A client nearing the end of life requests that he be given no food or fluids.
The physician orders the insertion of a nasogastric tube to feed the client.
What situation does this create for the nurse providing care?
The nurse must follow the physician's orders.
The physician's order creates a barrier to establishing an effective nurse-client relationship.
The nurse faces an ethical dilemma about inconsistent courses of action.
The nurse is unable to provide care for the client.
The Correct Answer is C
Choice A rationale
While nurses are generally expected to follow physician's orders, they also have a professional and ethical responsibility to advocate for their patients. In situations where an order conflicts with the patient's wishes and ethical principles, blindly following the order can lead to moral distress.
Choice B rationale
The physician's order, which contradicts the patient's explicit request, can indeed create a barrier to establishing an effective nurse-client relationship built on trust and respect for the patient's autonomy. The nurse may feel conflicted in carrying out an unwanted intervention.
Choice C rationale
The situation creates an ethical dilemma for the nurse because there are conflicting courses of action with moral implications. The nurse faces a conflict between the duty to follow the physician's order and the ethical principle of respecting the patient's autonomy and right to refuse treatment, even life-sustaining measures at the end of life.
Choice D rationale
The nurse is not unable to provide care but faces a complex ethical challenge in determining the most appropriate and ethical course of action that respects the patient's wishes while navigating the physician's order.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Anticipatory grieving is a normal psychological process of acknowledging and preparing for an expected loss. The family's expression of sorrow and crying directly indicates their emotional response to the impending death of their loved one, aligning with the defining characteristics of anticipatory grieving. This diagnosis acknowledges the family's current emotional state in relation to the anticipated loss.
Choice B rationale
Dysfunctional grieving implies an abnormal or maladaptive grief response. Age regression, while a potential manifestation of extreme stress, is not a typical or expected behavior in anticipatory grief. Without further evidence of significantly impaired functioning or prolonged, intense reactions disproportionate to the situation, labeling the grieving as dysfunctional is not supported.
Choice C rationale
Potential for grieving suggests a risk for developing grief, but the family members are already actively expressing sorrow, indicating that grieving has commenced, not just a potential for it. While crying is an expression of sorrow associated with grieving, insomnia, without further context, is a non-specific symptom and does not solely indicate anticipatory grieving related to loss.
Choice D rationale
Dysfunctional grieving, as mentioned before, implies a maladaptive response. While anxiety can be a component of grief, behaviors solely indicating anxiety do not necessarily define dysfunctional grieving related to the loss of a family member. The family's primary expression is sorrow, which is a typical component of anticipatory grief, not necessarily dysfunctional.
Correct Answer is B
Explanation
Choice A rationale
Sexually Transmitted Infections (STIs) primarily affect the reproductive system and do not directly cause abnormalities in PaCO2 levels. PaCO2 reflects the partial pressure of carbon dioxide in arterial blood, which is a key indicator of respiratory function and acid-base balance.
Choice B rationale
Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases that obstruct airflow, leading to impaired gas exchange. This impaired exchange often results in the retention of carbon dioxide, causing an elevated PaCO2 level on an ABG report, indicating respiratory acidosis.
Choice C rationale
Congestive Heart Failure (CHF) primarily affects the cardiovascular system, leading to fluid overload and potential pulmonary congestion. While severe CHF can indirectly affect gas exchange, the most direct and common cause of abnormal PaCO2 is a respiratory issue like COPD.
Choice D rationale
Chronic Renal Insufficiency or Failure (CRF) primarily affects the kidneys' ability to regulate electrolytes and waste products. While CRF can lead to metabolic acidosis, which can trigger respiratory compensation (altering PaCO2), it is not the most direct or likely cause of an abnormal PaCO2 level on an ABG report.
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