Chapter 16: End-of-Life Care

durable power of attorney

A 90-year-old home care client's son has been designated to make decisions regarding the client's medical care when the client is no longer able to do so. As the client nears the end of life, the son is consulted on an ever-increasing basis. What legal instrument activates the son's decision-making designation?

Atropine Atropine is used to manage excessive oral and respiratory secretions when death is imminent. Dexamethasone, megestrol, and dronabinol may be used to stimulate appetite in clients who are at the end of life

A client is experiencing anorexia and the physician is to order a medication to stimulate the client's appetite. Which of the following would the nurse least likely expect the physician to prescribe?

Grief

Which term is used to describe the personal feelings that accompany an anticipated or actual loss?

"Tell me more about what's on your mind."

A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give?

palliative care

A type of comprehensive care for clients whose disease is not responsive to cure is

Increased restlessness

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?

Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles Earlier, a client with failing cardiac function exhibits a higher pulse as the body attempts to circulate oxygen. Next, cardiac output is decreased due to ineffective filling of the chambers, impairing circulation, and diminishing the heart's own oxygen supply. The heart rate and blood pressure then decrease. Peripheral circulation is impaired with the feet and ankles becoming pale and mottled.

Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening?

Avoiding criticizing or giving advice

Which intervention should a nurse perform during the grieving period when caring for a dying client?

Clients have a life expectancy of 6 months or less.

Which is a true statement regarding hospice care?

closed awareness The patient is unaware of his or her terminal state, whereas others are aware. May be characterized as a conspiracy between the family and health care professionals to guard the "secret," fearing that the patient may not be able to cope with full disclosure about his or her status, and the patient's acceptance of others' accounts of his or her "future biography" as long as the others give him or her no reason to be suspicious.

Glaser and Strauss (1965) identified four "awareness contexts." Which awareness context occurs when the client is unaware of their terminal state, whereas others are aware?

Clients and families view palliative care as giving up

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services?

Maintaining a balanced diet

Which of the following would not be consistent with promoting nutrition in terminally ill patients?

a) Enhances quality of life c) Integrates spirituality d) Offers a team approach to care f) Provides pain relief The principles of palliative care include providing relief from pain and distressing symptoms. In the early course of disease, chemotherapy and radiation may be used to define care needed, but in the later stages, chemotherapy is typically not used. Psychological support including spirituality and bereavement counseling for family members is available. The care does not hasten nor postpone death but is aimed at enhancing a quality of the life that is remaining. A team approach meets the needs of the client and family.

A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply.

Anger Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?

Over the course of several visits Information about end-of-life care beliefs, preferences, and practices should be gathered in short segments over a period of time, such as over several visits. Trying to elicit the information in one visit would be overwhelming. Waiting until the client's condition begins to deteriorate or when signs of imminent death appear would be too late. The nurse needs to integrate the client's beliefs, preferences, and practices into the plan of care.

A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time?

"I understand that it would be wonderful to see your daughter's graduation."

Which statement, made by the nurse, can be most helpful when caring for a client in the third stage of Kubler-Ross' emotional reactions to dying?

Mourning

Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?

"Tell me some more about what is on your mind."

While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate?

Faith and belief

A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following?

The principle of autonomy By promoting open discussion and informed decision making, the nurse is empowering the client to make his own decisions leading to autonomy. The principle of justice requires fairness and justice to all clients. The principle of nonmaleficence requires that nurse does not intentionally or unintentionally inflict harm on others. The principle of fidelity maintains that nurses are faithful to the care of the clients.

The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?

a) Pain is viewed as a mechanism for cleansing. b) Death occurs through God's permission. e) The way a person dies is of great individual importance. According to Islamic beliefs, everyone will face death and the way a person dies is of great individual importance. Death cannot happen except by God's permission. People adhering to Islamic beliefs also view pain as a cleansing instrument from God and as a compensation for sin. In Hinduism, each caste system has a different view of death, and relatives must create a new ethereal body during the first 10 days after death.

The nurse is providing care to a terminally ill client and his family who practice the Islamic faith. Which of the following concepts would the nurse need to integrate into this client's plan of care? Select all that apply.

"Tell me more about what's on your mind." "This must be very difficult for you." The nurse needs to listen effectively and empathetically, acknowledging the client's fears and concerns. Statements such as "This must be very difficult for you" and "Tell me more about what's on your mind" address the client's concerns and help to focus the discussion on the client. Telling the client that the nurse knows how the client feels ignores the client's concerns. Saying that there is still time for a good life or telling the client to focus on what the doctor has planned ignores the client's feelings and blocks communication.

While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply.

Focus on the client's basic needs.

Which of the following is an appropriate method of assessing the dying client?

* Control the client's pain with prescribed medication. * Advise the client's physician of the client's condition. * Encourage the client to explain his or her wishes.

