A nurse is admitting a client who has a history of atrial fibrillation. Which of the following conditions should the nurse recognize atrial fibrillation places the client at risk for?

Rationale:
A. Pain: Persistent or severe pain in a client at the end of life indicates the need for a palliative care consultation. Palliative care focuses on symptom relief, comfort, and quality of life through interdisciplinary management, particularly when standard treatments fail to control pain effectively.

B. Dysphagia: While it requires assessment and dietary modification, it does not independently warrant a palliative consultation unless associated with uncontrolled distress or nutritional compromise.

C. Fatigue: Fatigue is a frequent symptom at the end of life, typically managed through rest, activity pacing, and supportive care. Although it contributes to discomfort, it is not the primary trigger for initiating palliative care unless it severely affects the client’s comfort.

D. Mottling: Mottling is a physical sign of imminent death resulting from decreased circulation. At this stage, palliative or hospice care is often already in place, and new consultation would not alter the course of care.

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.