A clinic nurse is preparing to teach student nurses about care of clients with viral pharyngitis. Which information should the nurse include in the teaching plan? Select all that apply.

A. Respond to ventilator alarms: While it is crucial to respond to ventilator alarms promptly to ensure the client’s safety and adequate ventilation, this action is not the highest priority in relation to the use of neuromuscular blockers. The use of neuromuscular blockade requires a broader focus on the patient's overall care and safety.
B. Report the absence of spontaneous respirations: Reporting the absence of spontaneous respirations is important, as neuromuscular blockers can cause paralysis of the respiratory muscles. However, the focus should be on maintaining the client's safety and comfort while they are on mechanical ventilation, rather than just reporting findings.
C. Provide passive range-of-motion exercises: This is the priority action when caring for a client receiving neuromuscular blockers. Since the client cannot move voluntarily due to the effects of the neuromuscular blockade, passive range-of-motion exercises are essential to prevent complications such as contractures and muscle atrophy. This intervention helps maintain joint mobility and circulation, which is critical in patients who are mechanically ventilated for an extended period.
D. Encourage the client to attempt to breathe on their own: Encouraging the client to breathe on their own is not appropriate when they are receiving neuromuscular blockade, as their respiratory muscles are paralyzed. Instead, the focus should be on ensuring that the mechanical ventilation settings are adequate to provide proper oxygenation and ventilation while the client cannot initiate breaths independently. This action could lead to respiratory distress if attempted while under neuromuscular blockade.

A. Cultural differences. While cultural beliefs may influence end-of-life decisions, the primary issue in this scenario is not cultural misunderstanding but rather the conflict between the client’s documented wishes and the family's demands. Cultural differences typically pertain to variations in values, traditions, or beliefs, rather than legal and ethical dilemmas regarding patient autonomy.
B. Ethical conflict. The nurse is experiencing moral distress due to a conflict between ethical principles—specifically, the principle of patient autonomy (respecting the client’s right to make their own healthcare decisions) and beneficence (providing care that benefits the client). The client’s living will, a legally binding document, states Do Not Resuscitate (DNR), yet the children are insisting on full resuscitation. The nurse’s distress arises from witnessing actions that contradict the client’s wishes and ethical nursing responsibilities.
C. Competition between groups. There is no indication that different groups, such as healthcare teams or family members, are competing for resources or control. The conflict stems from an ethical dilemma rather than rivalry or organizational disputes.
D. Scarcity, safety, and security. This situation does not involve limited resources, threats to safety, or security concerns. The distress is rooted in the ethical dilemma of honoring the client’s advance directive versus the family’s insistence on aggressive resuscitation measures.