A client with end-stage heart failure who is awaiting a transplant appears depressed and states, 'I know a transplant is my last chance, but I don't want to become a vegetable.' How should the nurse respond?

Correct Answer: A

Rationale: The correct answer is A: Would you like information about advance directives? This is the appropriate response as it addresses the client's concerns about becoming a vegetable and explores their wishes for end-of-life care. Advance directives can help the client make decisions about their care in case they are unable to communicate in the future. The other choices are incorrect because B assumes the client needs psychiatric evaluation, C suggests removing them from the transplant list without exploring their concerns further, and D focuses on spiritual support rather than addressing the client's specific worries about their quality of life post-transplant.

Correct Answer: A

Rationale: The correct answer is A because it demonstrates active listening and empathy, encouraging the client to express their feelings further. This response shows support and openness to discuss sensitive topics, promoting therapeutic communication. Choice B fails to address the client's emotional distress directly. Choice C may invalidate the client's feelings. Choice D may not be appropriate unless the client expresses interest in meeting with the chaplain. Overall, option A is the best response for addressing the client's emotional needs effectively.

Correct Answer: A

Rationale: The correct answer is A: Allow family members to remain at the bedside. This is the priority action as it provides emotional support and comfort to the client. Having familiar faces around can help calm the client and reduce agitation. It also promotes a sense of security and connection. Choices B, C, and D are incorrect because they do not address the client's immediate need for comfort and emotional support. Asking about a fan, tuning the TV, or speaking loudly do not directly address the client's restlessness and agitation. Prioritizing the presence of family members is essential in this situation.

Correct Answer: B

Rationale: The correct answer is B: Notify the provider immediately. This is the most important action because significantly slowed drainage in a client with a chest tube after surgery can indicate a potential complication like a blocked tube or bleeding. Notifying the provider allows for prompt assessment and intervention to prevent further complications. Increasing the suction setting (choice A) without knowing the reason for slowed drainage can potentially worsen the situation. Re-positioning the chest tube (choice C) may not address the underlying issue causing the slowed drainage. Taking the tubing apart to assess for clots (choice D) should not be done by the nurse as it can introduce the risk of infection and requires sterile technique.

Correct Answer: B

Rationale: The correct answer is B (Expired food found in the refrigerator) because it poses a potential health risk to the client. Expired food can lead to foodborne illnesses, especially for an older adult post-surgery. Dirty carpets (choice A) may not directly impact the client's health. Outdated medications (choice C) can be addressed by the nurse without additional referrals. The presence of multiple cats (choice D) may be a concern for allergies or cleanliness, but it is not as urgent as expired food in terms of health risks.