A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply.

Perform a thorough pain assessment with the patient. An effective combined approach to clinical depression includes relief of physical symptoms such as pain. Clinical depression should not be accepted as an inevitable consequence of dying. Researchers have linked the psychological effects of cancer pain to suicidal thought and, less frequently, to carrying out a planned suicide. An effective combined approach to clinical depression includes relief of physical symptoms and pharmacologic intervention with tricyclic antidepressants.

A client with long-term breast cancer who was recently enrolled in a hospice program demonstrates signs and symptoms of clinical depression. Which action by the hospice nurse is appropriate?

Side effects must be treated. Explanation: The nurse who is administering narcotics at the end of life still must realize that there are side effects from the narcotics which must be addressed. Depending on the status of the client, death may be days or weeks away, not imminent. Pain medications are liberally given at the end of life to ensure that the client is comfortable. Typically, pain medications relax the client as the pain level is eased. The client is not sedated.

The nurse is caring for a client at the end of life. The client is ordered a regular dosage of narcotics and short-acting narcotics for breakthrough pain. When administering the narcotics, the nurse is correct to realize which of the following?

"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death." When the terminally ill patient or the patient's legal proxy requests palliative sedation, the use of pharmacologic agents to induce sedation or near sedation when symptoms have not responded to other management measures), the purpose is not to hasten the patient's death but to relieve intractable symptoms. Palliative sedation may be controversial, but it is not illegal. Total sedation is rarely indicated in hospice care to provide comfort. Continuous pain assessments are not indicated at this stage; the patient requires intervention/treatment.

A 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia?

Durable power of attorney for health care

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?

Provide the spouse with an emergency kit that contains small doses of oral morphine liquid.

A client in hospice has end-stage renal failure. The client states that, of late, he has lost his appetite and feels like everyday situations have become more stressful. The client reports feeling restless. In addition, the client's spouse notices that the client is becoming more confused. What is the most important nursing intervention that needs to be carried out at this point?

Durable power of attorney for health care

Which is also known as a proxy directive?

The stages are applicable to any loss. The five stages of dying describe the five emotional reactions applicable to the experience of any loss. Not every client or family member experiences every stage. Many clients never reach a stage of acceptance. Clients and family fluctutate on a sometimes daily basis in their emotional responses.

A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan?

Client's goals

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms?

Respect the client's and family members' choices.

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client?

A proxy directive

A patient authorizes a son to make medical decisions and brings the completed forms for the nurse to place on the chart. What form does the nurse understand this is?

Encourage the family members to express their feelings and listen to them in their frank communication

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation?

Palliative care

The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using?

care that will reduce the client's physical discomfort and manage clinical symptoms.

The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is:

Proxy directive

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?

Mutual pretense awareness

Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions?

respite care Inpatient respite care is a 5-day inpatient stay, provided on an occasional basis to relieve the family caregivers.

Which is one level of hospice care covered under Medicare and Medicaid hospice benefits, includes a 5-day inpatient stay, and is provided occasionally to relive the family caregivers?

The dying client usually exhibits anger first. The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.

Which of the following does not coincide with Kübler-Ross's stages related to a dying client?

Respect the client's and family members' choices

A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client?

Use imagery, humor, and progressive relaxation

Despite having been administered prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea?

Medical directive Explanation: A living will is a type of advance medical directive in which the individual, who is of sound mind, documents treatment preferences. A proxy directive and health care power of attorney are other names for a durable power of attorney for health care, in which one individual is appointed and authorized to make medical decisions on behalf of another person when that person is no longer able to speak for him or herself.

Which term best describes a living will?

Cohesion and boundaries Assessment of family cohesion and boundaries focuses on how autonomous and interdependent family members are, such as their bonding and their ability to work as a team. Family constellation is revealed by the members of the family, who is important to the client and the roles and relationships among family members. Flexibility and adaptability is revealed by the family's ability to integrate new information and how they manage change. Communication is revealed by how open, clear, and direct the family is with information and by any topics that are avoided.

The nurse is providing care to a family who is facing a life-threatening illness. The nurse is assessing how family members bond and how the family works as a team. The nurse is assessing which of the following?

Add haloperidol to the client's treatment plan.

The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician?

"Tell me who or what gives you strength."

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care?

Profound protein loss

A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following?

Continuous care Continuous care is provided in the home for management of medical crisis. Routine home care would be used to provide the usual services to a client, such as nursing care, medical social services, counseling, home health aide/homemaker servies, and various therapies. Inpatient respite care would be used for a 5-day stay to provide relief for family caregivers. General inpatient care is used for symptom management that cannot be provided in the home.

A nurse is providing in-home hospice care to a terminally ill client. The client experiences a medical crisis requiring monitoring and medication administration. Which level of hospice care would the nurse implement?

