A nurse provides care to an older hospitalized client who is newly admitted for advanced liver failure. The client states, "I've told my doctor to let me die if my heart stops beating or if I quit breathing. I do not want to be revived." To best ensure the client's request is honored, which of the following should the nurse do?

Choice A reason : Conducting 15-minute checks can be part of the safety measures for a client at risk of self-harm, but it may not be sufficient for someone who is actively hearing voices commanding self-harm and refusing to engage in safety planning. These checks are less intensive and may not provide the immediate intervention needed to ensure the client's safety¹.

Choice B reason : Encouraging the client to express feelings related to suicide is an important therapeutic intervention that can provide insight into the client's emotional state and risk factors. However, if the client is actively psychotic and not engaging in safety planning, this approach alone may not be enough to ensure immediate safety¹.

Choice C reason : Placing the client on one-to-one observation is the most direct and immediate intervention to ensure safety when a client is experiencing psychotic features and is at risk of self-harm. This level of observation means that the client is never alone, and a staff member is always present to intervene if the client attempts self-harm¹.

Choice D reason : Obtaining an order for locked seclusion can be considered if other less restrictive measures are not sufficient to ensure the client's safety. However, it is generally a last resort due to the potential for negative psychological effects and should only be used when absolutely necessary and when other interventions have failed¹.

Choice A reason : Serum creatinine is a key indicator of renal function. It is a waste product that kidneys filter out. Elevated levels can indicate impaired kidney function, which is a concern in SLE due to the risk of lupus nephritis².

Choice B reason : Urine-specific gravity can provide information about the kidney's ability to concentrate urine but is not as specific as serum creatinine for assessing overall renal function².

Choice C reason : Blood urea nitrogen (BUN) can be influenced by factors other than renal function, such as hydration status and dietary protein intake, making it less reliable than serum creatinine for evaluating kidney function in SLE².

Choice D reason : Serum sodium levels can be affected by various factors, including fluid balance and medications. While it can reflect changes in kidney function, it does not provide as direct an assessment as serum creatinine².