A nurse is caring for a client who has lung cancer. The client tells the nurse they do not want to be resuscitated in the event of a cardiac arrest. Which of the following statements should the nurse make?

Choice A reason: A chaplain offers spiritual support, but it’s not the nurse’s primary role. Autonomy in end-stage kidney disease takes precedence over initiating such visits.

Choice B reason: Alternatives don’t apply post-decision in end-stage disease; dialysis cessation reflects prognosis acceptance. Discussing them now dismisses the client’s informed choice.

Choice C reason: Supporting the decision respects autonomy in end-stage kidney disease. It aligns with palliative care, honoring the client’s right to refuse treatment.

Choice D reason: Suggesting family discussion undermines autonomy, adding pressure. In terminal illness, the client’s choice to stop dialysis should be respected directly.

Choice A reason: Instructing another nurse to record risks errors; the receiving nurse must document directly for accuracy. Scientifically, this violates chain-of-command and transcription protocols, as firsthand recording ensures fidelity to the provider’s intent, reducing miscommunication in medication orders.

Choice B reason: Asking for spelling clarifies the medication, preventing errors like sound-alikes (e.g., Celexa vs. Celebrex). Scientifically, this aligns with safety standards, as precise identification ensures correct drug administration, critical in telephone orders where auditory mistakes are common.

Choice C reason: Withholding until signed delays care; telephone orders allow immediate action with later signature (e.g., 24-48 hours). Scientifically, this contradicts urgent care needs, as timely treatment outweighs procedural lag, provided documentation and verification are complete.

Choice D reason: Recording date and time establishes a legal timeline, ensuring accountability and sequence of care. Scientifically, this is mandatory in telephone orders, supporting traceability and adherence to protocols, critical for auditing and patient safety in medication administration.

Choice E reason: Read-back confirmation verifies accuracy, reducing errors in verbal orders. Scientifically, this is evidence-based, as it ensures the provider’s intent matches the nurse’s record, safeguarding against misheard doses or drugs, a key step in safe prescribing practices.