A nurse is caring for an adult client in the primary care clinic. The nurse is reviewing the client's medical record.

A nurse is reviewing the client's medical record. Which of the following findings places the client at risk for heart disease? Select all that apply.

Choice A rationale

The brachial pulse is located in the antecubital fossa and is primarily used for blood pressure measurement or assessing circulation in the infant. While it reflects systemic arterial pressure, it is not the standard peripheral site used for calculating a pulse deficit in adults. A pulse deficit occurs when the heart's contractions are too weak to transmit a palpable pressure wave to the periphery, and the radial artery is the conventional comparative site.

Choice B rationale

The dorsalis pedis pulse is found on the dorsal aspect of the foot and is used to evaluate peripheral vascular status in the lower extremities. Because of its significant distance from the heart, there is a natural delay and potential for dampened amplitude due to peripheral artery disease. It is not used for pulse deficit assessments because it does not provide a reliable immediate comparison to the central cardiac activity represented by the apical pulse.

Choice C rationale

A pulse deficit is determined by simultaneously measuring the apical pulse via auscultation and the radial pulse via palpation for one full minute. The radial artery is the most distal easily accessible site that should normally reflect every ventricular contraction. A difference between the apical and radial rates indicates that some cardiac contractions are not producing enough stroke volume to be felt peripherally, often seen in conditions like atrial fibrillation.

Choice D rationale

The carotid pulse is a central pulse located in the neck, reflecting pressure changes very close to the aorta. Because of its proximity to the heart, it is less likely to show a deficit compared to more distal peripheral sites. Using the carotid pulse would not accurately identify a pulse deficit because it usually remains palpable even when stroke volume is diminished, whereas the radial pulse would disappear, highlighting the discrepancy in perfusion.

Choice A rationale

Suggesting an antidepressant is inappropriate because wanting to die at home during the terminal stage of lung cancer is a rational preference for comfort and autonomy, not necessarily a sign of clinical depression. Pathologizing a client's end of life wishes ignores their right to self-determination. Furthermore, antidepressants take weeks to reach therapeutic levels, which may not align with the client's immediate terminal prognosis and the urgent need for a discharge plan focused on comfort.

Choice B rationale

Informing a patient that their wish to go home is not in their best interest is a paternalistic approach that violates the ethical principle of autonomy. A nurse's role is to support the client's informed decision-making process rather than imposing personal or professional biases. In end stage lung cancer, the focus shifts from curative care to quality of life. Denying the client's request can cause moral distress and prevent a peaceful death in their preferred environment.

Choice C rationale

Transferring a client to a long term care facility does not honor the client's specific request to go home. While long term care provides nursing assistance, it is still an institutional setting and may not provide the specialized end of life care required for a terminal diagnosis. This action bypasses the client's expressed wish for a home environment. The nurse should focus on resources that facilitate the client's transition to their own residence with appropriate medical support.

Choice D rationale

Discussing hospice services is the most important action because hospice provides palliative care for clients with a terminal illness and a life expectancy of six months or less. Hospice focuses on pain management, symptom control, and emotional support for both the client and family in the home setting. By coordinating this referral, the nurse ensures the client's wish to die at home is honored while maintaining safety and professional care standards during the dying process.