During transport to the operating room for mitral valve replacement, a patient with a signed consent form says that she does not want to go through with the surgery and asks to be returned to her room. What is the best response from the nurse?

Choice A reason: Normal ABG values (pH 7.40, CO2 39) don’t reflect COPD’s chronic hypercapnia and compensated acidosis. pH 7.32 with elevated CO2 is typical, making this incorrect, as it doesn’t match the nurse’s expected findings in a client with chronic obstructive pulmonary disease.

Choice B reason: In COPD, chronic CO2 retention (57 mEq/L) causes respiratory acidosis (pH 7.32) with compensatory HCO3 increase (26 mEq/L). Low PaO2 (85 mm Hg) reflects hypoxemia. This aligns with COPD pathophysiology, making it the correct ABG finding the nurse anticipates in this client.

Choice C reason: Alkalotic pH (7.47) and low CO2 (30 mEq/L) suggest hyperventilation, not COPD’s CO2 retention. Acidosis with high CO2 is expected, making this incorrect, as it contradicts the typical ABG profile in the nurse’s assessment of a COPD client.

Choice D reason: Low CO2 (22 mEq/L) and acidosis (pH 7.30) suggest metabolic acidosis, not COPD’s respiratory acidosis with hypercapnia. Elevated CO2 is typical, making this incorrect, as it doesn’t reflect the nurse’s expected ABG findings in chronic obstructive pulmonary disease.

Choice A reason: Disagreements among team members signal conflicting values, an early ethical dilemma indicator. This aligns with healthcare ethics, making it a correct situation, as it highlights potential ethical tensions that the nurse should recognize as requiring resolution in patient care.

Choice B reason: Failure to discuss end-of-life issues with the patient violates autonomy, creating an ethical dilemma. This aligns with ethical principles of patient involvement, making it a correct early sign the nurse should identify in healthcare decision-making processes.

Choice C reason: Aggressive pain management is a clinical decision, not inherently an ethical dilemma unless harm is suspected. Disagreements or belief in harm are clearer signs, making this incorrect, as it lacks the ethical conflict context in the nurse’s evaluation.

Choice D reason: Believing treatment is harmful raises ethical concerns about beneficence and nonmaleficence, indicating a dilemma. This aligns with ethical care standards, making it a correct situation the nurse should recognize as an early sign of an ethical issue in treatment decisions.

Choice E reason: Following an advance directive despite family objections creates an ethical conflict between patient autonomy and family wishes. This aligns with end-of-life ethics, making it a correct early sign of a dilemma the nurse should identify in patient care.

Choice F reason: Providing hope to the family is supportive and not inherently an ethical dilemma unless it involves deception. Failure to discuss end-of-life issues is a clearer sign, making this incorrect, as it lacks the ethical conflict context in the nurse’s assessment.