A nurse is caring for a client who has pneumonia and tells the nurse, "I feel like an elephant is sitting on my chest." The client is weak and unable to walk.
After the nurse initiates chest pain protocol, which of the following is the priority diagnostic test?

Choice A rationale: Hypoglycemia refers to low blood sugar levels. This condition can occur in newborns, especially those born to mothers with diabetes, preterm babies, babies who are small for gestational age, or those who have experienced a difficult delivery. However, the provided information does not indicate any signs of hypoglycemia such as jitteriness, poor feeding, or lethargy.

Choice B rationale: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects newborns and infants. It’s more common in premature infants who have received oxygen therapy or mechanical ventilation. The newborn’s information does not suggest any risk factors for BPD.

Choice C rationale: Transient tachypnea of the newborn (TTN) is a respiratory problem that can be seen shortly after delivery in babies who have no other health issues. It’s caused by fluid in the lungs. The newborn’s increased respiratory rate and grunting are signs of TTN. This condition is more common in babies delivered via cesarean birth, as in this case.

Choice D rationale: Tachycardia refers to a heart rate that’s too fast. While the newborn’s heart rate is on the higher side of normal (normal range: 120-160 beats per minute), it’s not high enough to be considered tachycardia. Therefore, based on the provided information, the newborn is at risk for developing Transient tachypnea of the newborn (Choice C). The other conditions mentioned do not align with the symptoms and risk factors presented in the scenario.

The correct answer is Choice B

Choice A rationale: Advance directives are voluntary and revocable; clients can change their decisions at any time as long as they are mentally competent.

Choice B rationale: Discussing advance directives with family ensures clarity, reduces future conflict, and supports informed decision-making aligned with the client’s wishes.

Choice C rationale: Witnesses are typically required, but a partner’s presence is not legally mandated unless designated as a healthcare proxy.

Choice D rationale: Notarization is not universally required; validity depends on state laws, and many jurisdictions accept signed and witnessed documents without attorney involvement.