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HTN Case study Meet the Client: Mark Dunn A group of nursing students are conducting blood pressure

and cholesterol screen ings outside a local home improvement store on Saturday morning for their commun ity service project. Mark Dunn, a 52-year-old Caucasian male, stops by their boo th to have his blood pressure and cholesterol checked. He tells the students tha t he is a construction foreman. Assessment Mr. Dunn's blood pressure reading is 189/110. His LDL cholesterol reading is 200 mg/dl. He asks the student nurse if he should be concerned about his blood pres sure.

1. How should the student respond? A) "Your blood pressure is very high. You need to see your healthcare provider t oday." INCORRECT Mr. Dunn's blood pressure is high. The student nurse needs to assess for other s ymptoms before making the determination that the healthcare provider must see hi m that day. B) "You have hypertension. You need to start making some lifestyle changes." INCORRECT The diagnosis of hypertension is not made until the client has an elevated blood pressure on two different occasions. C) "Please sit here quietly for a few minutes. I need to recheck your blood pres sure." CORRECT Mr. Dunn's blood pressure is high, but may be temporarily elevated due to activi ty or stress. The blood pressure should be rechecked after the client rests for a few minutes. D) "I need you to remain seated. I am going to call for the emergency squad." INCORRECT Based on the information currently available to the student nurse, there is no n eed to call the EMS.

The student nurse asks Mr. Dunn about his health history. He is 6 feet tall and his weight is 190 lbs. Mr. Dunn states that he has lost a lot of weight recently . He also reports experiencing a lot of stress at work and that he often goes ou t with the crew after work to have several beers. He reports that his mother, wh o had diabetes mellitus, has passed away. He believes that she also had hyperten sion. He smokes 1 packs of cigarettes a day and drinks 4 to 5 cups of coffee a da y.

2. What significant risk factor for hypertension does the student nurse identify fo r Mr. Dunn according to this health history? A) Family history of diabetes. INCORRECT If Mr. Dunn had diabetes, this would be a significant risk factor but the presen ce of diabetes in his family is not.

B) Recent weight loss. INCORRECT Weight loss is not a risk factor for hypertension. C) Caffeine intake. INCORRECT There is no current indication that caffeine intake is a risk factor for hyperte nsion. D) Alcohol consumption. CORRECT Excessive alcohol intake is strongly associated with hypertension. Client Teaching The student nurse rechecks Mr. Dunn's blood pressure now that he has been sittin g quietly for a few minutes. His blood pressure is 180/106.

3. According to the assessment of this client, what recommendation is most importan t for the student nurse to provide Mr. Dunn? A) See his healthcare provider within the next week for a BP recheck. CORRECT His blood pressure is significantly elevated. Since these BP readings were obtai ned on the same day, Mr. Dunn needs to see his healthcare provider soon for a se cond BP measurement so that a diagnosis can be determined and treatment initiate d. B) Limit his salt intake and start a weight loss program. INCORRECT Both of these actions may help decrease the client's blood pressure, but another intervention is more important at this time. C) Attend a stress reduction seminar offered in his community. INCORRECT While this may be useful, another intervention is more important at this time. D) Learn about high fiber foods and add more fiber to his diet. INCORRECT Increasing fiber in the diet promotes over-all health by helping cholesterol lev els, but it does not affect blood pressure.

The student nurse continues to talk with Mr. Dunn about hypertension. Mr. Dunn s tates he feels great physically and does not see why he needs to see his healthc are provider.

4. How should the student nurse respond? A) "Your blood pressure is dangerously elevated. You could have a heart attack o r stroke at any time." INCORRECT Threatening the client with a major problem is not the best way to motivate a cl ient to get care.

B) "While often there are no symptoms, high blood pressure does cause damage to many organs." CORRECT Often clients with hypertension have no symptoms and organ damage may occur befo re the client becomes symptomatic. C) "Hypertension is called the silent killer. I'm sure that you don't want to di e at your young age." INCORRECT While this answer may scare the client, it does not help the client understand t he disease process. D) "It is always better to treat high blood pressure before you start having sym ptoms." INCORRECT This is true, but does not provide the client with the best information needed a t this time.

