The client suffered cardiac arrest, was resuscitated and has now been on a ventilator for several days.
The client had a written advance directive which the spouse brought from home.
The primary care provider (PCP) is encouraging the spouse to consent for placement of a percutaneous endoscopic gastrostomy (PEG) tube, which is contrary to the client's advance directive.
After the PCP leaves, the spouse states, "I wish I knew what my spouse wanted.”. What is the best reply by the nurse?
"Didn't you ever discuss this possibility?"
"The PCP only wants what is best for your spouse.”.
"You will now have to make the decision.”.
"The spouse did tell you in the advance directive.”.
The Correct Answer is D
Choice A rationale
While it might seem natural to inquire about prior discussions, this response could induce guilt or regret in the spouse and doesn't directly address the current emotional distress and uncertainty about the spouse's wishes as explicitly stated in the advance directive. It shifts the focus to the past rather than the present need for clarification regarding the existing directive.
Choice B rationale
Although the primary care provider may indeed have the client's best interests in mind, this statement dismisses the spouse's expressed uncertainty and relies on an assumption about the PCP's motivations. It doesn't help the spouse understand or feel confident about the content of the advance directive, which is the core of their concern.
Choice C rationale
This statement, while true, places the burden of decision-making solely on the spouse without acknowledging the existence of the advance directive, which is meant to guide such decisions. It overlooks the possibility that the directive already contains the spouse's wishes and could offer clarity, thereby increasing the spouse's anxiety.
Choice D rationale
This response directly addresses the spouse's statement by reminding them that their spouse's wishes are likely documented in the advance directive. It encourages the spouse to review the directive, which is the most direct way to understand what their spouse wanted regarding medical interventions like a PEG tube, thus providing immediate and relevant support.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While cultural sensitivity is important, respecting the client's desire to have her uncle make decisions would undermine her legal and ethical right to self-determination, which is a fundamental principle in healthcare. This right ensures individuals make their own healthcare decisions free from coercion.
Choice B rationale
Revisiting the decision without the uncle present might pressure the client and still not directly address her right to make her own informed choices. It doesn't empower the client to exercise her autonomy.
Choice C rationale
Holding a family meeting and encouraging the client to speak on her own behalf is a supportive approach, but it doesn't guarantee the client will feel empowered to make her own decision, especially if cultural norms strongly favor the uncle's authority.
Choice D rationale
Educating the client about her right to autonomy directly addresses the ethical principle of self-determination. By understanding her rights, the client is empowered to make her own informed decisions about her treatment, regardless of cultural influences or family dynamics.
Correct Answer is D
Explanation
Choice A rationale
Anticipatory Grieving is a normal response to an expected loss, such as the impending death of oneself or a loved one. While the client is facing death, her statement "Why me, Lord" and inability to pray suggest a struggle with her spiritual beliefs and meaning in the face of this event, rather than primarily focusing on the emotional preparation for loss.
Choice B rationale
Ineffective Coping refers to an inability to manage stressors effectively. While the client's distress indicates difficulty coping with her situation, the specific mention of spiritual questioning and inability to pray points towards a disturbance in her spiritual well-being, which is more accurately described by spiritual distress.
Choice C rationale
Low Self-Esteem involves negative feelings about oneself and one's worth. While facing death can impact self-esteem, the client's direct questioning of her faith and inability to connect spiritually are the more prominent indicators in this scenario, suggesting a conflict or disruption in her spiritual domain rather than primarily a devaluation of self.
Choice D rationale
Spiritual Distress is characterized by a disruption in one's belief or value system that provides strength, hope, and meaning to life. The client's cry of "Why me, Lord" and her inability to pray indicate a struggle with her faith and a potential feeling of abandonment or questioning of her spiritual beliefs in the face of death. This aligns directly with the defining characteristics of spiritual distress.
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