A nurse in an outpatient clinic is assessing a client who is pregnant for unsafe behaviors during pregnancy. Which of the following findings indicates a need for further evaluation?

Rationale:
A. Discharge the client to hospice care: While hospice care may be appropriate for clients with end-stage disease, discharge to hospice is not the immediate nursing action in response to a DNR request. The priority is to acknowledge the client’s wishes and ensure the DNR order is properly documented.

B. Place a sign with "Do Not Resuscitate" outside the client's room: A visible sign is used after a formal DNR order is entered into the medical record. Placing a sign prematurely without provider authorization or documentation does not legally protect the client’s wishes.

C. Explain to the client they can change their mind at any time: It is important to respect client autonomy while clarifying that a DNR order is revocable. Providing this information supports informed decision-making and ensures the client understands that their preferences can be updated at any time.

D. Obtain consent from the family for the change to the plan of care: The client’s decision regarding resuscitation takes priority if they have decision-making capacity. Family consent is not required for a competent adult to make a DNR decision.

Rationale:
A. "Massage the ointment into the skin.": The ointment should not be massaged into the skin because doing so alters the absorption rate and can cause unpredictable vasodilation and hypotension.

B. "Spread the ointment in a thin, even layer.": The nurse should instruct the client to apply the prescribed amount of nitroglycerin ointment in a thin, even layer to a hairless area of the upper body or chest. This ensures consistent absorption of the medication.

C. "Apply the ointment to the forearm.": The forearm is not a recommended site for application. The preferred areas are the chest, back, or upper arm where the skin is less likely to be disturbed and has better absorption.

D. "Apply the ointment to the skin every 4 hr.": Nitroglycerin ointment is usually applied every 6 to 12 hours depending on the prescription, with a nitrate-free interval to prevent tolerance. Every 4 hours is not standard practice.