Encourage the family members to express their feelings and listen to them in their frank communication. Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying patient. It is not advisable for the nurse to encourage conversations on the impending death of the patient. Being a silent observer or encouraging the family members to spend time with the dying patient may not help the family members to express their feelings.

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

Call the physician to obtain an anxiolytic. Clients may become restless and agitated when experiencing difficulty breathing. Obtaining an anxiolytic can reduce the client's anxiety and agitation. It is difficult for families to see the client agitated and trying to express something. It leaves the family feeling frustrated and with a lingering memory after death. Before death, the client loses muscle control of the bowel and bladder, needing a disposable undergarment. Sitting in the chair and offering sips to drink is not something necessary at the end of life.

The family of a dying client is noticing that their loved one is short of breath, restless in bed, and appears to be trying to tell them something. Which nursing intervention is appropriate at this time?

"The moaning you hear is from air moving over very relaxed vocal cords." As a client approaches death, certain signs appear. The family is reporting irregular breathing with periods of apnea. The moaning that they hear reflects the sound of air passing over very relaxed vocal cords. It does not signify pain or distress. Therefore, no additional pain medication would be needed. Secretions collecting at the back of the throat are noted by a rattling or gurgling sound. Decreased oxygen to the brain would lead to confusion, which may be reported by the client as strange dreams or visions.

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" Which response by the nurse would be most appropriate?

Advice for the family to have fruit juices readily available at the client's bedside. To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care?

Explore own feelings on mortality and death and dying.

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following?

Weight loss and inadequate food intake The nurse should report weight loss and inadequate food intake so that the team can consider alternative nutritional and fluid administration routes for a dying client. The nurse need not report altered gastrointestinal function because it is a normal part of the dying process. A nurse should also not report a drop in blood pressure and rapid heart rate or irregular eating habits

Which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client?

"Let's take this one day at a time; remember you have your daughter's dance recital next month."

A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client?

"When your stay reaches 6 months, you will be recertified for a continued stay." Federal rules for hospices require that eligibility be reviewed periodically. Patients who live longer than 6 months under hospice care are not discharged, provided that their physician and the hospice medical director continue to certify that they are terminally ill with a life expectancy of 6 months or less (assuming that the disease continues its expected course)

A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse?

"It will enable the patient to remain home if that is what is desired." The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?

"I just want to see my daughter graduate from college. That's all."

A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying?

Ask the client to rate the dyspnea on a scale of 0 to 10. The most appropriate method for assessing the severity of the client's dyspnea is to have the client rate the severity using a scale from 0 to 10, with 0 indicating no dyspnea and 10 indicating the worst imaginable dyspnea. This provides an objective indicator of the severity. Asking the client to identify the complaint as mild, moderate, or severe, although somewhat helpful, is not the best means for assessing the severity because these terms are difficult to quantify. Questioning the client about easing or worsening of the complaint would be helpful to determine the possible underlying cause and obtain a more complete picture of the complaint, but it would not help determine severity. Dysnpea can occur for many reasons, including anxiety and fear. Therefore, auscultating the lungs would provide information only about respiratory involvement as a potential cause. It would not help determine the severity of the dyspnea

A nurse is providing care to a terminally ill client who is experiencing dyspnea. Which of the following would be most appropriate to do to assess the severity of the client's complaint?

There remains a conspiracy of silence about dying despite progress in the area. Despite the progress on many fronts associated with attitudes toward death and dying, there still is a belief in a conspiracy of silence about dying. Although a growing number of clinicians are becoming more comfortable with assessing clients' and famlies' information needs, many still avoid the topic in the hope that the client will ask or find out on his or her own. In addition, there are misconceptions that clients would subsequently lose all hope, give up, or be psychologically harmed by disclosure of a serious or terminal illness and that clients would ask for information if they really wanted to know.

Nursing students are reviewing information about attitudes related to death and dying. The students demonstrate understanding of the information when they identify which of the following as most accurate?

The health care provider provides the means for the clients to take their life. Explanation: Physician-assisted suicide is the practice of providing a means by which a client can end his or her life. Much controversy exists concerning the practice. California, Vermont, Oregon, Washington, and Montana are the only states that permit physician-assisted suicide. The physician does not personally administer the dose, wait until the client is dead, or have a third party physician involved.

The nurse is caring for a client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress?

20 According to federal guidelines, hospices may provide no more than 20% of the aggregate annual patient days at the inpatient level. The other numerical values are incorrect

According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level?

Speak to the client in a calm and soothing voice. Sight and touch diminish as the client approaches death; however, hearing tends to remain intact. Speaking to the client calmly is most appropriate.

As the moment of death approaches, which of the following does the nurse encourage the family to do?