A week later, Mr. Dunn has an appointment with his healthcare provider. After th e exam, the healthcare provider explains to Mr. Dunn that he has stage 2, primar y (essential) hypertension.

5. What information obtained during the assessment supports this diagnosis? A) Blood pressure of 184/98. CORRECT Stage 2 hypertension is described as a Systolic blood pressure of greater than o r equal to 160 mm Hg or a Diastolic blood pressure of greater than, or equal to, 100 mm Hg. B) Family history of hypertension. INCORRECT This is a risk factor not a symptom of primary hypertension. C) Irregular pulse rate of 110. INCORRECT Pulse rate and rhythm do not affect blood pressure classification. D) An auscultated heart murmur. INCORRECT A heart murmur does not directly support the diagnosis of stage 2 hypertension. However, a heart murmur may be a reflection of a problem that caused the client' s hypertension. If a cause for the hypertension is found, the client would then be diagnosed with secondary hypertension.

The healthcare provider informs Mr. Dunn that he needs to be on a low salt diet, stop smoking, limit his alcohol intake, decrease his stress level, and start ta king chlorothiazide (Diuril) and atenolol (Tenormin). The nurse enters the room to give Mr. Dunn his prescriptions and spend some time teaching him about his ca re. Mr. Dunn asks the nurse to please call him Mark. In speaking with the nurse, Mark expresses concern that the healthcare provider did not prescribe any additional tests. He asks, "Shouldn't the healthcare provi

der find out why I have hypertension?"

6. How should the nurse respond to Mark's question? A) "Your healthcare provider does not think we need to determine the cause now. Further tests may be done once your blood pressure is in the normal range." INCORRECT If there were indicators suggesting that there was a cause, it would be importan t to correct them, thereby helping bring the blood pressure down. B) "90-95% of all cases of hypertension are without an identified cause, so unle ss there is some indicator in your health history, the healthcare provider does not look for one." CORRECT Primary (essential) hypertension has no identifiable cause, even though there ar e several known contributing factors. C) "If there is a cause for your hypertension, it will become evident very soon. You will see the healthcare provider frequently until the cause is determined." INCORRECT If the hypertension did have a cause, clinical findings such as an abdominal bru it, variable pressures with a history of tachycardia, sweating, or a family hist ory of renal disease may well already be present. D) "Don't worry. Stress causes your blood pressure to go up even more. Your heal thcare provider does know what tests to order and when they should be done." INCORRECT This response avoids the client's question, rather than helping him understand t he disease process.

Mark also asks the nurse about his medications, chlorothiazide (Diuril) and aten olol (Tenormin). The nurse reviews the medications, side effects, and the import ance of taking them on a daily basis.

7. In evaluating Mark's understanding, which statement indicates that Mark understa nds the nurse's instructions about his medications? A) "I will be taking these medications for the rest of my life." INCORRECT These medications are the beginning regimen for Mark. He may need to switch to o ther medications or, with life-style modifications, he may not need both medicat ions or any medications at all. B) "I can expect my heart rate to increase as my blood pressure goes down." INCORRECT The pulse rate should not increase unless the client experiences significant hyp otension. In addition, atenolol (Tenormin) is a beta blocker, which may cause a decrease in heart rate. C) "I may experience impotence with this drug regimen." CORRECT This is a common side effect of many antihypertensive medications, including ate nolol (Tenormin), which is a beta blocker.

D) "An irritating cough often develops, but will subside in a few days." INCORRECT This is a common side effect of ACE inhibitors. Atenolol (Tenormin) is a beta bl ocker, not an ACE inhibitor, so the client should not experience this side effec t. Evaluation The nurse shares with Mr. Dunn that there are several things he can do besides t aking the medication to improve his health. Mark says, "I know, the doctor told me that I need to quit smoking, change my eating habits, decrease the stress in my life, and stop drinking so much alcohol. There is no way I can make all of th ose changes. There would be nothing left in life to enjoy!"

