A nurse is reviewing the medical record of a client who has end-stage renal disease and is receiving palliative care. The nurse notes that the client has an advance directive that states that they do not want dialysis or any other form of renal replacement therapy.
However, the nurse also notes that the client's spouse is the designated surrogate decision-maker and has consented to start dialysis for the client.
Which of the following actions should the nurse take?
Respect the spouse's decision and initiate dialysis for the client.
Contact the ethics committee or the legal department for guidance.
Educate the spouse about the client's advance directive and its implications.
Inform the health care provider of the discrepancy and request clarification.
The Correct Answer is D
The nurse should inform the health care provider of the discrepancy between the client's advance directive and the spouse's consent, and request clarification on how to proceed. The health care provider should then discuss the situation with the spouse and explain their role and responsibilities as a surrogate decision-maker, as well as the benefits and burdens of dialysis for the client. The health care provider should also try to resolve any conflicts or misunderstandings that may exist between the client's wishes and the spouse's beliefs or values.
Answer A is incorrect because it does not respect the client's advance directive or their right to self-determination, and it may cause harm or suffering to the client.
Answer B is incorrect because it may delay or complicate the decision-making process, and it may not be necessary unless there is a serious ethical dilemma or legal dispute that cannot be resolved by other means.
Answer C is incorrect because it is not within the nurse's scope of practice to educate or persuade the spouse about the client's advance directive or its implications; this should be done by the health care provider or another qualified professional.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The nurse should document the client's decision in the medical record and notify the health care team, as this is part of their professional responsibility and legal obligation. The nurse should also respect and support the client's autonomy and right to self-determination, even if it differs from their own or their family's values or beliefs.
Answer A is incorrect because it may cause conflict or distress for both the client and their family, and it is not within the nurse's scope of practice to mediate such issues.
Answer C is incorrect because it may imply that the nurse does not respect or accept the client's decision, and it may interfere with their dignity or quality of life.
Answer D is incorrect because it may suggest that the nurse thinks that there is something wrong with the client's decision, or that they need to be convinced otherwise.
Correct Answer is C
Explanation
T
he nurse should initiate antibiotic therapy as prescribed for a client who has COPD and develops signs of a respiratory infection, such as fever, productive cough, and increased dyspnea. Antibiotics can help treat the infection and prevent complications such as sepsis or respiratory failure.
Incorrect answers:
A) The nurse should not obtain a sputum culture and sensitivity test for a client who has COPD and develops signs of a respiratory infection, as this is not necessary or appropriate in palliative care. The goal of palliative care is to relieve symptoms and improve quality of life, not to diagnose or cure diseases. A sputum culture and sensitivity test may cause discomfort or distress for
the client, and delay treatment.
B) The nurse should not administer acetaminophen as prescribed for a client who has COPD
and develops signs of a respiratory infection, as this is not sufficient or effective in managing
the condition. Acetaminophen may help reduce fever, but it does not address the underlying cause of infection or relieve other symptoms such as cough or dyspnea.
D) The nurse should not increase fluid intake as tolerated for a client who has COPD and develops signs of a respiratory infection, as this may worsen dyspnea or cause fluid overload. Fluid intake should be individualized
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