Providing personal care Maintaining client comfort Supporting family members

A nurse is caring for a terminally ill client inquiring about physician-assisted suicide. Which statement if made by the nurse would correctly inform the client of this practice?

Benzodiazepine A kit might contain small doses of oral morphine liquid for pain or shortness of breath, a benzodiazepine for restlessness, and an acetaminophen suppository for fever. Atropine sulfate drops may be used for excess respiratory secretions.

Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?

Encourage the family members to express their feelings and listen to them in their frank communication.

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation?

Accept the client's denial of the situation. When working with terminally ill clients, nurses need to understand that denial is often a useful coping mechanism that enables the client to gain temporary emotional distance from a situation that is too painful to think about. Therefore, nurses must accept clients regardless of the degree to which they are in denial about their illness and work with other health care providers to present the same message. Consulting with other team members would be helpful to ensure that all members present the same information to the client. Denial is a coping mechanism and only becomes unhealthy if the client or family refuses to acknowledge a diagnosis or refuse to hear about treatment options. Correcting the client's misconceptions would disrupt the client's coping mechanism of denial and possibly lead to greater upset.

A nurse assesses a client with a terminal illness and determines that the client is in denial about the condition. Which of the following would be most important for the nurse to do when developing the client's plan of care?f

Attitude of health care professionals toward terminal illness. Explanation: Clinicians' attitudes toward the terminally ill and dying remain the greatest barrier to improving care at the end of life. Clinicians' reluctance to discuss disease and death openly with patients stems from their own anxieties about death, as well as misconceptions about what and how much patients want to know about their illnesses.

A nurse has been working in hospice care for 10 years. Based on her experience, she drafts her plan of care with the understanding that the most significant barrier to improving care at the end of life is the:

Allows for the nurse to facilitate the grieving process Grieving is a painful yet normal reaction that helps clients cope with loss and leads to emotional healing. The nurse is responsible for facilitating the grieving process and helping the client and family deal with their emotions. Evidence-based medical and nursing research (2009) has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following?

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

"This must be very difficult for you." Using open-ended questions allows the nurse to elicit the patient's and family's concerns, explore misconceptions and needs for information, and form the basis for collaboration with physicians and other team members. For example, a seriously ill patient may ask the nurse, "Am I dying?" The nurse should avoid making unhelpful responses that dismiss the patient's real concerns or defer the issue to another care provider. In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind").

A dying patient wants to talk to the nurse. The patient states, "I know I'm dying, aren't I?" What would an appropriate nursing response be?

The client entered a clinical trial through the National Cancer Institute. The client involved in a clinical trial needs additional teaching about hospice care. This treatment option suggests that the client isn't ready for palliative care, which is a criterion for hospice care. Preferring not to discuss death around the girlfriend and not feeling ready to complete a will are normal responses to the grieving process. Blood transfusions are considered palliative care.

A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care?

"We'll try adding powdered milk to milk and other foods to make them more nutritious." Increasing the nutritional value of foods, such as by adding powdered milk to milk and other foods, is appropriate. The client should be allowed and encouraged to eat when he is hungry regardless of the regular meal times. Cooking odors should be eliminated or reduced because they can precipitate nausea, vomiting, or anorexia. Unless there is a definite problem with chewing or swallowing, foods do not need to be pureed (mashed) or in liquid form.

A nurse is working with the family of a terminally ill client, providing them with suggestions about how to manage the client's anorexia. Which statement by the family indicates that they have understood the instructions?

Risk for constipation related to the effects of an opioid When an opioid is used for around-the-clock pain management, the nursing diagnosis, risk for constipation, would be most likely because of the opioid's effect on the gastrointestinal system. Therefore, a regimen to combat constipation is key. Although opioids depress the central nervous system and cause sedation, a risk for ineffection and impaired physical mobility would be less likely. Other factors involved in the client's care, not just the around-the-clock pain control, would contribute to caregiver role strain.

A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify?

Using a soft toothbrush to vigorously clean the mouth Secretions are often more distressing to the family than their presence is to the client. Gentle mouth care with a moistened swab or very soft toothbrush helps maintain the integrity of the client's mucous membranes. Other helpful measures include positioning the client on the side with the head supported with pillows to allow secretions to drain freely from the mouth, gently suctioning the oral cavity, and admnistering prescribed anticholingergic agents sublingually or transdermally. Deeper suctioning may cause significant discomfort to the dying client and rarely is of benefit because secretions tend to reaccummulate quickly.

When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include?

Ask the family members about spiritual care. When clients are too ill to express their wishes, the nurse should ask the family members about spiritual care. Encouraging family members in their frank communication and providing spiritual books may not be helpful in providing spiritual care for a dying client. Allowing a period of privacy may not be helpful. The nurse allows a period of privacy to the client's family members after the death of the client.

Which of the following interventions should the nurse perform while providing spiritual care for a dying client?