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?

Assure the client that their end-of-life wishes are followed right away.

Check the medical record for a DNR order.

Ask the client if they have a healthcare proxy who can speak for them if needed.

Verify a signed copy of the advance directives in the medical record.

Answer and Explanation

The Correct Answer is B

Choice A reason : While it is important to assure the client, the nurse must first verify that there is a formal DNR order in place to legally honor the client's wishes¹².

Choice B reason : Checking for a DNR order in the medical record is the correct action to ensure that the client's wishes regarding resuscitation are documented and will be followed by all healthcare providers¹².

Choice C reason : Asking about a healthcare proxy is important, but it is secondary to confirming that the client's wishes are documented in the medical record through a DNR order or advance directives¹².

Choice D reason : Verifying a signed copy of the advance directives is crucial, but the immediate step is to check for a DNR order, which is specifically related to the client's request not to be resuscitated¹².

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Correct Answer is D

Explanation

Choice A reason : Abdominal distension is more commonly associated with right-sided heart failure due to fluid accumulation in the abdominal cavity. Left-sided heart failure primarily affects the lungs, leading to respiratory symptoms¹.

Choice B reason : Jugular venous distention is typically a sign of right-sided heart failure, indicating increased pressure in the right atrium and venous system. It is not a primary symptom of left-sided heart failure¹.

Choice C reason : Dependent edema, or swelling in the lower extremities, is also more indicative of right-sided heart failure, where fluid accumulates due to poor venous return. In left-sided heart failure, fluid backs up into the lungs rather than the extremities¹.

Choice D reason : A hacking cough, especially when lying down, is a symptom of left-sided heart failure, as fluid backs up into the lungs causing pulmonary congestion. This can lead to coughing and shortness of breath, particularly during exertion or when lying flat¹.

A. Hypervolemia B. Hypovolemia C. Hyponatremia D. Hyperkalemia

Correct Answer is A

Explanation

Choice A reason : In end-stage kidney disease, the kidneys are unable to excrete excess fluid, leading to fluid overload or hypervolemia. This condition can manifest as shortness of breath due to pulmonary edema, swelling in the lower extremities, and crackles in the lungs upon auscultation. Elevated blood pressure is also a common finding in hypervolemia due to the increased volume of fluid in the bloodstream⁵⁶⁷⁸.

Choice B reason : Hypovolemia, or decreased blood volume, is not consistent with the symptoms described. It typically presents with signs of dehydration, low blood pressure, and tachycardia, which are not mentioned in the client's manifestations.

Choice C reason : Hyponatremia, or low sodium levels in the blood, can occur in ESKD due to dilution from retained fluids, but the primary symptoms described by the client are more indicative of fluid overload rather than electrolyte imbalance alone.

Choice D reason : Hyperkalemia, or high potassium levels, is a serious complication of ESKD due to the kidneys' inability to excrete potassium. While it is a concern in ESKD, the symptoms described by the client are more directly related to fluid overload.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

Correct Answer is A

Explanation

A nurse in a clinic is reviewing the laboratory values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following laboratory values?

A nurse is teaching a client about the seven warning signs of cancer. Which of the following signs should the nurse include as manifestations of cancer? (Select all that apply.)

A nurse is caring for a client scheduled to receive external radiation to the neck for cancer of the larynx. During a pre-treatment exam, the nurse explains to the client that the most likely side effect would be :

A nurse is reviewing the laboratory results of a client who was admitted with a history of multiple myeloma. The nurse should expect to find an increase in which of the following laboratory values?

A nurse is providing discharge teaching to a client who has a new diagnosis of heart failure. Which of the following instructions should the nurse include in the teaching?

A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as contributing to this lab value?

A nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, which of the following should the nurse anticipate using?