309 - Neuro - Quiz 15

571. Which clinical indicator does the nurse expect to identify when assessing a client admitted with a herniated lumbar disk? 1. Pain radiating to the hip and leg 2. Bowel and bladder incontinence 3. Paralysis of both lower extremities 4. Overgrowth of tissue on the lower back

1

15. The nurse is caring for a pt with a spinal cord injury who is experiencing neurogenic shock. The pt's systolic BP is 88 mmHg despite starting a dopamine drip 2 hours earlier. There is a new order to infuse 500 mL of Dextran-40 over 4 hours. At what rate does the nurse set the infusion pump? a. 75 mL/hr b. 100 mL/hr c. 125 mL/hr d. 150 mL/hr

c

25. What is a potential adverse outcome of autonomic dysreflexia in a pt with a spinal cord injury? a. heatstroke b. paralytic ileus c. hypertensive stroke d. aspiration and pneumonia

c

31. The pt with a spinal cord injury has a heart rate of 42/min. Which drug does the nurse expect to administer? a. methylprednisolone b. dextran c. atropine d. dopamine

c

33. The pt is an adolescent who is quadriplegic as a result of diving accident. The nursing assistant reports that the pt started yelling and spitting at her while she was trying to bathe him. He is angry and hostile, stating "nobody is going to do anything else to me! I'm trying to get out of this place!" what is the best priority pt problem? a. noncompliance b. cognitive limitations c. inability to cope with the situation d. feelings of hopelessness

c

17. Because the pt is at risk for spinal shock, what does the nurse monitor for? a. decreased BP, bradycardia, and decreased bowel sounds b. tachycardia and a change in the level of consciousness c. decreased respiratory rate and loss of sensation to pain and touch d. paralytic ileus and loss of bowel and bladder function

a

10. A pt has just undergone spinal fusion surgery and returned from the operating room 12 hours ago. Which task is best to delegate to the UAP? a. log-roll the pt every 2 hours b. help the pt dangle the legs on the evening of surgery c. assist the pt to put on a brace so he can get out of bed d. help the pt ambulate to the bathroom as needed

a

18. Which neurologic assessment technique does the nurse use to test a pt for sensory function? a. touch the skin with a clean paper clip and as whether it is a sharp or dull sensation b. ask the pt to elevate both arms off the bed and extend wrists and fingers c. have the pt close the eyes and move the toes up or down; the pt identifies positions d. have the pt sit with the legs dangling; use a reflex hammer to test reflex responses

a

26. After suffering an SCI, a pt develops autonomic dysfunction, including a neurogenic bladder. What is the priority pt problem for this condition? a. risk for urinary tract infection b. risk for dehydration c. risk for urinary retention d. risk for urinary incontinence

a

3. Which position is therapeutic and comfortable for a patient with lower back pain? a. semi-fowler's position with a pillow under the knees to keep them flexed b. supine position with arms and legs in a correct anatomical position c. orthopneic position; sitting with trunk slightly forward; arms supported on a pillow d. modified sims' position with upper arm and leg supported by pillows

a

6. Which assessment data warrants immediate intervention by the ED nurse? (select all) a. ryan complains of loss of sensation and reflexes below his elbows. His skin is flushed and his extremities are warm to touch. b. ryan is not able to demonstrate deep breaths when asked to breathe in deep and cough c. ryan's respirations are 20 breaths/min and he is talking without difficulty d. ryan's BP is 80/45 mmHg and his pulse is 48 BPM e. ryan appears to have bladder distention

ade

11. Which outcome should the nurse use for evaluation of the efficacy of interventions designed for this nursing diagnosis? a. the client's family inspects the skin for reddened areas daily b. the client exhibits no reddened areas or breaks in the skin c. the nursing staff rotates the client's kinetic bed per unit protocol d. the physical therapist performs passive ROM exercises

b

Based on description of ryan's limited physical mobility after the accident, the nurse suspects that ryan has experienced a SCI involving the lower cervical region. 3. which intervention has highest priority when assessing ryan? a. palpate the lower abdomen for any signs of urinary retention b. assess sensation by gently pinching the skin distal to proximal c. assess ryan's breathing pattern and ability to cough d. monitor client's vital signs, especially tympanic temperature