8. In discussing these lifestyle modifications with Mark, what information is most important for the nurse to share with him? A) Use of tobacco products is linked with increased risk for cardiovascular dise ase. CORRECT Discontinuation of tobacco use decreases blood pressure and has cardiovascular b enefits within the first year of quitting. B) Drinking 24 ounces of beer a day or less is acceptable for clients with hyper tension. INCORRECT This is a true statement, but another issue has a higher priority for the client to know. C) Clients with hypertension respond differently to sodium restricted diets. INCORRECT Sodium restriction has been shown to be more effective in the African American p opulation and in the elderly. Since Mr. Dunn is not a member of either of these groups, the nurse should focus on the lifestyle modification that would be the m ost beneficial to this client. D) There is evidence that stress only elevates blood pressure for a short time. INCORRECT This a true statement, but Mr. Dunn does work in a field where he is constantly under stress. Relaxation therapy or guided imagery may be helpful in decreasing his blood pressure, especially during periods of high stress; however, another r esponse is of greater priority.

Mr. Dunn expresses interest in learning more about how to reduce his stress leve l. He states that he has seen episodes on television about biofeedback and guide d imagery, but he can't imagine either of those techniques fitting into his life style.

9. How should the nurse respond? A) "Biofeedback is really simple and fits into everyone's lifestyle." INCORRECT This response does not acknowledge the client's feelings or his thoughts about t his stress management technique.

B) "Of course you can use guided imagery, it works well for me." INCORRECT The nurse needs to focus on the client, rather than on the nurse's personal expe riences. C) "You could try music therapy. What kind of music do you like?" INCORRECT Music therapy does help many people reduce their stress level, but there is a be tter answer. D) "Many methods can help reduce stress. Tell me about your work day." CORRECT With this response, the nurse helps Mark identify strategies that might fit into his lifestyle. This response empowers the client to be engaged in the process o f determining which strategy will be most effective for him.

Mark admits that he has tried to quit smoking several times in his life by using nicotine gum.

10. What is the most effective nursing intervention to help Mark be successful this time? A) Encourage Mark to make a quit plan. CORRECT A quit plan, which includes the quit date, notifying friends and relatives of th e plan to quit, anticipating withdrawal symptoms, and throwing away all tobacco products on the quit date is an excellent method to quit smoking. Using more tha n one method helps ensure success. Mark's use of the nicotine gum, along with a quit plan may increase the potential for success. B) Give Mark free samples of nicotine gum. INCORRECT Mark has tried using nicotine gum as the method to quit smoking in the past with out success. C) Talk with Mark's wife about how she can help him quit. INCORRECT Support and encouragement are important, but there is a better answer. D) Review with Mark all of the negative effects of cigarette smoking. INCORRECT Mark may already understand all of the harmful effects of smoking. Mark is looki ng for a way to help him stop. This response does not answer his request.

Mark expresses concern about the problems that can arise if he doesn't get his b lood pressure under control. The nurse explains that hypertension can damage the kidneys, heart, lungs, and blood vessels. Mark states that he had an uncle and a grandfather who both died from an aortic aneurysm. He asks the nurse if high b lood pressure causes this problem.

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How should the nurse respond to Mark's concern? A) Reassure him that there is no cause for concern since aortic aneurysms only o ccur in about 5-7% of people over the age of 60. INCORRECT The statistics given in this answer are correct, but telling the client not to w orry does not address his concern. B) Advise him that, due to his family history, his healthcare provider may want to do further testing. CORRECT Studies have shown a strong genetic predisposition in the development of abdomin al aortic aneurysms. This response provides immediate feedback that addresses th e client's concern. C) Instruct him that the symptom of an abdominal aortic aneurysm is a pulsating mass in the abdomen. INCORRECT A pulsating mass in the abdomen is usually only noted in thin clients. Often, ab dominal aortic aneurysms are asymptomatic. D) Encourage him to share his concern with his healthcare provider during his ne xt scheduled office visit. INCORRECT Mark has shared this concern now. It should be addressed during this visit. Abdominal Aortic Aneurysm During the initial office visit, Mark is also scheduled for an abdominal ultraso und to determine the presence of an aneurysm. The nurse notes that the healthcar e provider has asked Mark to return for a follow-up visit in 1 month.

