An older adult male who is in his early 70's is admitted to the emergency department because of a COPD exacerbation. The client is struggling to breathe and the healthcare team is preparing for endotracheal intubation. The spouse's wile, who is 30 years younger than the client, asks the nurse to stop the procedure and provides the nurse a copy of the client's living will. Which action should the nurse take?
Alert the nursing staff of the client's do not resuscitate status.
Notify the healthcare provider of the client's wishes.
Place a certified copy of the living will in the client's record.
Facilitate a family meeting with the palliative care team.
The Correct Answer is B
A. While the nursing staff should be aware of the DNR status, the immediate concern is the client's expressed wishes regarding treatment.
B. Notifying the healthcare provider is essential so that the medical team can respect the client’s wishes, especially in an acute situation where life-saving measures are being discussed.
C. Placing a certified copy of the living will in the record is important, but it should be done after informing the healthcare provider.
D. Facilitating a family meeting may be helpful, but the priority is to communicate the client's wishes to the medical team immediately.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Instructing the client to increase protein intake is inappropriate, as jaundice may indicate liver dysfunction, which can affect protein metabolism.
B. Preparing the client for repeat blood cultures may be necessary if there is suspicion of an infection, but the priority is to assess the liver's function first due to the presence of jaundice. C. Arranging emergency transport to an inpatient facility is not immediately necessary unless the client shows signs of severe distress or complications. Evaluation of liver function is a more prudent first step.
D. Explaining the need to evaluate liver function is critical because jaundice indicates a potential liver issue that needs immediate assessment. This evaluation will guide further treatment and management.
Correct Answer is A
Explanation
A. Ensuring the client takes a diuretic every morning is the first intervention because it addresses fluid overload, which is indicated by the significant weight gain and elevated blood pressure. Diuretics help reduce excess fluid and alleviate symptoms of SIADH.
B. Measuring ankle circumference is useful for assessing edema but is not the immediate priority compared to addressing fluid overload through diuretics.
C. Monitoring daily sodium intake is important for managing SIADH, but the priority is to manage the fluid overload first.
D. Obtaining serum creatinine levels daily is part of monitoring kidney function, but it is not the immediate concern compared to managing fluid balance in this context.
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