c

the neuro-ICU nurse is developing the nursing care plan for Ryan. 10. which nursing diagnosis has priority at this time? a. self-care deficit b. disturbed sensory perception c. risk for impaired skin integrity d. risk for ineffective coping

c

4. a patient has been talking to his physician about drugs that could potentially be used in the treatment of acute low back pain. Which statement by the patient indicates a need for additional teaching? a. "the doctor may prescribe an antiseizure drug such as oxcarbazepine; therefore, I would need to have blood tests to check my sodium level" b. "the doctor may suggest over-the-counter ibuprofen; therefore, I should watch for and report dark and tarry stools" c. "the doctor may prescribe an oral steroid such as prednisone; this would be short-term therapy and the dose would gradually taper off" d. "the doctor may prescribe hydromorphone and it may cause drowsiness; I should not drive or drink alcohol when I take it"

d

575. What does the nurse do for a client with a cervical laminectomy that differs from the nursing care for a client with a laminectomy? 1. Assist with the removal of oral secretions 2. Maintain the client's head in a flexed position 3. Elevate the head of the client's bed to a 45-degree angle 4. Provide ROM exercise early during the postoperative period

1

576. A nurse finds a victim under the wreckage of a collapsed building. The individual is conscious, supine, breathing satisfactorily, and reporting back pain and an inability to move the legs. Which action should the nurse take FIRST? 1. Leave the individual lying on the back with instructions not to move, and seek additional help 2 Roll the individual onto the abdomen, place pad under the head, and cover with any material available 3. Gently raise the individual to a sitting position to see whether the pain either diminishes or increases in intensity 4. Gently lift the individual onto a flat piece of lumber and, using any available transportation, rush to the closest medical institution

1

577. After a client is treated for a spinal cord injury, the health care provider informs the family that the client is a paraplegic. The family asks the nurse what this means. What explanation should the nurse provide? 1. Lower extremities are paralyzed 2. Upper extremities are paralyzed 3. One side of the body is paralyzed 4. Both lower and upper extremities are paralyzed

1

578. A client with a spinal cord injury has paraplegia. The nurse assesses for which major problem the client may experience early in the recovery period? 1. Bladder control 2. Nutritional intake 3. Quadriceps setting 4. Use of aids for ambulation

1

584. What should the nurse assess for when a client with a cervical injury reports a severe headache and nasal congestion? 1. Suprapubic distention 2. Increased spinal reflexes 3. Adventitious breath sounds 4. Imminent development of shock

1

586. A nurse in a rehabilitation center teaches clients with quadriplegia to use an adaptive wheelchair. Why is it important that the nurse provide this instruction? 1. They usually will never walk 2. It prepares them for wearing braces 3. It assists them in overcoming orthostatic hypotesion 4. They have the strength in the upper extremities for self-transfer

1

7. You are preparing to discharge a client with chronic low back pain. Which statement by the client indicates the need for additional teaching? 1. "i will avoid exercise because the pain gets worse" 2. "i will use the heat or ice to help control the pain" 3. "i will not wear the high-heeled shoes at home or work 4. "i will purchase a firm mattress to replace my old one

1 - exercises are used to strengthen the back, relieve pressure on compressed nerves, and protect the back from reinjury

572. A nurse expects a client with a herniated intervertebral disk to report a sudden increase in pain with which activities? SELECT ALL THAT APPLY 1. Coughing or sneezing 2. Sitting on cold surfaces 3. Standing for extended periods 4. Lying supine while flexing the knees 5. Straining when having a bowel movement

1, 5

12. You are helping a client with an SCI to establish a bladder retraining program. Which strategies may stimulate the client to void? (select all) 1. stroking the client's inner thigh 2. pulling on the client's pubic hair 3. initiating intermittent straight catheterization 4. pouring warm water over the client's perineum 5. tapping the bladder to stimulate the detrusor muscle

1245

13. A client with a cervical SCI has been placed in fixed skeletal traction with a halo fixation device. When caring for this client, the nurse may delegate which actions to an LPN/LVN? (select all) 1. checking the client's skin for pressure from the device 2. assessing the client's neurologic status for changes 3. observing the halo insertion sites for signs of infection 4. cleaning the halo insertion sites with hydrogen peroxide 5. developing the nursing plan of care for the client

