A nurse is teaching a client who is receiving radiation therapy about skin protection. Which of the following client statements indicates an understanding of the teaching?

Rationale:

A. "The care team will discuss how to change the DNR prescription.": While discussions about code status may occur, the care team cannot override the client’s documented wishes. Focusing on changing the DNR for the family disregards the ethical and legal principle of patient autonomy.

B. "I will ask the client's provider to change the prescription.": The provider cannot unilaterally change a DNR order without the client’s consent. Doing so would violate the client’s legal rights and established advance directive.

C. "A family member can change a DNR prescription once it has been signed.": Only the client has the authority to modify or revoke a DNR unless the client is incapacitated and has legally designated a healthcare proxy. Family members do not have the right to override the client’s documented wishes arbitrarily.

D. "These are the client's wishes, and we must respect them.": The nurse’s response acknowledges the ethical and legal obligation to honor the client’s autonomy. DNR orders reflect the client’s informed decisions about life-sustaining treatments, which must be respected even if family members disagree.

Rationale:

A. Administer pancreatic enzymes with meals: Pancreatic enzymes are used to aid digestion in clients with pancreatic insufficiency, not for epiglottitis. This intervention is unrelated to the acute respiratory management required for this condition.

B. Carefully suction the child's oropharynx to remove secretions: Suctioning the oropharynx in a child with epiglottitis can trigger laryngospasm and complete airway obstruction. Suctioning should be avoided unless absolutely necessary and performed only by experienced personnel with emergency airway equipment ready.

C. Continuously monitor the child's respiratory status: Epiglottitis can rapidly progress to airway obstruction. Continuous assessment of respiratory rate, effort, oxygen saturation, and signs of distress is critical to detect deterioration early and initiate emergency interventions, making this a priority nursing action.

D. Instill normal saline drops to nares before meals: Nasal saline drops are used to relieve mild nasal congestion and facilitate feeding in children but do not address the life-threatening airway risk in epiglottitis. This is a supportive measure, not a priority intervention.