A nurse is changing the bed linen for a client who is on contact precautions. Which of the following personal protective equipment should the nurse wear?

A. Delayed gastric emptying (gastroparesis) typically manifests with symptoms related to the gastrointestinal system, such as nausea, vomiting, bloating, and early satiety. It does not cause changes in lung auscultation findings.
B. Pulmonary edema is characterized by the accumulation of fluid in the lungs, leading to symptoms such as shortness of breath, crackles (rales) on lung auscultation, and possibly decreased oxygen saturation. While pulmonary edema can cause abnormal lung sounds, it is less likely in a client recovering from a lacerated spleen unless there are additional complications or comorbidities.
C. Atelectasis refers to the collapse or closure of a part of the lung, resulting in reduced or absent air exchange. It can occur due to prolonged bedrest, shallow breathing, or conditions that restrict lung expansion. A client who has been on bedrest for several days is at increased risk for developing atelectasis, especially in the lower lobes where ventilation may be compromised. Decreased breath sounds in the lower lobes suggest atelectasis as a likely condition.
D. An upper respiratory infection typically affects the upper airways (nose, throat, sinuses), causing symptoms such as nasal congestion, sore throat, cough, and sometimes fever. Lung auscultation findings in an upper respiratory infection are more likely to include rhonchi or wheezes rather than decreased breath sounds in the lower lobes.

A. An advance directive is a legal document that outlines a person's preferences for medical treatment, including end-of-life care. Asking the client if they have a copy of their advance directive is appropriate because it can provide valuable information about their wishes regarding medical interventions. It allows the nurse to review the document to ensure that the client's current wishes align with what is documented in their advance directive.
B. In most cases, a competent adult's healthcare decisions, including decisions to refuse treatment, are legally binding and cannot be overridden by family members. It is important for the nurse to educate the client about their rights and ensure that their wishes are respected. Family members may be involved in discussions and support the client's decisions, but they cannot override a competent adult's wishes regarding their medical care.
C. While it's important to involve family members in discussions about the client's wishes, especially if they are the client's designated healthcare proxy or legally authorized decision-maker, family agreement is not required for the client's decision to refuse life-saving measures. The nurse should primarily focus on the client's expressed wishes and ensure that these wishes are understood and respected.
D. The provider's agreement with the client's decision may be necessary to document and implement the plan of care accordingly, but ultimately, the decision to refuse treatment rests with the competent client. The nurse should facilitate communication between the client and the provider to ensure that the client's wishes are understood and documented appropriately.