134

11. You are floated from the ED to the neurologic floor. Which condition should you delegate to the UAP when providing nursing care for a client with an SCI? 1. assessing the client's respiratory status every 4 hours 2. taking the client's vital signs and recording every 4 hours 3. monitoring the client's nutritional status, including calorie counts 4. instructing the client how to turn, cough, and breathe deeply every 2 hours

2

573. For which clinical indicator should the nurse assess a client who just had a microdiskectomy for a herniated lumbar disk? 1. Cerebral edema 2. Sensory loss in legs 3. Spasms of the bladder 4. Pain referred to the flanks

2

574. What should the nurse include in the plan of care for a client who just had a posterior lumbar laminectomy? 1. Encourage the client to cough 2. Reposition the client by log rolling 3. Assess the client for indication of peritonitis 4. Instruct the client to bend the knees when turning

2

580. A client has paraplegia as a result of a motorcycle accident. What is the reason the nursing care plan should include turning the client every 1-2 hours? 1. Maintain comfort 2. Prevent pressure ulcers 3. Prevent flexion contractures of the extremities 4. Improve venous circulation in the lower extremities

2

8. A client with a SCI reports sudden severe throbbing headache that started a short time ago. Assessment of the client reveals increased BP (164/94) and decreased heart rate (48 BPM), diaphoresis, and flushing of the face and neck. What action should you take first? 1. administer the ordered acetaminophen (tylenol) 2. check the foley tubing for kinks or obstruction 3. adjust the temperature in the client's room 4. notify the physician about the change in status.

2

155. A client is in the ICU after sustaining a T2 spinal cord injury. Which priority interventions should the nurse include in the client's POC? SELECT ALL THAT APPLY 1. Minimizing environmental stimuli 2. Assessing for respiratory complications 3. Monitoring and maintaining BP 4. Initiating a bowel and bladder training program 5. Discussing long-term treatment plans with the family

2,3

14. You are preparing a nursing care plan for a client with an SCI for whom the nursing diagnoses of Impaired Physical Mobility and Toileting Self-Care Deficit have been identified. The client tells you "I don't know why we're doing all this. My life's over" Based on this statement, which additional nursing diagnosis takes priority? 1. risk for injury related to altered mobility 2. imbalanced nutrition: less than body requirements 3. impaired individual resilience related to spinal cord injury 4. disturbed body image related to immobilization

3

165. A nurse is caring for a client with a spinal cord injury during the immediate post-injury period. What is the PRIMARY focus of nursing care during this immediate phase? 1. Inhibiting UTIs 2. Preventing contractures and atrophy 3. Avoiding flexion or hyperextension of the spine 4. Preparing the client for vocational rehabilitation

3

583. After a traumatic spinal cord severance, a young client is having difficulty accepting the paralysis. One day the client has severe leg spasms and says, "My strength is coming back, and I know I will walk again." The nurse's response should be based on what understanding? 1. The nerves are regenerating and motor function is returning 2. Motor function may be returning now that the edema is subsiding 3. Spinal shock has subsided and the client's reflexes are hyperactive 4. The client has developed thrombophlebitis and is experiencing pain

3

582. A client has a functional transection of the spinal cord at C7-8, resulting in spinal shock. Which clinical indicators does the nurse expect to identify when assessing the client immediately after the injury? SELECT ALL THAT APPLY 1. Spasticity 2. Incontinence 3. Flaccid paralysis 4. Respiratory failure 5. Lack of reflexes blow the injury

3, 5

579. A nurse should expect a client with a spinal cord injury to have some spasticity of the lower extremities. What should the nurse include in the plan of care for this client to prevent the development of lower extremity contractures? 1. Deep massage 2. Active exercise 3. Use of a tilt board 4. Proper positioning

4

581. What problem is the nurse primarily attempting to prevent when encouraging a client with a spinal cord injury to increase oral fluid intake? 1. Dehydration 2. Skin breakdown 3. Electrolyte imbalances 4. Urinary tract infections

4

585. A client with quadriplegia is placed on a tilt table daily. Each day the angle of the head of the table gradually is increased. What should the nurse identify as its purpose when the client asks the reason for the tilt table? 1. Facilitates turning 2. Prevents pressure ulcers 3. Promotes hyperextension of the spine 4. Limits loss of calcium from the bones

4

10. A client with a new SCI at the level C3-C4 is being cared for in the ED. what is the priority assessment? 1. determine the level at which the client has intact sensation 2. assess the level at which the client has retained mobility 3. check BP and pulse for signs of spinal shock 4. monitor respiratory effort and oxygen saturation level

