A client with a Do-Not-Intubate (DNI) order is admitted to the hospital with respiratory distress. As the nurse responsible for care, which nursing actions are appropriate to implement in accordance with the client's code status? (Select all that apply)

Rationale:
A. Delay discussing the medication changes until the client experiences worsening symptoms is incorrect because waiting could cause unnecessary suffering. Beneficence requires the nurse to actively promote the client’s well-being, not postpone interventions that could improve their health and comfort.

B. Encourage the client to try the new medication while providing thorough education on its benefits and side effects is correct because beneficence involves taking actions that benefit the client and enhance their quality of life. By educating the client and addressing concerns, the nurse supports informed decision-making while promoting optimal pain management and overall well-being.

C. Respect the client’s decision not to change medications without further discussion is incorrect in this context because while respecting autonomy is important, beneficence focuses on promoting the client’s health. The nurse should provide information and guidance rather than simply accepting a decision that may result in continued pain or ineffective treatment.

D. Administer the current medication as ordered without discussing alternatives is incorrect because it ignores the client’s expressed concerns and may not optimize their well-being. Beneficence requires proactive measures to enhance health outcomes, including evaluating the effectiveness of current therapy and discussing safer or more effective options.

Rationale:

A. Ask the caller specific questions such as the location and appearance of the bomb is correct because this allows the nurse to collect critical information that can assist law enforcement in assessing and neutralizing the threat. Questions should be factual, non-confrontational, and focused on details like location, type of device, timing, and potential triggers. Care should be taken not to provoke the caller, which could escalate the situation.

B. Write down the exact words used by the caller and note any background noises is correct because verbatim documentation preserves information that may be crucial in identifying the caller, assessing credibility, and guiding emergency response. Background noises, accents, speech patterns, or other environmental sounds can provide valuable clues for authorities. A written record ensures accuracy and can be immediately shared with law enforcement.

C. Hang up the phone after alerting security to avoid further stress and distraction is incorrect. Hanging up prematurely may result in the loss of important information about the threat. Authorities recommend keeping the caller on the line if it can be done safely while waiting for security or law enforcement to intervene.

D. Keep the caller on the line as long as possible to gather information is correct because sustained engagement allows for collection of additional critical details, such as device location, timing, and any other information that may aid in planning the response and evacuation. Remaining calm and professional while gathering information maximizes safety and the usefulness of the data collected.

E. Immediately begin evacuating all clients using the elevators for a quick exit is incorrect because elevators are unsafe during bomb threats or fires. Elevators may fail or become a hazard during emergencies. Evacuations should follow the facility’s emergency plan, using stairwells and designated safe routes under the direction of security personnel or the incident commander.