End of Life and Ethics
A client with advanced directives says “no feeding tube,” but family insists on feeding tube at bedside. What is your FIRST nursing action?
Clarify the client’s wishes and check the advance directive — then advocate for the client’s right to refuse tube feeding.
A client with a spinal cord injury suddenly has a pounding headache and blurred vision. Which action do you do FIRST?
Raise the HOB, check for bladder distention, remove tight clothes — autonomic dysreflexia!
A client on chemo develops a fever of 100.5°F. What is your immediate concern?
Neutropenic → any fever is critical! Notify provider, draw cultures, start antibiotics.
A client with GERD asks about bedtime snacks. Which option should you tell them to avoid and why?
Avoid chocolate, peppermint, high-fat snacks — relax LES → reflux worse.
A burn client has potassium 6.2. What dangerous condition should you monitor for right now?
Hyperkalemia → monitor for dysrhythmias → cardiac monitor immediately!
Brain death is declared. The family wants organ donation but the client has no donor card. What must happen before procurement?
A legal consent from the legal next-of-kin must be obtained before organs can be procured.
A client with MS reports double vision and difficulty swallowing. Which is your PRIORITY risk to prevent?
Risk of aspiration — priority is airway!
A breast cancer client says, “I want to stop treatment and go home.” The family demands you persuade her otherwise. What do you say?
Respect client’s autonomy — clarify wishes and support her decision.
A cirrhosis client is vomiting bright red blood. What is your FIRST action?
Turn to side, protect airway, call for help → suspect esophageal varices.
A client on high-dose prednisone for rheumatoid arthritis wants to stop the med suddenly. Why must you teach them NOT to do this?
Stopping steroids suddenly → adrenal crisis → must taper.
Which ethical principle are you upholding when you respect a client’s wish to refuse a life-saving blood transfusion?
What is Autonomy?
A client with a cervical fracture is immobilized in traction. They suddenly develop new crackles in lungs. What complication should you suspect?
Pulmonary embolism → immobility + trauma → monitor for PE signs.
A client receiving chemo is at risk for tumor lysis syndrome. Which lab is your priority to monitor?
Potassium, uric acid, phosphorus → tumor lysis syndrome → hyperkalemia & hyperuricemia risk.
A client with pancreatitis is NPO but asks why they can’t even have ice chips. Explain the critical reason.
Pancreatic enzymes are triggered by any intake — even ice chips stimulate the pancreas → must stay fully NPO.
A client with SIADH is receiving 3% NaCl IV. What is your priority assessment during this therapy?
Watch for fluid overload, cerebral edema → monitor Na+ closely, watch LOC.
A dying client’s spiritual needs conflict with the facility's policy on visiting hours. What action shows ethical advocacy?
Negotiate to allow the spiritual visitor outside normal hours — advocate for the client’s spiritual comfort at end of life.
Your client with retinal detachment says, “It feels like a curtain closed over my eye.” What is the nurse’s priority teaching?
Lie still, cover both eyes with patches, prep for surgery.
A lung cancer client suddenly develops facial swelling and neck vein distention. What emergency is this?
Superior vena cava syndrome → obstructed blood flow → airway risk → sit up, notify provider.
A Crohn’s client has severe diarrhea and potassium of 3.0 mEq/L. Which prescription do you question: 1) KCL IV, 2) High-fiber diet, 3) Loperamide?
Question high-fiber diet → worsens diarrhea.
A client with end-stage liver failure is receiving lactulose. Which lab shows it’s working? Which shows it’s NOT?
Ammonia down → it’s working. If ammonia stays up → not enough → adjust dose.
Your client with a DNR is found pulseless. Another nurse starts chest compressions. What do you do next?
Stop compressions and remind the team the client is DNR — contact the charge nurse and document.
A client with Meningitis has a sudden drop in LOC. What two actions do you do IMMEDIATELY?
Elevate HOB, call provider — suspect increased ICP → risk for herniation.
A sickle cell anemia client reports severe pain and has crackles in the bases. What complication is this — and what do you do first?
Acute chest syndrome → pneumonia or embolus → give O2, fluids, pain control → notify provider.
A diabetic insipidus client has new signs of confusion and muscle twitching. Which lab explains this and what do you do?
Low sodium → DI → confusion → monitor sodium → give fluids, watch neuro.
A client with hypothyroidism is prescribed levothyroxine but says, “I feel my heart racing at night.” What is your priority nursing action?
Possible overdose → hold dose, check vitals, notify provider → risk for thyrotoxicosis.