A nurse is assisting with the care of a client. Laboratory Results

1100:

Abdominal ultrasound: mass present in small intestine proximal to ileocecal valve. Size of mass is 6 cm x 7 cm (2.4 in x 2.8 in).

Select the 4 responsibilities the nurse has in relation to the client's advance directives.

Provide the client with written information about advance directives

Instruct the client that an advance directive is a legal document and must be honored by care providers

Initiate a power of attorney for health care document

Communicate advance directives status via the medical record and shift report

Document that the provider discussed-do-not-resuscitate status with the client

Inform the client that an advance directive discontinues further care

Answer and Explanation

Correct Answer : A,B,C,D

Provide the client with written information about advance directives: It is important for the nurse to educate the client about advance directives, their purpose, and how they can make informed decisions about their healthcare.

Instruct the client that an advance directive is a legal document and must be honored by care providers: The nurse should explain to the client that an advance directive is a legally binding document that guides healthcare decisions, and it must be respected and followed by healthcare providers.

Communicate advance directives status via the medical record and shift report: The nurse should ensure that the client's advance directives status is accurately documented in the medical record and communicated to other members of the healthcare team during shift handoffs. This helps ensure that the client's wishes are known and respected by all involved in their care.

Initiate a power of attorney for health care document: The nurse can assist the client in initiating a power of attorney for healthcare document if the client wishes to appoint someone as their healthcare proxy or agent. This document designates someone to make medical decisions on behalf of the client if they become unable to do so.

The other options listed are not appropriate or accurate in relation to the responsibilities of the nurse regarding advance directives:

Document that the provider discussed-do-not-resuscitate status with the client: While discussing do-not-resuscitate (DNR) status may be part of the advance care planning process, it is not directly related to advance directives as a whole.

Inform the client that an advance directive discontinues further care: This statement is incorrect and misleading. An advance directive does not automatically discontinue care but rather guides the provision of care according to the client's wishes.

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Correct Answer is A

Explanation

A. Protein supports tissue repair, maintains muscle mass, and provides sustained energy. Leukemia and its treatments can lead to muscle wasting and general weakness, so additional protein can help counteract these effects and improve energy levels. It is also essential for immune support as well.

B.Increasing fluids to 4 L per day is generally excessive and may not be appropriate for this client. Excessive fluid intake can place strain on the cardiovascular system, which could be problematic, especially if the client is receiving chemotherapy or other treatments that may impact fluid balance.

C.Continual bed rest is not recommended, as it can contribute to deconditioning, muscle atrophy, and worsening fatigue over time. While rest periods are essential for clients experiencing fatigue, it is equally important to incorporate balanced, low-intensity activity to maintain strength and circulation.

D.Such exercises require significant energy and exertion, which might not be tolerable and could exacerbate fatigue. Instead, gentle, low-impact activities like walking or stretching are more appropriate for maintaining function without overwhelming the client’s energy reserves.

A. The client has artificial flowers in the room. B. The client is assigned to a room with negative airflow. C. The client's meal tray contains hard boiled eggs D. The client's meal tray includes ice cream with fresh fruit.

Correct Answer is D

Explanation

Correct answer: D

a.Artificial flowers are generally considered safer than fresh flowers because they do not harbor water, which can be a source of bacterial growth. However, they can collect dust, which might carry pathogens, though this is typically a lesser concern compared to fresh flowers.

b. Being assigned to a room with negative airflow is actually beneficial for a client with an immunocompromised condition, as it helps prevent the spread of airborne pathogens.

c.Hard boiled eggs do not inherently increase the risk of infection. However, it is important to ensure that all food items are properly prepared, handled, and stored to minimize the risk of foodborne illnesses.

d. Fresh fruit can harbor bacteria and other pathogens on their surfaces, which can pose a significant risk to a neutropenic patient. Even with thorough washing, there is a higher risk compared to cooked or pasteurized foods.

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A nurse is assisting with the care of a client. Laboratory Results 1100: Abdominal ultrasound: mass present in small intestine proximal to ileocecal valve. Size of mass is 6 cm x 7 cm (2.4 in x 2.8 in). Select the 4 responsibilities the nurse has in relation to the client's advance directives.

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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A nurse is assisting with the care of a client. Laboratory Results

1100:

Abdominal ultrasound: mass present in small intestine proximal to ileocecal valve. Size of mass is 6 cm x 7 cm (2.4 in x 2.8 in).

Select the 4 responsibilities the nurse has in relation to the client's advance directives.