A nurse provides care to an older hospitalized client who is newly admitted for advanced liver failure. The client states, "I've told my doctor to let me die if my heart stops beating or if I quit breathing. I do not want to be revived." To best ensure the client's request is honored, which of the following should the nurse do?
Assure the client that their end-of-life wishes are followed right away.
Check the medical record for a DNR order.
Ask the client if they have a healthcare proxy who can speak for them if needed.
Verify a signed copy of the advance directives in the medical record.
The Correct Answer is B
Choice A reason : While it is important to assure the client, the nurse must first verify that there is a formal DNR order in place to legally honor the client's wishes¹².
Choice B reason : Checking for a DNR order in the medical record is the correct action to ensure that the client's wishes regarding resuscitation are documented and will be followed by all healthcare providers¹².
Choice C reason : Asking about a healthcare proxy is important, but it is secondary to confirming that the client's wishes are documented in the medical record through a DNR order or advance directives¹².
Choice D reason : Verifying a signed copy of the advance directives is crucial, but the immediate step is to check for a DNR order, which is specifically related to the client's request not to be resuscitated¹².
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason : Anginal pain is commonly triggered by physical exertion or emotional stress, which increases the heart's demand for oxygen. When the narrowed coronary arteries cannot supply enough oxygen-rich blood to the heart muscle, angina occurs³⁷.
Choice B reason : While sitting up may help relieve discomfort for some conditions, anginal pain is typically relieved by resting or taking prescribed medication such as nitroglycerin, which helps to widen the blood vessels and improve blood flow to the heart muscle³⁶.
Choice C reason : This statement is incorrect. Anginal pain does not persist with rest and organic nitrates; these are actually the measures taken to alleviate the pain. Resting decreases the heart's demand for oxygen, and nitrates are effective in relieving anginal pain³.
Choice D reason : Typically, anginal pain does not last longer than a few minutes. If chest pain persists for more than 20 minutes, it may indicate a more serious condition, such as a heart attack, and immediate medical attention is required³.
Correct Answer is B
Explanation
Choice A reason : Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) which can be detrimental to patients with congestive heart failure (CHF). NSAIDs can lead to sodium and fluid retention, exacerbating CHF symptoms and potentially leading to a worsening of the condition⁶⁷. Therefore, it is not recommended for managing discomfort in CHF patients.
Choice B reason : Slowing down if feeling tired after exercising is a prudent measure for anyone, especially for CHF patients. It indicates the patient is listening to their body and respecting its limits, which is essential in managing CHF. Overexertion can strain an already compromised heart, so moderation and careful monitoring of physical activity are key¹².
Choice C reason : The recommended daily sodium intake for heart failure patients is generally less than 2,000 mg¹⁶¹⁷¹⁸. A limit of 4 grams per day is significantly higher than the recommended amount and could lead to fluid retention and worsening of heart failure symptoms. Therefore, this statement does not reflect effective teaching.
Choice D reason : Diuretics are often prescribed to CHF patients to manage fluid retention. However, taking diuretics before sleep can lead to nocturia, disrupting sleep due to the need to urinate at night. It is generally recommended to take diuretics earlier in the day, with the last dose no later than 4 p.m., to minimize nighttime disruptions¹³¹⁴. Drinking fluids during the day without restriction can also contribute to fluid overload, which is counterproductive in CHF management.
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