The nurse is reviewing the client's medical record.

Exhibits

The nurse is assisting with the care of the client prior to a blood transfusion. Which of the following actions should the nurse take? Select all that apply.

A. Communicate advance directives status via the medical record and shift report. The nurse is responsible for ensuring that all members of the healthcare team are aware of the client’s advance directives. Documenting this information in the medical record and shift report helps guide care in accordance with the client’s wishes.
B. Provide the client with written information about advance directives. Clients have the right to receive information about advance directives, including living wills and do-not-resuscitate (DNR) orders. The nurse should provide educational materials to help the client make informed decisions.
C. Inform the client that an advance directive discontinues further care. An advance directive does not automatically discontinue all medical care. It provides instructions regarding specific interventions the client wishes to accept or decline, such as resuscitation, mechanical ventilation, or artificial nutrition. The nurse should clarify this to avoid misconceptions.
D. Instruct the client that an advance directive is a legal document and must be honored by care providers. Advance directives are legally binding documents that must be followed by healthcare providers. The nurse should reinforce that the client’s wishes, as stated in the directive, will be respected.
E. Document that the provider discussed do-not-resuscitate status with the client. Proper documentation is essential to ensure the client's preferences regarding resuscitation and end-of-life care are acknowledged and followed. The nurse should record discussions regarding advance directives in the medical record.
F. Initiate a power of attorney for health care document. The nurse does not have the authority to initiate a power of attorney for health care. The client must complete this legal document independently or with legal assistance, and it typically requires notarization or witness signatures. The nurse can provide information about it but cannot create or execute it on the client’s behalf.

A. "I can have a meal up to 2 hours before the procedure." Eating before an intravenous pyelogram (IVP) is not recommended, as fasting is typically required to prevent interference with imaging and reduce the risk of nausea from the contrast dye. Clients are usually instructed to refrain from eating for several hours before the procedure.
B. "I should limit my fluid intake for 2 days after the procedure." Increasing, rather than limiting, fluid intake is advised after the procedure to help flush the contrast dye from the kidneys and reduce the risk of nephrotoxicity. Adequate hydration is essential for kidney function following contrast administration.
C. "I do not need to sign a consent form before this procedure." An IVP involves the injection of contrast dye, which carries risks such as allergic reactions and kidney impairment. Because it is an invasive diagnostic procedure, informed consent is required before proceeding.
D. "I will feel a warming sensation after the injection of the dye." The contrast dye used in an IVP often causes a transient warm or flushed feeling, as well as a metallic taste in the mouth. This is a common and expected reaction, indicating that the client understands the procedure.