12. Considering the overall plan of care, what is the primary reason for the nurse t o encourage Mark to keep his next appointment? A) Discussion of the results of the ultrasound. INCORRECT If the ultrasound does indicate the presence of an abdominal aortic aneurysm, Ma rk would be called immediately and called in for a follow-up appointment at that time. B) Evaluation of the effectiveness of Mark's lifestyle changes. INCORRECT Mark does need to be evaluated in how he is doing with smoking cessation, stress management, and decreased alcohol consumption, but these changes will make a di fference over time. A month later is too soon to determine the effectiveness of these changes. C) Follow-up measurement of his blood pressure. CORRECT Mark has just been started on antihypertensive medications. The effectiveness of this treatment needs to be assessed. Many people who are on antihypertensive me dications are still hypertensive. Follow-up evaluation is essential. D) Scheduling for further diagnostic testing. INCORRECT The nurse does not know if any further testing will be needed. Since Mark has be en diagnosed with primary hypertension, further tests are not needed to find the cause of the hypertension.

Mark returns to the office in 1 month with his wife. The ultrasound exam showed the presence of a 3 cm Fusiform aneurysm on the abdominal aorta.

13. In teaching Mark about the aneurysm, what information should the nurse include? A) This type of aneurysm is a weakness in the wall of the aorta causing an outpo uching. INCORRECT A weakness in the wall of the aorta causing an outpouching is a saccular aneurys m. B) Immediate surgery to repair the aneurysm is the recommended treatment. INCORRECT Surgical repair is the treatment of choice for aneurysms 5 cm and larger. C) Further testing is needed immediately to determine if it is enlarging. INCORRECT There are no signs or symptoms present at this time indicating that the aneurysm may be enlarging. D) Maintaining a normal blood pressure can effectively treat this size of aneury sm. CORRECT For aneurysms less than 5 cm in size, the treatment of choice is to keep the cli ent's blood pressure under control and to monitor the size of the aneurysm every 6 months.

Mark's vital signs are T 98.4 F, P 78, R 20, and BP 148/90. Mark states he has be en feeling fine except that he seems to be more tired than he usually is and has had some trouble sleeping. When asked, Mark replies that he has cut down to onl y 1 pack of cigarettes a week and he has signed up to take a class on reducing s tress next month.

14. Which assessment finding is of most concern to the nurse? A) Current blood pressure reading of 148/90. CORRECT Mark's blood pressure is still hypertensive. With the presence of an abdominal a ortic aneurysm (AAA), attaining and maintaining a normal blood pressure is essen tial. B) Commitment to a stress reduction class. INCORRECT While it would be beneficial for Mark to take a stress reduction class, there is another assessment finding that is of greater concern. C) Has reduced smoking, but continues to smoke. INCORRECT Mark has made strides in decreasing the number of cigarettes he smokes a day. Th ere is another assessment finding that is of greater concern.

D) Fatigue and difficulty sleeping. INCORRECT Both of these are expected side effects of his medications.

The nurse asks Mark if he is limiting his salt intake. He states that his wife f ixes all the meals.

15. Which statement by his wife shows she understands a 2 gm sodium diet? A) "The main change I made was to remove the salt shaker from our dining table." INCORRECT While not adding salt to the food after preparation is important, that change al one will not establish a 2 gram sodium diet. B) "I am preparing a variety of fresh vegetables and avoiding processed foods." CORRECT Processed foods are a major source of sodium. Replacing processed foods with fre sh is a key to maintaining a low sodium diet. C) "I measure out 2 teaspoons of salt each morning and that is all I use that da y for cooking." INCORRECT One teaspoon of salt is over 2 grams of sodium. D) "We quit cooking with salt. Instead we are using condiments to season our mea ls." INCORRECT Many condiments such as ketchup, steak sauce, and soy sauce are high in sodium c ontent.

