off to sleep.

Correct Answer is B

Explanation

Choice A rationale

While silence might help a nurse avoid impulsive or unhelpful comments, its primary clinical purpose is not self-censorship. Therapeutic communication focuses on the needs and progress of the client rather than the nurse’s internal struggles with what to say next. Using silence as a shield against saying the wrong thing is a defensive posture rather than a proactive therapeutic tool. Effective silence is a deliberate choice made to facilitate the patient's own processing and expression.

Choice B rationale

Silence provides a quiet space that encourages the client to organize their thoughts and share their feelings at their own pace. It signals that the nurse is present, attentive, and willing to wait, which reduces the pressure on the client to speak quickly. This technique is especially useful when discussing sensitive or emotional topics, as it allows the individual to lead the conversation and find the words they need to describe their internal experiences or concerns.

Choice C rationale

Silence is not intended to be an awkward gap that suggests a lack of rapport or a need for a different healthcare provider. If a client prefers to speak with someone else, that should be addressed through direct communication or observation of the client's comfort levels. Using silence to test whether a patient wants another nurse is an inefficient and potentially confusing approach. Therapeutic silence should instead foster a sense of safety and openness within the current relationship.

Choice D rationale

While a quiet environment is necessary for rest, therapeutic silence is a communication strategy used during active interaction. If the goal is to allow the patient to sleep, the nurse would typically leave the room or dim the lights rather than sitting in silence as a communication technique. Silence in therapy is about engagement and active listening without verbal interruption, aimed at promoting psychological insight and verbalization rather than physical sleep or unconsciousness for the patient.

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A client is scheduled to have heart surgery and informs the nurse that she does not want any life saving measures done should there be any complications. Which of the following responses by the nurse is appropriate?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for an adult client in the primary care clinic. The nurse is reviewing the client's medical record. A nurse is reviewing the client's medical record. Which of the following findings places the client at risk for heart disease? Select all that apply.

Correct Answer is ["A","B","D","E"]

Explanation

The nurse uses silence as a therapeutic communication technique. What is the purpose of the nurse's silence?

Correct Answer is B

Explanation

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