A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client's family wants the client to have life-sustaining measures. Which of the following actions should the nurse take?

Arrange for an ethics committee meeting to address the family's concerns.

Complete an incident report.

Support the family's decision and initiate life-sustaining measures.

Encourage the family to contact an attorney.

Answer and Explanation

The Correct Answer is A

A. Arrange for an ethics committee meeting to address the family's concerns. An ethics committee can provide guidance in situations where there is conflict between advance directives and family wishes. This supports ethical decision-making while honoring the client’s autonomy and legal rights.
B. Complete an incident report. An incident report is used for errors or unusual events, not ethical dilemmas or conflicts over advance directives. It is not appropriate in this scenario.
C. Support the family's decision and initiate life-sustaining measures. The nurse is legally and ethically bound to follow the client’s advance directives, not the family’s wishes, especially when the client’s decisions are documented and clear.
D. Encourage the family to contact an attorney. While families have legal rights, referring them directly to an attorney does not address the immediate ethical issue or facilitate collaborative resolution in the care setting.

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Correct Answer is A

Explanation

A. "I will hang a new bag of TPN and IV tubing every 24 hours." This is the correct action. TPN solutions are high in glucose and lipids, which create an ideal environment for bacterial growth. Changing the bag and tubing every 24 hours reduces the risk of infection and sepsis, especially in clients with central lines.
B. "I will obtain the client's weight every other day." Weight should be monitored daily in clients receiving TPN to assess for fluid status, nutritional progress, and potential complications like fluid overload or retention.
C. "I will monitor the client's blood glucose level every 8 hours." Clients receiving TPN require more frequent glucose monitoring, typically every 4 to 6 hours, especially when therapy is initiated, due to the high dextrose content that can cause hyperglycemia.
D. “I will increase the rate of the TPN infusion to ensure the correct amount is given." TPN infusion rates should never be adjusted independently by a nurse. Changes must be made only with a provider’s order, as improper rate adjustments can lead to electrolyte imbalances, hyperglycemia, or fluid overload.

A. Provide a verbal report of the client's condition to the paramedic performing the transfer. B. Email the client's health information to the facility in an unencrypted file. C. Discuss the client's response to the transfer with another staff nurse. D. Fax the client's name and identifiable information to the rehabilitation facility

Correct Answer is A

Explanation

A. Provide a verbal report of the client's condition to the paramedic performing the transfer. This is an appropriate and secure method for communicating essential health information directly involved in the client’s care. It ensures continuity of care while maintaining confidentiality.
B. Email the client's health information to the facility in an unencrypted file. Sending health information via unencrypted email violates HIPAA guidelines and poses a risk to client confidentiality due to potential unauthorized access.
C. Discuss the client's response to the transfer with another staff nurse. Unless the staff nurse is directly involved in the client’s care, this would be a breach of confidentiality. Personal health information should only be shared on a need-to-know basis.
D. Fax the client's name and identifiable information to the rehabilitation facility. Faxing is permissible only when appropriate safeguards are in place. However, faxing identifiable information without confirming the recipient or using secure protocols can risk a confidentiality breach.

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A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client's family wants the client to have life-sustaining measures. Which of the following actions should the nurse take?

Nursing Test Bank

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