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?

Arrange for an ethics committee meeting to address the family's concerns.

Complete an incident report.

Support the family's decision and initiate life-sustaining measures.

Encourage the family to contact an attorney.

Answer and Explanation

The Correct Answer is A

A. Arrange for an ethics committee meeting to address the family's concerns. An ethics committee can provide guidance in situations where there is conflict between advance directives and family wishes. This supports ethical decision-making while honoring the client’s autonomy and legal rights.
B. Complete an incident report. An incident report is used for errors or unusual events, not ethical dilemmas or conflicts over advance directives. It is not appropriate in this scenario.
C. Support the family's decision and initiate life-sustaining measures. The nurse is legally and ethically bound to follow the client’s advance directives, not the family’s wishes, especially when the client’s decisions are documented and clear.
D. Encourage the family to contact an attorney. While families have legal rights, referring them directly to an attorney does not address the immediate ethical issue or facilitate collaborative resolution in the care setting.

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Correct Answer is A

Explanation

A. Flush the tubing with 30 mL of water every 4 hr. Flushing the tube regularly helps maintain patency, prevent clogging, and ensure that the feeding is delivered effectively. This is a standard practice in managing enteral feeding systems.
B. Check for gastric residual every 12 hr. Gastric residuals should typically be checked every 4 to 6 hours, or per facility protocol, especially in clients at risk for aspiration. Waiting 12 hours is too long and may delay identifying feeding intolerance.
C. Place enough formula in the container to last 18 hr. Open systems should have fresh formula added every 4 hours to reduce the risk of bacterial contamination. Leaving formula in the feeding bag for 18 hours exceeds safety guidelines and increases infection risk.
D. Maintain bed elevation at 20°. The head of the bed should be elevated to at least 30 to 45 degrees to reduce the risk of aspiration. A 20° elevation is insufficient and does not provide adequate protection during feeding.

A. Premature atrial complexes B. First-degree atrioventricular block C. Complete heart block D. Atrial fibrillation

Correct Answer is B

Explanation

A. Premature atrial complexes. These are early electrical impulses originating in the atria that cause premature heartbeats, but they do not consistently lengthen the P-R interval. The P-R interval usually remains within normal limits unless another condition is present.
B. First-degree atrioventricular (AV) block. A constant P-R interval longer than 0.20 seconds (normal range: 0.12–0.20 seconds) is characteristic of a first-degree AV block. A P-R interval of 0.35 seconds indicates a prolonged conduction delay through the AV node, consistent with this dysrhythmia.
C. Complete heart block. In complete (third-degree) heart block, there is no consistent relationship between P waves and QRS complexes, and the P-R interval is not constant. This is not consistent with a stable, prolonged P-R interval.
D. Atrial fibrillation. Atrial fibrillation is marked by irregularly irregular rhythm and absent, unidentifiable P waves, not a consistent P-R interval. The atria are quivering, not contracting in a coordinated way.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

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