A nurse is caring for a client who has named someone to serve as their health care proxy. The client states they need clarification about this part of the advance directive.
Which of the following statements by the client indicates that need for clarification?

Choice A rationale

While obtaining a magnesium level is important for monitoring therapeutic range (typically 4-7 mEq/L), the client's current signs of respiratory depression (8/min) and absent deep tendon reflexes indicate severe magnesium toxicity, a life-threatening emergency. Immediate intervention is required to prevent respiratory arrest and cardiac complications.

Choice B rationale

Administering calcium gluconate is the antidote for magnesium sulfate toxicity because calcium ions competitively antagonize the effects of magnesium at the neuromuscular junction, reversing respiratory depression and cardiac effects. However, the priority action is to stop the causative agent first before administering the antidote.

Choice C rationale

Stopping the magnesium sulfate infusion is the most immediate and critical action to prevent further escalation of magnesium toxicity. The respiratory rate of 8/min is indicative of significant respiratory depression, a severe complication. Halting the infusion prevents additional magnesium from entering the bloodstream, allowing the body to excrete the excess.

Choice D rationale

Taking the client's blood pressure is part of a complete assessment; however, it is not the most immediate priority when the client is exhibiting severe signs of respiratory depression and absent deep tendon reflexes. These signs suggest impending respiratory arrest, which requires immediate intervention to preserve life.

Choice A rationale

Frequent enemas are sometimes used in the management of Hirschsprung's disease, but their primary purpose is to empty the bowel of accumulated stool, not to stimulate bowel movements. The disease is characterized by an absence of ganglion cells, which prevents normal peristalsis, making stimulation ineffective.

Choice B rationale

Avoiding medications that can cause constipation is crucial for children with Hirschsprung's disease. Since their colon lacks the necessary ganglion cells for normal peristalsis, any further slowing of bowel transit due to medication can exacerbate fecal impaction and increase the risk of enterocolitis.

Choice C rationale

Maintaining a high-fiber diet is generally contraindicated in Hirschsprung's disease. High-fiber diets increase stool bulk, which can worsen constipation and impaction in a colon that is unable to propel stool effectively due to the absence of ganglion cells in the affected segment.

Choice D rationale

There is no specific evidence or recommendation for strict adherence to a low-protein diet in the management of Hirschsprung's disease. Dietary interventions primarily focus on managing constipation and preventing enterocolitis, rather than protein restriction, which can impact growth and development.

Choice E rationale

Daily laxative use is generally not recommended as a primary long-term management strategy for Hirschsprung's disease. While laxatives might provide temporary relief, they do not address the underlying physiological defect and can lead to dependency or electrolyte imbalances. Surgical correction is the definitive treatment.

Choice F rationale

Surgical intervention is the definitive treatment for Hirschsprung's disease. This involves removing the aganglionic segment of the bowel, allowing for normal peristalsis to be restored. Without surgery, the child will continue to experience severe constipation, impaction, and potential life-threatening complications like enterocolitis.

Choice G rationale

While complications like enterocolitis in Hirschsprung's disease may necessitate emergency department visits, the goal of management is to minimize these occurrences through appropriate medical and surgical interventions. Frequent visits for routine bowel management indicate suboptimal long-term care, not a planned approach.