A nurse cares for a client with amyotrophic lateral sclerosis (ALS). The client states, "I do not want to be placed on a mechanical ventilator." How should the nurse respond?
a. "You should discuss this with your family and health care provider."
b. "Why are you afraid of being placed on a breathing machine?"
c. "Using the incentive spirometer each hour will delay the need for a ventilator."
d. "What would you like to be done if you begin to have difficulty breathing?"
ANS: D
ALS is an adult-onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting, and spasticity, eventually leading to paralysis. Once muscles of breathing are involved, the client must indicate in the advance directive what is to be done when breathing is no longer possible without intervention. The other statements do not address the client's needs.
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