A client is admitted to the hospital with terminal cancer and expresses a wish to die at home. The client has an advance directive that states they do not want any life-sustaining treatments. Which statement by the nurse indicates an understanding of legal and ethical principles related to end-of-life care?

Rationale: The nurse's priority action in this situation is to review the client's advance directives and code status with the family, as these documents indicate the client's preferences and wishes regarding end-of-life care and resuscitation measures. The nurse should ensure that the family understands and respects the client's choices and that they have a copy of these documents available at home.

Incorrect options:

B) Assess the client's pain level and administer analgesics as prescribed. - This is an important action, but not the priority in this situation. The nurse should assess and manage the client's pain and other symptoms as part of palliative care, but this should be done after reviewing the advance directives and code status with the family.

C) Provide emotional support and counseling to the client and the family. - This is an important action, but not the priority in this situation. The nurse should provide emotional support and counseling to the client and the family as part of holistic care, but this should be done after reviewing the advance directives and code status with the family.

D) Educate the client and the family about the signs and symptoms of impending death. - This is an important action, but not the priority in this situation. The nurse should educate the client and the family about what to expect as death approaches, such as changes in breathing, circulation, consciousness, and skin color, but this should be done after reviewing the advance directives and code status with the family.

Rationale: The best response by the nurse is to inform the spouse that they cannot give any ice chips or water to the client, as this would constitute artificial hydration and nutrition, which is against the client's living will. However, the nurse should also offer an alternative way of providing comfort to the client, such as using a moist sponge or swab to gently clean their mouth. This would help to relieve dryness and prevent cracking of the lips and tongue.

Incorrect options:

A) "Yes, you can give them some ice chips or water, as this will not prolong their life or interfere with their decision." - This is an incorrect response, as giving ice chips or water to a terminally ill client who has refused artificial hydration or nutrition would be unethical and potentially harmful. Ice chips or water could cause aspiration pneumonia, fluid overload, electrolyte imbalance, or increased blood pressure in a client who has end-stage renal disease.

B) "No, you cannot give them any ice chips or water, as this will violate their living will and cause them more discomfort." - This is a partially correct response, as giving ice chips or water to a terminally ill client who has refused artificial hydration or nutrition would violate their living will. However, this response does not offer any alternative way of providing comfort to the client, such as using a moist sponge or swab to gently clean their mouth.

C) "Yes, you can give them some ice chips or water, but only if they ask for it or indicate that they are thirsty." - This is an incorrect response, as giving ice chips or water to a terminally ill client who has refused artificial hydration or nutrition would be unethical and potentially harmful, regardless of whether they ask for it or not. Ice chips or water could cause aspiration pneumonia, fluid overload, electrolyte imbalance, or increased blood pressure in a client who has end-stage renal disease.