4 - first priority = respiratory pattern and ensuring adequate airway

11. The nurse reviews the discharge and home care instructions with a patient who had back surgery. Which statement by the pt indicates further teaching is needed? a. "i will drive myself to my doctor's office next week" b. "i will put a piece of plywood under my mattress" c. "i will try to increase fruits and vegetables and decrease fat intake" d. "i plan to get a new ergonomic chair at work"

a

8. which nursing intervention is included in the care plan when managing a client w/ Gardner-wells tongs? a. do not remove the traction weights and ensure they hang freely b. ensure that an extra set of drill bits are available in case a new set of predrilled holes must be made in ryan's skull c. place the velcro binders securely around ryan's head d. apply a halo vest when ryan is in the upright position

a

32. What key points does the nurse include in teaching an SCI pt about bowel and bladder retraining? (select all) a. ensure the pt gets a sufficient quantity of fluid each day b. instruct the pt about the purpose of stool softeners c. teach the pt about high-fiber foods d. teach the pt that continence is dependent upon spinal cord healing e. digital rectal stimulation is essential for regular bowel movements

abc

5. A patient is scheduled for lumbar surgery. Which key points must the nurse include in a preoperative teaching plan for this patient? (select all) a. techniques for getting in and out of bed b. expectations for turning and moving in bed c. limitations and restrictions for home activities d. restriction of bedrest for at least 48 hours e. report any numbness and tingling to the nurse immediately

abce

7. A patient has just undergone a spinal fusion and a laminectomy and has returned from the operating room. Which assessments are done in the first 24 hours? (select all) a. take vital signs every 4 hours and assess for fever and hypotension b. perform a neurological assessment every 4 hours with attention to movement and sensation c. monitor intake and output and assess for urinary retention d. assess for ability and independence in ambulating and moving in bed e. observe for clear fluid on or around the dressing

abce

Ryan is transferred to the rehab unit. He is tetraplegic at the C6 level. He has some movement in his hands, but is still unable to move his arms and legs independently. he is able to sit up in a wheelchair and advances to a regular diet. the nurse discusses autonomic dysreflexia and reflexic bowel program with ryan, his girlfriend, and his mother. 14. to evaluate the teaching, the nurse asks ryan to explain his understanding of all intructions give. Which statements indicate ryan's understanding? (select all) a. "it is important to drink hot fluids prior to defecation" b. "i will plan bowel evacuation at the same time everyday" c. "i should try to empty my bladder at least every 2-3 hours" d. "daily enemas will be needed to help achieve a bowel movement" e. "if i have a pounding headache, i should move to a sitting position"

abce

14. Which statements about spinal shock are accurate? (select all) a. it lasts for from less than 48 hrs up to a few weeks b. there is temporary loss of motor and sensory function c. there is permanent loss of motor and sensory function d. there is temporary loss of reflex and autonomic function e. there is permanent loss of reflex and autonomic function

abd

4. Ryan is scheduled to have an open CT scan w/ contrast procedure. What questions should be asked prior to administering the IV contrast through ryan's saline lock? (select all) a. what happens when he eats shellfish (crustaceans)? b. has he ever been allergic to peanuts? c. does he have an allergy to iodine? d. does he have any metal piercing on his body or metal implants?

ac

30. The nurse is caring for a pt who has been in a long-term care facility for several months following an SCI. The pt has had problems with urinary retention and subsequent overflow incontinence, and a bladder retraining program was recently initiated. Which are expected outcomes of the training program? (select all) a. demonstrates a predictable pattern of voiding b. is able to independently catheterize himself c. pours warm water over perineum to stimulate voiding d. takes bethanechol chloride (Urecholine) 1 hr before voiding e. is able to empty bladder completely f. does not experience a urinary tract infection

aef

1. The nurse is taking a history on an older adults pt who reports chronic back pain. The nurse seeks to identify factors that are contributing to the pain. Which question is the most useful in eliciting this information? a. "have you had any recent falls or have you been in an accident?" b. "do you have a history of osteoarthritis?" c. "do you have a history of diabetes mellitus?" d. "are you having pain that radiates down your leg or into the buttocks?"

