A nurse is admitting a client who has end-stage chronic obstructive pulmonary disease (COPD) and has been intubated on previous hospitalizations. The client refuses intubation and any invasive treatment. Which of the following client rights is the client exercising?
Right of autonomy
Right to medical records
Right of justice
Right of confidentiality
The Correct Answer is A
Rationale:
A. Autonomy is a fundamental ethical principle in healthcare that recognizes the client’s right to make decisions about their own body and treatment based on personal values, beliefs, and preferences. It is particularly relevant in situations involving advance directives, Do-Not-Resuscitate (DNR) orders, and refusal of life-sustaining treatments. In this scenario, the client with end-stage COPD refuses intubation and invasive treatments, clearly exercising autonomy. The nurse’s role includes assessing decision-making capacity, ensuring the client is fully informed of risks and benefits, and advocating for the client’s choices in accordance with legal and ethical standards. Autonomy emphasizes that competent clients have the ultimate authority over their own healthcare decisions, even when those decisions may not align with the healthcare team’s clinical judgment or desire to prolong life.
B. The right to access medical records allows clients to review their personal health information and request amendments. While important for informed decision-making, this right does not directly relate to refusing treatment. Exercising the right to access records is a different facet of client empowerment and does not demonstrate autonomy in treatment decisions by itself.
C. Justice in healthcare refers to fair and equitable distribution of healthcare resources, including access to treatment, care, and protections. While ethically important, this principle addresses societal-level fairness, not an individual client’s right to accept or refuse interventions. The client’s decision to decline intubation is about personal choice, not equitable resource allocation.
D. Confidentiality involves protecting the client’s private health information from unauthorized disclosure. While essential for trust and ethical care, it does not involve making choices about medical treatments. Maintaining confidentiality is a separate duty that supports ethical practice but is unrelated to exercising autonomy regarding treatment refusal.
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Related Questions
Correct Answer is B
Explanation
Rationale:
A. At the end of life, clients often experience bradycardia or irregular heart rhythms, rather than persistent tachycardia. Heart rate may decrease as cardiac output declines, and tachycardia is usually associated with pain, fever, or anxiety, not the natural dying process.
B. Irregular or Cheyne-Stokes respirations (periods of rapid breathing alternating with apnea) are common in the terminal phase of life. Respiratory patterns become irregular due to decreased neurological and respiratory system function, reflecting the body’s natural decline. Monitoring these changes allows the nurse to provide comfort-focused care and anticipate needs such as oxygen support or positioning to ease dyspnea.
C. Mucous membranes often become dry at the end of life due to dehydration, reduced oral intake, and decreased salivary production. Interventions such as oral care or small sips of fluid may be used for comfort, but moist mucous membranes are not a typical expected finding.
D. Blood pressure typically declines as the body approaches death due to decreased cardiac output and vascular tone. Hypertension is not characteristic of end-of-life physiological changes and may indicate another acute issue if present.
Correct Answer is A
Explanation
Rationale:
A. Insomnia is a common physical manifestation of grief. Emotional stress and psychological distress from loss can disrupt sleep patterns, leading to difficulty falling asleep, frequent awakenings, or early-morning waking. Sleep disturbances are often accompanied by fatigue, irritability, and decreased coping ability, reflecting the mind-body connection in grief responses.
B. Grief and stress are more likely to cause tachycardia (increased heart rate) due to activation of the sympathetic nervous system, rather than bradycardia. Bradycardia is not a typical physiological response to grief.
C. While grief may cause tearfulness or eye strain, blurred vision is not a standard physical manifestation associated with the grieving process. Any vision changes should prompt assessment for other underlying medical conditions.
D. Grief often results in difficulty concentrating, poor attention, and memory lapses, rather than an increased ability to focus. Cognitive disturbances are common during acute or prolonged grief.
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