A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of the following information should the nurse include in the change-of-shift report?

Choice A reason: A nurse refusing to actively participate during an elective abortion procedure scheduled for their client is not a behavior that indicates a need for further education. The nurse has the right to conscientious objection, which means they can decline to perform or assist in a procedure that violates their moral or religious beliefs. The nurse should inform the charge nurse of their objection and request to be reassigned to another client.

Choice B reason: A nurse explaining to a client's family that a DNR order includes withholding comfort measures is a behavior that indicates a need for further education. The nurse is providing false and misleading information that can cause harm and distress to the client and the family. A DNR order only means that no cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) will be initiated in the event of a cardiac or respiratory arrest. A DNR order does not affect the provision of other treatments, such as pain management, hydration, nutrition, oxygen, or emotional support.

Choice C reason: A nurse informing a confused client who wants to go home that they are going to stay at the facility until they are better is not a behavior that indicates a need for further education. The nurse is using therapeutic communication and providing reassurance to the client. The nurse is also respecting the client's autonomy and right to refuse treatment, as long as the client is competent and informed. The nurse should assess the client's mental status and decision-making capacity, and involve the client's family or surrogate decision-maker if needed.

Choice D reason: A nurse giving prescribed opioids to a client who has a terminal illness and respirations of 8/min is not a behavior that indicates a need for further education. The nurse is following the principle of beneficence, which means doing good and preventing harm to the client. The nurse is also following the principle of double effect, which means that an action that has both a good and a bad effect is morally permissible if the good effect outweighs the bad effect. The nurse is providing adequate pain relief to the client, even if it may hasten their death. The nurse should monitor the client's vital signs and level of consciousness, and adjust the opioid dose as prescribed.

Choice A reason: Closing the fire doors and the doors to the room is an appropriate action, but not the first one that the nurse should take. The nurse should first activate the fire alarm to alert the fire department and the facility staff.

Choice B reason: Extinguishing the fire is an appropriate action, but not the first one that the nurse should take. The nurse should first activate the fire alarm to alert the fire department and the facility staff. Then, the nurse should use the fire extinguisher to put out the fire, following the RACE protocol (rescue, alarm, contain, extinguish).

Choice C reason: Removing clients from nearby rooms is an appropriate action, but not the first one that the nurse should take. The nurse should first activate the fire alarm to alert the fire department and the facility staff. Then, the nurse should evacuate the clients who are in immediate danger, following the RACE protocol (rescue, alarm, contain, extinguish).

Choice D reason: Activating the fire alarm is the first and most appropriate action that the nurse should take. The nurse should activate the fire alarm to alert the fire department and the facility staff. Then, the nurse should follow the RACE protocol (rescue, alarm, contain, extinguish) to protect the clients and the facility.