16. Based on the data the nurse has obtained, which nursing diagnosis should be incl uded in the plan of care? A) Ineffective health maintenance. CORRECT Mark remains hypertensive. His treatment regimen needs to be re-evaluated in ord er for Mark to become normotensive. B) Anxiety related to lifestyle changes. INCORRECT Nothing that Mark or his wife has shared indicates that anxiety is a problem at this time. C) Disturbed body image. INCORRECT To determine if this is a problem, the nurse needs to complete additional assess ment. D) Self neglect. INCORRECT No data obtained by the nurse so far supports this problem. Mark is continuing t o work and take care of his self care needs. Antihypertensive Therapy

The healthcare provider adds nifedipine (Procardia) to Mark's other prescription s.

17. What instruction related to this medication is essential for the nurse to provid e Mark? A) Do not take any non-steroidal antiinflammatory drugs (NSAIDs). INCORRECT The effectiveness of angiotensin-converting enzyme inhibitors (ACE inhibitors) i s reduced by NSAIDs. Nifedipine is not an ACE inhibitor. B) Discontinue the medication if he is lightheaded when he gets up suddenly. INCORRECT Postural hypotension is an expected side effect when starting an antihypertensiv e. The client should be instructed to change positions slowly at first. This sid e effect usually resolves with time. C) Notify the healthcare provider if he has any urinary retention. INCORRECT Urinary retention is not a side effect of the antihypertensive medications. Inst ead, some alpha adrenergic blockers such as doxazosin (Cardura) and prazosin (Mi nipress) can help with urinary retention due to benign prostatic hypertrophy. D) Avoid eating fresh grapefruit or grapefruit juice. CORRECT Grapefruit decreases the effectiveness of nifedipine (Procardia), a calcium chan nel blocker.

18. What statement by Mark indicates to the nurse that he understands his current pl an of care? A) "I should take my blood pressure at home frequently. If it is low, I can quit taking my medications." INCORRECT It is important for the client to monitor his blood pressure, but stopping his b lood pressure medication suddenly may cause rebound hypertension. B) "If I quit smoking, eat a low sodium diet, decrease my alcohol intake, and ge t my stress level down, I can quit taking these medications." INCORRECT Rebound hypertension can occur with sudden discontinuation of many antihypertens ives. Discontinuation of these medications should be done under the direction of his healthcare provider. C) "If my blood pressure is in the normal range on my next visit, I will probabl y continue on these medications for at least 1 year." CORRECT Step-down therapy is not started until after 1 year of good blood pressure contr ol. D) "This combination of medications is used frequently. I do not need to worry a bout drug interactions." INCORRECT Each individual must be assessed for possible drug interactions. Mark and his wife leave the office feeling comfortable with their knowledge abou

t hypertension and the life style modifications they need to make. A Complication Occurs Six months later, Mark's wife takes an overdose of diazepam (Valium) and alcohol . She is brought to the Emergency Department by the EMS. Mark arrives a little w hile later from work. He is obviously upset and very angry. As Mark is giving in formation to the registration clerk, he becomes pale and complains of the sudden onset of severe back pain. Mark is taken to the triage nurse.

19. What assessment data obtained during the triage assessment alerts the nurse that Mark needs immediate medical evaluation? A) History of hypertension and blood pressure of 175/90. INCORRECT Mark's blood pressure is high, but he has a history of hypertension and has had this problem for awhile. While he may need to be seen by the healthcare provider , this assessment alone does not warrant immediate care. B) Respiratory rate of 26 and pulse rate of 96. INCORRECT These values are within normal parameters. Although slightly elevated and warran t further assessment, by themselves they are less significant than another findi ng. C) Headache on and off for last week with nausea. INCORRECT Headache and nausea are not symptoms of a major medical emergency. D) History of 3 cm aortic aneurysm and sudden onset of back pain. CORRECT The sudden onset of back pain in the client with a history of an aneurysm is a s ign that the aneurysm may be dissecting or may have ruptured.

