A nurse is caring for a client who is pregnant. The nurse is reviewing the client's medical record.

Exhibits

Select 4 findings that indicate a potential prenatal complication

Rationale:

A. Obtaining the initial assessment of assigned clients: Initial assessments require nursing judgment and are part of the nursing process, which cannot be delegated to assistive personnel. Only licensed nurses may perform comprehensive initial assessments.

B. Changing a nonsterile dressing: This is a routine and predictable task that does not require clinical judgment and can be safely delegated to assistive personnel, depending on facility policy and the client’s condition.

C. Interpreting a client's diagnostic laboratory results: Interpretation of lab values requires analysis and clinical decision-making, which are nursing responsibilities. Assistive personnel are not licensed to interpret or evaluate clinical data.

D. Educating a client and family members on home care: Client education involves assessing understanding, using clinical knowledge, and adapting teaching methods, functions reserved for licensed nurses, not assistive personnel.

Rationale:

A. Explain to the client they can change their mind at any time: Clients have the right to make or revoke decisions about resuscitation at any time. Informing the client of this autonomy supports informed consent and respects their evolving preferences and values regarding end-of-life care.

B. Obtain consent from the family for the change to the plan of care: The decision for a Do Not Resuscitate (DNR) order is made by the client, not the family, if the client is competent. Family involvement is supportive but does not override the client’s autonomy in this matter.

C. Discharge the client to hospice care: While hospice may be appropriate for end-stage disease, requesting a DNR does not automatically necessitate discharge. Clients can remain in the current care setting with appropriate adjustments to their goals of care.

D. Place a sign with "Do Not Resuscitate" outside the client's room: Displaying such signs can violate privacy and confidentiality. Instead, the DNR order should be documented clearly in the medical record and care plan, accessible to the healthcare team.