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 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.

Rationale: The nurse should respect the client's autonomy and right to self-determination, and ask the client to confirm their wishes regarding the DNR order. The client has the right to change or revoke their DNR order at any time, as long as they are competent and able to communicate.

Incorrect options:

A) Inform the spouse that the nurse is legally obligated to follow the DNR order. - This is an incorrect action, as it does not address the client's wishes or involve them in the decision-making process. The nurse should not assume that the spouse has the authority to make decisions for the client, unless there is evidence of a durable power of attorney for health care.

C) Notify the health care provider of the spouse's request. - This is an incorrect action, as it does not respect the client's autonomy or involve them in the decision-making process. The health care provider cannot change or revoke the DNR order without the client's consent, unless there is evidence of a court order or an advance directive that states otherwise.

D) Suggest the spouse to contact a lawyer to revoke the DNR order. - This is an incorrect action, as it does not respect the client's autonomy or involve them in the decision-making process. The spouse does not need a lawyer to revoke the DNR order, as long as the client is competent and able to communicate.