A nurse is caring for a client who is seeking information about end-of-life decisions. According to the Patient Self-Determination Act, which of the following applies to medical decisions that can be made within organizations that receive Medicare and Medicaid reimbursements?

Choice A reason: Explaining the implications of a Do Not Resuscitate (DNR) status ensures the client understands that no CPR or intubation will occur if their condition deteriorates. This supports informed consent and autonomy, clarifying the scope of DNR to prevent misunderstandings. It respects the client’s decision-making capacity, ensuring their wishes align with end-of-life care preferences.
Choice B reason: Placing a “Do Not Resuscitate” sign outside the room breaches confidentiality under HIPAA, risking unauthorized disclosure of sensitive information. DNR status is communicated via medical records or wristbands. This action is inappropriate, as it does not contribute to implementing the client’s wishes and violates privacy standards, making it an incorrect response.
Choice C reason: Obtaining family consent is unnecessary for a competent client’s DNR request, as autonomy rests with the client. If decisionally capable, their wishes override family input. The nurse’s role is to support the client’s decision, not seek family approval, unless the client is incapacitated, which is not indicated, making this action inappropriate.
Choice D reason: Documenting the DNR request in the medical record ensures the care team follows the client’s wishes, preventing unwanted interventions. Accurate documentation communicates code status, supports legal and ethical standards, and ensures continuity of care. This is critical for aligning treatment with the client’s end-of-life preferences, making it a necessary action.

Choice A reason: Suggesting a support group helps the client address emotional resistance to the colostomy through peer support. This fosters psychological adjustment, reduces stigma, and promotes self-management by sharing experiences, aligning with evidence-based strategies to improve coping and adaptation in clients with new ostomies.
Choice B reason: Encouraging avoidance of negative feelings dismisses the client’s emotional response, hindering psychological adaptation. Accepting a colostomy requires processing grief and fear. Suppressing emotions delays coping, as psychological adjustment involves acknowledging feelings to integrate the stoma into the client’s self-image effectively.
Choice C reason: Instructing the partner to assume colostomy care undermines the client’s autonomy and delays self-management. Independence in stoma care is critical for psychological and practical adaptation. Dependency may hinder adjustment, as clients need to develop skills to manage their condition independently.
Choice D reason: Transferring to a rehabilitation facility is premature without trying in-hospital education or support groups. Most clients learn stoma care with nursing guidance. Transfer disrupts care continuity and may increase distress, failing to address emotional resistance directly, unlike peer support interventions.