A nurse is caring for a client who has breast cancer and is postoperative following a bilateral mastectomy. Which of the following statements indicates the client has an altered body image?

Rationale:

A. Anemia: End-stage kidney disease reduces erythropoietin production by the kidneys, which impairs red blood cell formation in the bone marrow. This often leads to normocytic, normochromic anemia in affected clients.

B. Oliguria: As kidney function declines, urine output diminishes. Oliguria, defined as urine output less than 400 mL/day, is a common clinical feature of advanced kidney failure due to decreased glomerular filtration.

C. Hypotension: Clients with end-stage kidney disease more commonly experience hypertension due to fluid overload and impaired renin-angiotensin-aldosterone regulation. Hypotension may occur during dialysis but is not a typical baseline finding.

D. Bradypnea: Respiratory compensation for metabolic acidosis in kidney disease typically results in tachypnea, not bradypnea. The body increases respiratory rate to blow off excess CO₂ and correct the acid-base imbalance.

E. Edema: Impaired fluid excretion leads to sodium and water retention, resulting in peripheral, facial, or pulmonary edema. This is a hallmark feature of volume overload in chronic kidney disease.

Rationale:

A. Contact the client's family to discuss the decision: While family members may be involved, the nurse must prioritize respecting the client’s autonomy. The client has expressed their wishes, and involving family without consent may violate confidentiality and autonomy.

B. Encourage the client to complete a final hemodialysis treatment: Pressuring or encouraging a client to undergo treatment they have refused especially when they have advance directives in place disregards their legal and ethical right to make decisions about their own care.

C. Discuss possible options for discharge with the client: Respecting the client’s decision and exploring care planning, such as hospice or palliative care services, is appropriate. This supports autonomy while ensuring comfort and dignity in the end-of-life process.

D. Discuss future treatment options with the client's health care surrogate: A surrogate decision-maker is only consulted when the client is unable to make decisions. In this case, the client is alert and capable, so the discussion should remain between the nurse and client.