After examining Mark, the healthcare provider writes several prescriptions.

20. Which prescription should the nurse complete first? A) Stat 12 lead electrocardiogram (EKG). INCORRECT While the healthcare team will need a baseline EKG, other actions are more criti cal to keeping Mark alive. B) Computed tomography scan (CT) of abdomen. INCORRECT A CT of the abdomen is needed to confirm the diagnosis, but another action is of greater priority. C) IV of 0.9% Normal Saline with large bore angiocath. CORRECT When a dissecting or ruptured aneurysm occurs, the client requires large amounts of fluid replacement to maintain the blood pressure. It is essential that an IV be started before Mark's blood pressure starts to fall. D) Type and cross match for 4 units packed red blood cells (PRBC).

INCORRECT Mark will need blood replacement, and will need more than 4 units. However, anot her nursing action needs to be completed first.

When Mark returns from radiology where the abdominal CT was performed, the diagn osis of dissecting aortic aneurysm is made. Mark is informed that he needs immed iate surgery. Unfortunately, his wife is intubated and nonresponsive.

21. Which nursing action should take priority? A) Call report to the operating room staff. INCORRECT It is important to call report, but other nursing actions take priority in this life and death situation. B) Get the surgical consent form signed. INCORRECT The surgeon does need to inform the client about the procedure and the risks inv olved, but actually getting the consent form signed is not the highest immediate priority for the nurse. C) Notify Mark's children and family. CORRECT A significant number of clients who have surgery to repair a dissecting abdomina l aortic do not live through the surgery. Mark and his family need time to conne ct before the surgery. D) Consult a social worker. INCORRECT A social worker will need to be involved to help deal with the family's psychoso cial issues, but there is another action that should take priority. Delegation Several things need to be done before Mark goes to surgery.

22. Which action can be safely delegated to the unlicensed assistive personnel (UAP) ? A) Observe Mark sign the surgical consent form. INCORRECT The surgeon is responsible for informing the client about the surgery. The nurse , after assessing that the client has been informed, may get the consent signed. B) Obtain a full set of vital signs along with a neurologic check. INCORRECT While the UAP may take the client's vital signs, a nurse must perform all assess ments. Neurological checks are an important assessment parameter. C) Call a report of the client's condition to the surgery staff. INCORRECT Calling report is the responsibility of the nurse who has the knowledge and expe rtise to provide the correct information.

D) Document a list of Mark's personal belongings. CORRECT This is the only action listed that does not require the expertise of the nurse.

After these tasks are completed, the nurse asks the UAP to obtain a second set o f vital signs on Mark.

23. What result indicates that this task was successfully delegated? A) The vital signs were obtained by an experienced UAP. INCORRECT This only reflects that the right person was assigned to the task, the first ste p in the delegation process. B) A complete set of vital signs are documented on the chart. INCORRECT This only indicates that the UAP did get a set of vital signs. C) The UAP reports the current vital signs to the nurse. CORRECT For delegation to be complete, not only must the right task be assigned to the r ight person and completed, but the results must be reviewed by the nurse. D) The UAP obtains an accurate set of vital signs. INCORRECT An accurate set of vital signs indicates the right task was performed, but the l ast step in the delegation process needs to be completed. Communication The first unit of packed red blood cells is available before Mark goes to the op erating room. While the nurse is hanging the first unit of blood, Mark asks if h e is going to die. Mark states that he has never been around anyone who was dyin g and he is scared of what happens after death.

