A nurse is caring for a client who has a fractured leg and rates their pain as 7 on a scale of 0 to 10. Which of the following medications should the nurse expect to administer?

A. Support the family's decision and initiate life-sustaining measures: The nurse must honor the client’s advance directives, which take precedence over family wishes. Initiating life-sustaining measures against the client’s documented wishes would violate ethical and legal standards.

B. Complete an incident report: Completing an incident report is not appropriate in this situation because no error or unsafe practice has occurred. The issue involves ethical conflict, not a reportable incident.

C. Encourage the family to contact an attorney: While the family may seek legal guidance, the nurse’s role is to facilitate ethical and clinical discussions, not direct them toward legal action. Legal counsel may complicate timely decision-making.

D. Arrange for an ethics committee meeting to address the family's concerns: Involving the ethics committee provides a structured forum to discuss the client’s wishes, clarify ethical obligations, and mediate the conflict between the family and the advance directives. This supports patient autonomy while addressing family concerns.

Rationale:

• Hypoxia: Hypoxia occurs in both epiglottitis and RSV due to airway obstruction or lower respiratory involvement. In epiglottitis, airway swelling can limit oxygen intake, whereas in RSV, lower airway inflammation and bronchiolitis cause oxygen desaturation. Streptococcal pharyngitis typically does not impair oxygenation.

• Fever: Fever is a nonspecific finding seen in epiglottitis, RSV, and streptococcal pharyngitis. Infection-induced inflammation and immune response in all three conditions cause elevated temperatures. The degree and onset of fever can vary among the conditions.

• Tachypnea: Tachypnea is a compensatory response to hypoxia and airway compromise. It is commonly observed in epiglottitis due to upper airway obstruction and in RSV due to bronchiolar inflammation. It is usually absent in isolated streptococcal pharyngitis.

• Drooling: Drooling is a hallmark sign of epiglottitis due to painful swallowing and airway obstruction. It is not typical in RSV or streptococcal pharyngitis. Presence of drooling indicates urgent airway assessment.

• Exudate on pharynx: Exudative pharyngitis is characteristic of streptococcal infections. It is rarely seen in epiglottitis and RSV. White or yellow exudates on the tonsils help differentiate bacterial pharyngitis from viral or upper airway conditions.

• Wheezing upon auscultation: Wheezing is associated with lower airway involvement, commonly seen in RSV bronchiolitis. It is not typically present in epiglottitis or streptococcal pharyngitis. Wheezing reflects bronchospasm or airway inflammation.