A nurse is caring for a client who has end-stage kidney disease and refuses further hemodialysis treatments. The client has advance directives that indicate no life-sustaining treatments. Which of the following actions should the nurse take?
Contact the client's family to discuss the decision.
Encourage the client to complete a final hemodialysis treatment.
Discuss possible options for discharge with the client.
Discuss future treatment options with the client's health care surrogate.
The Correct Answer is C
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. The nurse explained the risks and benefits of the surgery: Explaining the risks and benefits of a surgical procedure is the responsibility of the surgeon, not the nurse. The nurse may clarify or reinforce information but does not provide the primary explanation.
B. The nurse explained the surgical procedure in detail: Nurses can offer general clarification, but it is the surgeon’s legal and ethical duty to explain the procedure in detail, including alternatives, risks, and benefits, as part of obtaining informed consent.
C. The client knows they may no longer refuse the procedure: Clients have the legal right to refuse a procedure at any time, even after signing consent. Consent is not binding and must remain voluntary and revocable until the procedure begins.
D. The client agreed to the procedure voluntarily: Informed consent requires that the client makes the decision freely, without coercion. Observing the client voluntarily agree to the procedure meets this core legal and ethical requirement of informed consent.
Correct Answer is D
Explanation
Rationale:
A. "You are feeling anxious now; why don't you give it some time before making a final decision?": This minimizes the client’s current emotional distress and does not address the seriousness of the statement. It may come across as dismissive rather than therapeutic.
B. "You should talk with your family members before making this decision.": Although involving family in major decisions can be helpful, the focus should be on the client's feelings and wishes first.
C. "I will discuss this with your primary health care provider, and we can discuss this more tomorrow.": Deferring the conversation may delay support for someone expressing emotional exhaustion and possible suicidal ideation. Prompt intervention is essential in these situations.
D. "Let me refer you to talk to someone regarding your treatment options.": This response acknowledges the client's emotional state while also offering a supportive and appropriate next step. It opens access to counseling or mental health services and helps the client explore options without judgment.
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