A nurse is caring for a client who has end-stage kidney disease and refuses further hemodialysis treatments. The client has advance directives that indicate no life-sustaining treatments. Which of the following actions should the nurse take?
Encourage the client to complete a final hemodialysis treatment.
Contact the client’s family to discuss the decision.
Discuss future treatment options with the client’s health care surrogate.
Discuss possible options for discharge with the client.
The Correct Answer is D
Choice A reason: Encouraging a final hemodialysis treatment contradicts the client’s advance directives, which refuse life-sustaining treatments. Respecting autonomy is paramount, and persuading the client undermines their decision, making this action unethical and inappropriate in this end-of-life scenario.
Choice B reason: Contacting the family to discuss the decision is unnecessary unless the client is incapacitated, which is not indicated. The client’s advance directives guide care, and family input is secondary to the client’s wishes, making this action incorrect and irrelevant.
Choice C reason: Discussing treatment options with the surrogate is inappropriate, as the client is competent and has clear advance directives refusing treatment. The surrogate’s role applies only if the client cannot decide, making this action misaligned with the client’s autonomy and directives.
Choice D reason: Discussing discharge options respects the client’s refusal of treatment and advance directives, focusing on palliative care or home arrangements. This supports autonomy and aligns with end-of-life care principles, ensuring comfort and dignity, making it the correct action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Decreased BUN is not typical in preeclampsia, where renal impairment often elevates BUN due to reduced glomerular filtration. Normal or increased BUN is expected, so this finding does not align with preeclampsia’s pathophysiology, making it an incorrect expectation.
Choice B reason: Increased protein in urine (proteinuria) is a hallmark of preeclampsia, resulting from glomerular damage due to hypertension and endothelial dysfunction. This diagnostic criterion, often >300 mg/24 hours, is critical for identifying preeclampsia, making it the correct finding the nurse should expect.
Choice C reason: Increased platelet count is not associated with preeclampsia, which often causes thrombocytopenia due to endothelial activation and platelet consumption. A decreased count (<100,000/mm³) is more likely, making this finding incorrect for preeclampsia’s clinical presentation.
Choice D reason: Decreased serum uric acid is not expected in preeclampsia, where elevated uric acid occurs due to reduced renal clearance from glomerular dysfunction. Increased levels are a marker, so this finding is opposite to preeclampsia’s effects, making it incorrect.
Correct Answer is ["A","C","E"]
Explanation
Choice A reason: Hypothermia increases metabolic demand in newborns, depleting glucose stores rapidly. Neonates have limited glycogen reserves, and cold stress accelerates glucose use for thermogenesis, risking hypoglycemia. This is critical in nurseries, as thermoregulation is essential to prevent metabolic imbalances in vulnerable infants.
Choice B reason: Thrombocytopenia, low platelet count, affects clotting, not glucose metabolism. It may occur in sepsis but does not directly cause hypoglycemia. Glucose regulation depends on liver function and insulin balance, not platelets, making this irrelevant to hypoglycemia risk in newborns.
Choice C reason: Prematurity heightens hypoglycemia risk due to immature liver glycogen stores and limited gluconeogenesis. Preterm infants have high metabolic demands and low reserves, increasing susceptibility to low blood glucose, necessitating close monitoring and early feeding to stabilize glucose levels.
Choice D reason: Anemia, low red blood cell count, impacts oxygen delivery but not glucose metabolism directly. Severe anemia may increase metabolic stress, but it is not a primary hypoglycemia cause. Glucose regulation relies on hepatic and insulin functions, not hematologic status, in newborns.
Choice E reason: Maternal diabetes causes fetal hyperinsulinemia from maternal hyperglycemia, leading to neonatal hypoglycemia post-birth. Excess insulin depletes glucose stores after umbilical cord clamping, as maternal glucose supply ceases, making this a critical risk factor requiring vigilant monitoring in newborns.
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