Exhibits

A nurse is reviewing the electronic medical record of a client who is at 29 weeks of gestation. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Rationale:
A. A financial power of attorney manages financial affairs, not medical decisions. Health care decisions are instead guided by a health care proxy or durable power of attorney for health care, as outlined in the client’s advance directives.

B. The Patient Self-Determination Act upholds the client’s autonomy by allowing them to accept or refuse medical or life-sustaining treatment. This includes the right to decline care, even if such refusal may lead to death, ensuring that personal values and wishes guide end-of-life care.

C. Advance directives can be revised or revoked by the client at any time, regardless of notarization, as long as the client remains mentally competent. The document reflects current wishes and is not legally binding indefinitely.

D. Family members cannot alter a legally valid advance directive. The document represents the client’s own decisions, and only the client can modify or revoke it while competent to do so.

Rationale:
A. "Avoid consuming grapefruit juice while taking this medication.": Grapefruit juice inhibits the cytochrome P450 enzyme system in the liver, leading to increased serum levels of nifedipine. This can potentiate adverse effects such as hypotension, dizziness, and tachycardia.

B. "Your magnesium level will be monitored while taking this medication.": Nifedipine, a calcium channel blocker, does not significantly affect magnesium levels. Monitoring magnesium is more relevant for clients receiving magnesium sulfate.

C. "This medication can cause changes in thyroid function.": Nifedipine has no known effects on thyroid hormones or gland function. Drugs affecting thyroid function include amiodarone or lithium, not calcium channel blockers like nifedipine.

D. "This medication can cause an increase in blood glucose levels.": Nifedipine does not alter glucose metabolism. Medications such as corticosteroids and thiazide diuretics are more likely to cause hyperglycemia, whereas nifedipine’s primary effects involve smooth muscle relaxation and vasodilation.