A nurse is caring for a client who has COPD. The client tells the nurse, "I get short of breath during meals. It is too much trouble to eat." Which of the following instructions should the nurse suggest?

A. Ask the client whether they have advance directives: Upon admission, the nurse is responsible for determining whether the client has completed any advance directives, such as a living will or durable power of attorney for health care. Directly asking the client ensures accurate, up-to-date information and respects client autonomy.

B. Refer to the client's identification card for their advance directives status: An identification card may indicate the existence of an advance directive, but it does not confirm current validity or specific wishes. Relying solely on an ID card does not ensure that documentation is available or accurately reflects the client’s present decisions.

C. Verify the client's advance directives with their health care surrogate: Contacting the health care surrogate is not the first step if the client is competent and able to communicate. The client remains the primary decision-maker unless deemed incapacitated. Verification with a surrogate is appropriate only when the client cannot provide information.

D. Check for a written do-not-resuscitate prescription in the client's medical record: A do-not-resuscitate (DNR) order is only one type of directive and may not reflect the presence of a broader advance directive. Additionally, a DNR must be written as a provider order and may not exist at admission even if the client has other advance directives in place.

A. "Are you thinking of harming yourself?": Directly assessing for suicidal ideation is the immediate priority when a caller expresses hopelessness or statements suggesting despair. Asking clearly and directly about self-harm does not increase suicide risk and allows the nurse to determine intent, plan, and urgency. Early identification of suicidal thoughts is essential.

B. "You made the right decision by calling the hotline.": Offering reassurance and support is therapeutic, but it does not immediately assess the level of suicide risk. While validation can build rapport, determining whether the client is at imminent risk of self-harm takes priority over supportive statements.

C. "Tell me more about what is going on in your life.": Encouraging the client to elaborate is helpful for understanding stressors and emotional context. However, when suicidal ideation is suspected, directly assessing for self-harm risk must occur first to determine immediate safety needs before exploring background details.

D. "Is there anyone with you right now?": Determining whether the client is alone is important in crisis management, particularly if suicide risk is confirmed. However, this question should follow direct assessment of suicidal intent so that the nurse understands the level of immediate danger before addressing environmental support.