24. What is the best response by the nurse? A) "No one knows if you will live or die. Right now you need to focus on being s trong for your children when they arrive." INCORRECT The nurse is negating the patient's feelings with this response. B) "This is a frightening experience. Is there someone with whom you would like to talk about your fears?" CORRECT The nurse acknowledges Mark's feelings and addresses the issue. C) "There is a real chance you may die from this. Many people do die from a diss ecting aneurysm." INCORRECT This is a true statement, but not the best response. The nurse closes the conver sation with this statement without offering support. D) "Your healthcare provider is the best person to answer your questions about w hether or not you will live through the surgery."

INCORRECT This response does not address Mark's fears about what happens after death and a lso closes the conversation. Legal-Ethical Issues Mark's children arrive in the Emergency Department and spend a few minutes with him before he goes to surgery. After a short period of time, the surgeon reports to the family that the aneurysm repair was unsuccessful and Mark died in surger y. One of Mark's sons returns to the ER and starts yelling at the nurse.

25. What is the nurse's best initial response? A) Call security to handle the situation. INCORRECT The nurse may need to call security to assist in the situation, but this does no t help the son address his feelings and is not the best initial response. The pr esence of a security guard may aggravate the son's anger further. B) Explain that the nursing staff did everything possible. INCORRECT Justifying the nurse's actions is not the priority concern in this situation. C) Acknowledge the son's anger. CORRECT Understanding that the son's anger is not directed personally at the nurse will help the nurse respond to the son in an effective, caring manner. D) Redirect the son's hostility. INCORRECT Redirecting the son's anger is not the best initial response to this situation.

26. In addition to talking with Mark's children and preparing the body for transport to the morgue, what other action must the surgical nurse perform? A) Call the organ procurement agency for the region. CORRECT Federal law requires the nurse to notify the organ procurement agency for their region with all hospital deaths. B) Notify the hospital's sentinel event committee. INCORRECT Sentinel events are occurrences where a mistake made results in harm to a client . There is no indication at this time that a mistake was made by the healthcare team. C) Assist the family in deciding which funeral home to use. INCORRECT Deciding on a funeral home is the responsibility of the family and their support network. D) Bring the children into surgery to say goodbye to Mark. INCORRECT Bringing the family into the operating room to see Mark may be a task that the n urse does perform, but it is not mandatory.

Mark's wife has been taken to the intensive care unit (ICU). The next day, she b ecomes alert and responsive. The children tell the ICU nurse that they do not wa nt their mother told of her husband's death.

27. How should the nurse respond? A) Honor their wishes, recognizing that the children know what is best for their mother. INCORRECT One of the ethical principles guiding nursing practice is veracity. The nurse ca ring for Mrs. Dunn needs to respond to her questions with honesty. B) Tell the children that legally the nurse must inform their mother. INCORRECT This is not a legal issue. C) Call pastoral care to consult with the family. INCORRECT Calling pastoral care to become involved may be an appropriate nursing action ev entually, but another action takes precedence. D) Talk further with the children and explore options with them. CORRECT The nurse needs to do a further assessment and allow the children to communicate their concerns.

The children are adamant that the nurse not tell their mother of their father's death. Meanwhile, Mark's wife continues to ask the nursing staff where her husba nd is.

28. What resource is most valuable for the nurse to use to resolve this situation? A) The hospital ethics committee. CORRECT The nurse needs to have others involved in this decision. Consulting the ethics committee is the appropriate channel to take to resolve this ethical dilemma. B) Policy and procedure manual. INCORRECT This situation cannot be resolved using a policy and procedure manual. C) The unit case manager. INCORRECT The case manager is not the best resource to resolve this conflict. D) Mental health services. INCORRECT Mental health services may need to be consulted at some point, but another resou rce is more useful to resolve the immediate situation. Case Outcome Mark's children, accompanied by their pastor, tell Mrs. Dunn about Mark's death. After signing a contract with the counselor stating she will not attempt to com

mit suicide, Mrs. Dunn is released from the hospital. A funeral service for Mark is held. Mrs. Dunn does continue with outpatient counseling sessions.