b

13. The pt with chronic back pain is receiving ziconotide (Prialt) by intrathecal (spinal) infusion with a surgically implanted pump. The pt develops hallucinations. What is the nurse's best first action? a. request a psychiatric evaluation b. notify the health care provider c. perform an assessment of level of consciousness d. decrease the dose of the medication

b

16. A pt involved in a high-speed motor vehicle accident with sustained multiple injuries and active bleeding is transported to the ED by ambulance with immobilization devices in place. There is a high probability of cervical spine fracture; the pt has altered mental status and extremities are flaccid. What is the priority assessment for this pt? a. check the mental status using the glasgow coma scale b. assess the respiratory pattern and ensure a patent airway c. observe for intraabdominal bleeding and hemorrhage d. assess for loss of motor function and sensation

b

19. Assessment of a pt with a lower spinal cord injury confirms that the pt has paralysis of the bilateral lower extremities. How does the nurse document this finding? a. paraparesis b. paraplegia c. quadriparesis d. quadriplegia

b

2. The nurse is preparing to physically assess a pt's subjective report of paresthesia in the lower extremities. In order to accomplish this assessment, which assessment technique does the nurse use? a. use a doppler to locate the pedal pulse, dorsalis pedis pulse, or popliteal pulse b. ask the pt to identify sharp and dull sensation by using a paperclip and cotton ball c. use a reflex hammer to test for deep tendon patellar or Achilles reflex d. ask the patient to walk across the room and observe his gait and equilibrium

b

21. The nurse is assessing a pt with a spinal cord injury and recognizes that the pt is experiencing autonomic dysreflexia. What is the nurse's first priority action? a. check for bladder distention b. raise the head of the bed c. administer an antihypertensive medication d. notify the primary health care provider

b

23. The nurse is preparing a quadriplegic pt for discharge and has taught the pt's spouse to assist the pt with a "quad cough" to prevent respiratory complications. Which observation indicates that the spouse has understood what has been taught? a. the spouse assists the pt to the side of bed to encourage deep breaths b. the spouse places her hands below the pt's diaphragm and pushes upward as the pt exhales c. the spouse places her hands above the pt's diaphragm and pushes upward as the patient inhales d. the spouse places the pt in an upright sitting position to encourage deep breaths

b

27. The nurse and the nursing student are working together to bathe and reposition a pt who is in a halo fixator device. Which action by the nursing student causes the supervising nurse to intervene? a. uses the log-roll technique to clean the patient's back and buttocks b. turns the pt by pulling on the top of the halo device c. positions the pt with the head and neck in alignment d. supports the head and neck area during the repositioning

b

28. The nurse is caring for several pts with SCIs. Which task is best to delegate to the UAP? a. encourage use of incentive spirometry; evaluate the pt's ability to use it correctly b. log-roll the pt; maintain proper body alignment and place a bedpan for toileting c. check for skin breakdown under the immobilization devices during bathing d. insert a foley catheter and report the amount and color of the urine

b

6. The nurse is assessing a pt who presented to the ED reporting acute onset of numbness and tingling in the right leg. How does the nurse document this subjective finding? a. paraparesis b. paresthesia c. ataxia d. quadriparesis

b

8. A pt has a long history of chronic back pain and has undergone several back surgeries in the past. At this point, the surgeon is recommending a surgical procedure for spine stabilization. Which procedure does the nurse anticipate this pt will need? a. laparoscopic diskectomy b. spinal fusion c. laminectomy d. traditional diskectomy

b

An ambulance arrives in a few minutes. two paramedics and an ED RN on a ride-along take control of situation. the nurse assists the paramedics as they prepare ryan for transport to the trauma center. 2. if respiratory compromise occurs, what action should the nurse take to keep the airway open without compromising ryan's spine further? a. logroll to side while maintaining neutral alignment b. perform the jaw-thrust technique c. flex the neck with a wedge pillow d. use the chin-life/head-tilt technique

b

Ryan is experiencing S&S of spinal shock and neurogenic shock. clients are at greater risk of developing both simultaneously with SCI involving cervical and upper thoracic areas. 7. Which intervention should the nurse implement first? a. assess ryan for symptoms of paralytic ileus b. notify ED HCP immediately c. assist ED HCP in inserting an endotracheal tube d. prepare to administer the vasoconstrictor dopamine

