After an interdisciplinary team meeting regarding the client's request to die a natural death, the primary healthcare provider refuses to write the do-not-resuscitate instructions. Which action should the nurse take?

Choice A Reason: Instructing UAPs to transfer all non-ambulatory clients via wheelchairs is not a good intervention, as it may expose the clients and the UAPs to smoke and fire, and cause panic and congestion in the hallways. The charge nurse should follow the RACE protocol (Rescue, Alarm, Contain, Extinguish), which means rescuing only those clients who are in immediate danger, and containing the fire by closing doors and windows.

Choice B Reason: Instructing the nursing staff to evacuate ambulatory clients to the nearest fire exits is not a good intervention, as it may also expose the clients and the staff to smoke and fire, and interfere with the fire

department's efforts. The charge nurse should follow the RACE protocol, which means evacuating only as a last resort, and only after receiving instructions from the fire department.

Choice C Reason: Shutting all doors to client rooms and telling everyone to stay in their rooms until the fire

department arrives is the best intervention, as it follows the RACE protocol, which means containing the fire by closing doors and windows, and extinguishing it if possible with a fire extinguisher. This intervention also helps protect the clients and staff from smoke inhalation and fire spread, and allows the fire department to access and control the fire.

Choice D Reason: Announcing in a calm voice that all visitors should proceed immediately to the first floor via the service elevators is not a good intervention, as it may endanger the visitors and cause more damage. The charge nurse should follow the RACE protocol, which means alarming others by activating the fire alarm system and calling 911. The charge nurse should also instruct visitors not to use elevators during a fire, as they may malfunction or trap them inside.

Choice A Reason: Demonstrating how to complete an adverse occurrence or variance report is important, but not the most important objective. This report is a tool for quality improvement and risk management, but it does not prevent litigation by itself. The nurse should also communicate effectively with the client and/or their family, and document the incident and the actions taken.

Choice B Reason: Discussing how to handle complaints from clients and/or their families is the most important objective, as it can help prevent or resolve conflicts, and avoid escalation to legal action. The nurse should listen empathetically, acknowledge the client's feelings and concerns, apologize if appropriate, explain the situation and the plan of care, and involve the supervisor or other resources if needed.

Choice C Reason: Describing how to obtain legal services if needed is relevant, but not the most important objective.

This objective implies that litigation is inevitable or expected, which may create a negative or defensive attitude in the staff nurses. The nurse should focus on preventing litigation by providing safe and quality care and building trust and rapport with the clients and/or their families.

Choice D Reason: Maintaining personal malpractice insurance is advisable, but not the most important objective. This objective may protect the nurse's personal assets in case of a lawsuit, but it does not prevent litigation from occurring. The nurse should follow the standards of practice and the policies and procedures of the organization, and document accurately and thoroughly.