A student nurse is conversing with her family about the role of the nurse. Which statement below best describes the significant role of nursing in providing healthcare?

Choice A rationale

Ethical medical practice always prioritizes the wishes of the client, even if those wishes were expressed previously or are currently being voiced by a surrogate. Stating that the client's wish is not followed is incorrect and violates the principles of autonomy and patient centered care. Palliative sedation is intended to provide comfort at the end of life, and the decision making process must involve the client or their designated legal representative to ensure ethical compliance.

Choice B rationale

When a client lacks an advance directive and has a decreased level of consciousness, medical decisions fall to a legal proxy or next of kin. This individual acts as a surrogate to make decisions based on what the client would have wanted, known as substituted judgment. Palliative sedation is a comfort measure for refractory symptoms like extreme dyspnea. Obtaining consent from a legal proxy allows the medical team to proceed with treatments that alleviate suffering while respecting legal requirements.

Choice C rationale

It is incorrect to claim that consent must have been obtained before a change in consciousness occurred. While proactive planning via advance directives is ideal, the healthcare system has mechanisms in place to handle situations where a client becomes incapacitated. If no prior directive exists, the legal proxy or surrogate is empowered to provide informed consent for treatments. Denying palliative care based solely on the absence of a prior written document would lead to unnecessary and unethical suffering.

Choice D rationale

Informed consent is a fundamental requirement for palliative sedation because the treatment involves the administration of medications that significantly alter consciousness. Even in terminal cases where the goal is comfort, the nurse and physician must ensure that the family or legal proxy understands the nature, purpose, and potential outcomes of the sedation. Administering such a potent intervention without any form of legal or surrogate consent would be a violation of medical ethics and professional nursing standards.

Choice A rationale

A respiratory rate of 28/min is considered tachypneic, as the normal range for an adult is typically 12 to 20 breaths per minute. An elevated respiratory rate suggests that the body is still struggling to compensate for low oxygen levels or high carbon dioxide. Therefore, this finding would indicate that the oxygen therapy has not yet fully stabilized the client's respiratory status. Effective intervention should result in the respiratory rate returning toward the normal physiological range.

Choice B rationale

Pink mucous membranes are a primary indicator of adequate tissue perfusion and oxygenation of hemoglobin. When hypoxia is present, membranes may appear pale or cyanotic due to the lack of oxygenated blood. The transition to pink signifies that the supplemental oxygen is effectively increasing the arterial oxygen tension and saturating the hemoglobin molecules. This clinical observation is a reliable sign that the oxygen therapy is successfully delivering necessary oxygen to the systemic peripheral tissues.

Choice C rationale

Restlessness is a common early neurological sign of hypoxia and cellular oxygen deprivation within the cerebral cortex. As oxygen levels drop, the brain triggers a stress response that manifests as agitation, anxiety, or confusion. If the client remains restless, it suggests that the supplemental oxygen has not yet resolved the underlying hypoxia at the cellular level. A successful intervention would typically lead to a calmer, more alert state as brain tissue receives sufficient oxygenation.

Choice D rationale

A heart rate of 110/min is classified as tachycardia, exceeding the normal adult resting range of 60 to 100 beats per minute. Tachycardia is a compensatory mechanism where the heart pumps faster to circulate limited oxygen to vital organs. If the heart rate remains elevated, it indicates that the cardiovascular system is still under stress from oxygen deficiency. Effective oxygen therapy should reduce the workload on the heart, leading to a decrease in the pulse rate.