A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client's family wants the client to have life-sustaining measures. Which of the following actions should the nurse take?

Rationale:

A. Possible alternative treatments: The provider is responsible for informing the client about all viable treatment options. This allows the client to make an informed decision by weighing the benefits and risks of each option.

B. Expected outcome of the procedure: Clients must understand the intended benefits and goals of the procedure. This helps them form realistic expectations and evaluate whether the procedure aligns with their preferences and values.

C. Explanation of the procedure: A clear and complete description of the procedure must be provided, including what it involves and how it will be performed. This is essential for valid informed consent.

D. Cost of the procedure: While important for financial planning, cost information is typically handled by billing or administrative staff, not required for medical informed consent by the provider.

E. Potential complications: Clients need to be informed about potential risks and complications to fully understand the implications of undergoing the procedure. This disclosure is legally and ethically required for consent.

Rationale for correct choices:

• Apply oxygen via nasal cannula: The client’s oxygen saturation levels of 87–88% on room air indicate moderate to severe hypoxemia, requiring immediate correction. Since the client has a history of COPD and is post-MI, improving oxygenation is essential to reduce myocardial workload and prevent further ischemia or respiratory distress.
• Initiating a consult for cardiac rehabilitation: Once the client's immediate needs are stabilized, early initiation of cardiac rehabilitation is appropriate. This supports physical recovery, promotes lifestyle changes like smoking cessation and exercise, and reduces future cardiac risk.

Rationale for incorrect choices:

• Administer a second dose of nitroglycerin: The client’s chest pain has resolved following the initial dose, so there is no current indication to give a second dose. Re-administering nitroglycerin unnecessarily can lead to hypotension or reflex tachycardia, especially risky in a post-MI patient.
• Request a prescription for a PRN anxiolytic: The client has already been prescribed alprazolam 0.5 mg three times daily, and their anxiety has improved. Requesting an additional anxiolytic is unnecessary at this point and does not address the more urgent issue of low oxygen saturation.
• Requesting a prescription for a WBC count: There are no signs or symptoms of infection such as fever, chills, or elevated WBC to justify this request. The focus should remain on the client’s cardiopulmonary status and rehabilitation rather than diagnostics that are not clinically indicated.
• Administering a bolus of fluids: There is no clinical indication of fluid volume deficit, hypotension, or dehydration. Administering fluids to a post-MI patient with COPD may lead to fluid overload, pulmonary edema, or increased myocardial strain.