b

24. The nurse is caring for a pt with a recent SCI. Which interventions does the nurse use to target and prevent the potential SCI complication of autonomic dysreflexia? (select all) a. frequently perform passive ROM exercises b. loosen or remove any tight clothing c. monitor stool output and maintain a bowel program d. keep the pt immobilized with neck or back braces e. monitor urinary output and check for bladder distention

bce

5. After the CT is done, ryan is transported to the MRI scan. what questions are appropriate to ask ryan prior to beginning the procedure? (select all) a. has he ever been told he is allergic to iodine? b. is he claustrophobic or afraid of closed-in, small spaces? c. when was the last time he ate or drank anything? d. does he have any metal piercings on his body or metal implants? e. does he have any allergies to eggs?

bd

20. Which symptoms indicate that a pt with a spinal cord injury is experiencing autonomic dysreflexia? (select all) a. flaccid paralysis b. hypertension c. hypotension d. severe headache e. blurred vision f. loss of reflexes below the injury

bde

34. The nurse is giving home care instructions to a pt who will be discharged with a halo device. What does the nurse instruct the pt to avoid? (select all) a. going out in the cold b. swimming or contact sports c. sexual activity d. bathing in the bathtub e. driving

be

Ryan's friends are standing around him, unsure of what to do. They are afraid he is badly hurt; ryan states he will be fine in a few minutes. someone calls 911. 1. what should ryan's friends do while waiting for emergency personnel to show up? (select all) a. help ryan move his legs and assist him to sit up b. place a blanket over ryan and make sure no one moves him c. attempt to stabilize his neck with any type of soft material d. carefully put ryan in the back of a truck with one man holding his neck e. ensure that the scene around ryan is safe and that he is not in any immediate danger

be

9. which intervention should be implemented for a paralytic ileus? a. encourage ryan to eat a high-calorie, high-fiber diet b. turn ryan every 2 hours in kinetic bed c. obtain an order to insert a nasogastric tube and set the siphon drainage to a low, intermittent suction d. continue to reassess ryan, but take no action at this time

c

The nurse is walking by the neuro-ICU waiting room and notices ryan's mother sitting and crying. there is no one else in the waiting room. 13. Which action should the nurse implement at this time? a. allow ryan's mother to cry and do not disturb her b. ask the hospital chaplain to come and see ryan's mother c. sit down beside ryan's mother d. discuss the situation with ryan as soon as possible

c

22. The nurse is providing discharge teaching for a pt with a spinal cord injury who will be performing intermittent self-catheterizations at home. Which signs and symptoms will the nurse instruct the pt to report immediately to the primary health care provider? (select all) a. dysuria b. retention c. fever d. urgency e. foul-smelling urine f. back pain

ce

9. A pt has just undergone a laminectomy and returned from surgery at 1300 hours. At 1530 hours, the nurse is performing the change of shift assessment. Which postoperative findings are reported to the surgeon immediately? (select all) a. minimal serosanguineous drainage in the surgical drain b. pain at operative site c. swelling or bulging at the operative site d. reluctance or refusal to cough and deep breathe e. moderate clear drainage on the postoperative dressing

ce

12. A pt has had an anterior cervical diskectomy with fusion and has returned from the recovery room. What is the priority assessment? a. assess for the gag reflex and ability to swallow own secretions b. check for bleeding and drainage at incision site c. monitor vital signs and check neurological status d. assess for patency of airway and respiratory effort

d

29. A pt with an SCI has paraplegia and paraparesis. The nurse has identified a priority pt problem of inability to ambulate. The nurse assesses the calf area of both legs for swelling, tenderness, redness, or possible complaints of pain. This assessment is specific to the pt's increased risk for which condition? a. contractures of joints b. bone fractures c. pressure ulcers d. deep vein thrombosis

d

the night nurse finds ryan crying and asks ryan if he would like to talk. tonight, ryan tells the nurse, "i dont want to live if people will have to take care of me. Please tell my family and the doctors that I want to die. I don't want any medications or treatments. I have already told them, but they won't listen to me" 12. which intervention should the nurse implement? a. reassure ryan that everything will be fine and encourage him to not think like that b. encourage ryan to talk to the chaplain about his feelings as soon as possible c. request the hospital ethics committee to meet and discuss ryan's wishes d. arrange a meeting with ryan, his family, and the healthcare team to discuss ryan's concerns

d