A nurse is caring for a client who is unresponsive and has advance directives stating they do not want treatment to extend their life. The client's partner is their health care surrogate and requests the nurse begin tube feedings. Which of the following responses should the nurse make?

"The ethics committee will need to make that decision."

"The client's wishes are to not be given life-saving treatment."

"Your partner will feel better with tube feeding."

"We should discuss this with the rest of your partner's family."

Answer and Explanation

The Correct Answer is B

A. Involving the ethics committee may be unnecessary if the client's advance directives are clear.

B. This response directly addresses the client's wishes as stated in their advance directives, reinforcing the importance of honoring their preferences regarding life-sustaining treatment.

C. Suggesting that tube feeding will make the client feel better contradicts the advance directives and does not respect the client's wishes.

D. Discussing the matter with the rest of the family may not be appropriate if the partner is the designated surrogate and the client's wishes are clearly outlined in the advance directives.

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Correct Answer is A

Explanation

A. Documenting nursing interventions as they are completed ensures accuracy and helps avoid missing critical information. This practice also enhances time management by reducing the likelihood of forgetting details.

B. Skipping breaks can lead to fatigue and reduce productivity over time. It's important to take breaks to maintain focus and energy levels.

C. Completing similar tasks for all clients may seem efficient but can lead to delays in addressing higher-priority needs. Tasks should be prioritized based on client needs.

D. Completing the lowest priority task at the beginning of the shift is inefficient, as higher-priority tasks should be addressed first to ensure timely care and prevent complications.

A. Notify the provider. B. Complete an incident report. C. Inform the nursing supervisor. D. Observe the client's condition.

Correct Answer is D

Explanation

A. While notifying the provider is important, it should not be the first action taken. The priority is to assess the client's condition to determine if there are any immediate effects from the additional medication dose.

B. Completing an incident report is necessary but comes after assessing the client’s condition.

C. Informing the nursing supervisor is important for documentation and support but should follow the assessment of the client.

D. Observing the client's condition is the most critical first step. This ensures that the nurse can identify any potential adverse effects from the additional dose and provide necessary interventions promptly.

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A nurse is caring for a client who is unresponsive and has advance directives stating they do not want treatment to extend their life. The client's partner is their health care surrogate and requests the nurse begin tube feedings. Which of the following responses should the nurse make?

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