The nurse is reviewing the client's medical record.

The nurse is assisting with the care the client prior to a blood transfusion

Which of the following actions should the nurse take? Select all that apply.

A) *Once you have completed a living will, it cannot be changed: This statement is inaccurate. A living will can be revised or updated at any time while the client is still capable of making decisions. The client can amend or revoke their living will if they change their mind about their wishes regarding end-of-life care or other medical decisions.

B) "You will need an attorney to appoint a health care surrogate": This statement is incorrect. While legal assistance might be beneficial in some cases, it is not required to appoint a health care surrogate. The appointment can typically be done through a simple form provided by the facility, and it is not necessary to hire an attorney for this process.



C) "You should appoint a family member as your health care surrogate": While appointing a family member as a health care surrogate is common, it is not a requirement. The person appointed should be someone who understands the client’s wishes and will act in the client's best interest. It is important to select someone who can make tough decisions, but it
doesn’t have to be a family member.

D) "Your health care surrogate will make decisions on your behalf if you are unable": This statement is correct. A health care surrogate is a person appointed to make medical decisions on behalf of the client if they are unable to do so themselves due to incapacity. This role is critical when the client cannot communicate their wishes due to illness or injury.

A) "You should lay down for 1 hour following a meal.":
Laying down after eating can exacerbate GERD symptoms by promoting acid reflux. The nurse should advise the client to remain upright for at least 30 minutes after eating to prevent reflux. Lying down increases the likelihood of gastric contents moving back into the esophagus.

B) "You should only drink 2 cups of coffee per day.":
Caffeine is a known trigger for GERD and can relax the lower esophageal sphincter, increasing the risk of acid reflux. The nurse should suggest limiting or avoiding coffee altogether, rather than recommending a specific quantity, as even small amounts may aggravate symptoms.

C) "You should elevate the head of the bed while sleeping.":
Elevating the head of the bed is a common and effective strategy for managing GERD. This helps prevent acid reflux during sleep by utilizing gravity to keep stomach contents from flowing back into the esophagus. A common recommendation is to elevate the head by 6-8 inches using blocks or a wedge pillow.

D) "You should eat three large meals and two snacks per day.":
Eating large meals can increase intra-abdominal pressure and promote acid reflux in clients with GERD. The nurse should recommend smaller, more frequent meals to reduce the risk of reflux and improve symptom control.