A patient is brought to the emergency department after falling from a ladder and is exhibiting signs of confusion and disorientation.

The spouse reports that the patient seemed to have lost consciousness.

The nurse has been provided with a list of current medications and healthcare power of attorney.

When reporting to the healthcare provider using SBAR (Situation, Background, Assessment, Recommendation) communication, which information should the nurse provide first?

Choice D rationale
Seeking clarification of the type of advance directive the client has is the most appropriate response. A living will typically outlines a person’s wishes for end-of-life care, but it may not specifically address emergency situations like cardiac arrest.

Choice A rationale
Scheduling a client and family conference to review the plan of care may be helpful, but it is not the immediate priority. The nurse first needs to understand the client’s wishes as outlined in their advance directive.

Choice B rationale
Explaining that living wills cannot be followed by emergency personnel is not entirely accurate. While it’s true that emergency personnel initiating resuscitative measures may not have immediate access to a person’s living will, in a hospital setting, a person’s known wishes should be respected as much as possible.

Choice C rationale

Checking the client’s arm for a “Do Not Resuscitate” (DNR) bracelet is not the most appropriate response. While some people may choose to wear such a bracelet, not all do. Furthermore, a DNR order is just one type of advance directive, and it’s important to clarify what specific directives the client has in place.

The correct answer is Choice A

Choice A rationale: Crohn’s disease involves transmural inflammation of the gastrointestinal tract, often leading to hypermotility and increased peristalsis. Activity restriction reduces sympathetic stimulation, thereby minimizing intestinal motility and mechanical stress on inflamed mucosa. This helps prevent exacerbation of symptoms and promotes mucosal rest. By limiting physical exertion, the body can redirect energy toward immune modulation and tissue repair. Normal bowel motility varies, but excessive activity worsens inflammation and nutrient malabsorption in Crohn’s pathology.

Choice B rationale: While diarrhea is a common symptom in Crohn’s disease, activity restriction does not directly modulate stool frequency or water reabsorption. Diarrhea results from mucosal damage, cytokine-mediated secretion, and impaired absorption, not physical activity. Management typically involves anti-inflammatory agents, antidiarrheals, and dietary modifications. Restricting movement may indirectly reduce diarrhea by decreasing intestinal stimulation, but it is not the primary mechanism. Stool water content normally ranges from 60–85%, and inflammation disrupts this balance.

Choice C rationale: Healing in Crohn’s disease is multifactorial, involving immunosuppression, mucosal regeneration, and nutritional support. While rest contributes to systemic recovery, it is not the primary driver of mucosal healing. Healing requires suppression of TNF-alpha, IL-6, and other pro-inflammatory mediators. Activity restriction may support healing indirectly by reducing metabolic demand and stress hormone release, but pharmacologic and nutritional interventions are more central. Normal mucosal turnover occurs every 3–5 days, but inflammation delays this process.

Choice D rationale: Abdominal pain in Crohn’s disease arises from transmural inflammation, bowel distension, and neural sensitization. Although rest may reduce visceral stimulation, pain control is better achieved through anti-inflammatory therapy, bowel rest, and analgesics. Activity restriction does not directly modulate nociceptive pathways or cytokine levels. Pain perception involves complex neuroimmune interactions, and physical rest alone cannot address the underlying pathology. Normal visceral pain thresholds are altered in Crohn’s due to chronic inflammation and fibrosis.