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?

Choice A reason: Performing ADLs independently is not a specific indicator of donepezil’s effectiveness, as it treats cognitive symptoms in Alzheimer’s, not physical function. While improved cognition may indirectly aid ADLs, this outcome is too broad and not directly tied to the medication’s primary action, making it incorrect.
Choice B reason: Increased food intake is not an expected outcome of donepezil, which targets acetylcholinesterase to improve cognitive function in Alzheimer’s. Appetite changes are unrelated to its mechanism, and this finding does not indicate effectiveness, making it an incorrect measure of the drug’s impact.
Choice C reason: Enhanced mood is not a primary effect of donepezil, which focuses on slowing cognitive decline. While mood may improve indirectly, it is not a direct indicator of efficacy. Other medications address mood in Alzheimer’s, making this finding less relevant and incorrect.
Choice D reason: Improved short-term memory is a key indicator of donepezil’s effectiveness, as it increases acetylcholine levels to slow cognitive decline in Alzheimer’s. Enhanced memory reflects the drug’s intended action, aligning with clinical expectations, making this the correct measure of therapeutic success.

Choice A reason: Raising the head of the bed during transfer does not prioritize ergonomic principles. It may strain the nurse’s back or misalign the client, increasing injury risk. Ergonomics focuses on neutral spine alignment and mechanical aids to reduce physical strain during client transfers.
Choice B reason: Placing pillows under the head is a comfort measure, not an ergonomic principle. Ergonomics emphasizes reducing musculoskeletal strain through proper mechanics or devices. Pillows do not directly prevent nurse injuries, unlike transfer devices that minimize physical effort during client movement.
Choice C reason: Using a lateral transfer device, like a slide board, aligns with ergonomic principles by reducing manual lifting and spinal strain. It prevents back injuries, ensuring safe client transfer. This evidence-based practice supports occupational health guidelines, minimizing musculoskeletal risks for nurses during patient handling.
Choice D reason: Standing close during ambulation ensures client stability but is not a primary ergonomic principle. Ergonomics focuses on equipment and mechanics to reduce strain, not proximity, which addresses patient safety more than nurse injury prevention during transfers or repositioning tasks.