A client who has a terminal illness tells the nurse that they want to have a do-not-resuscitate (DNR) order in their medical record. The nurse knows that the client's family is opposed to this decision and has tried to persuade the client to change their mind.

Which of the following actions should the nurse take?

T

he nurse should initiate antibiotic therapy as prescribed for a client who has COPD and develops signs of a respiratory infection, such as fever, productive cough, and increased dyspnea. Antibiotics can help treat the infection and prevent complications such as sepsis or respiratory failure.

Incorrect answers:

A) The nurse should not obtain a sputum culture and sensitivity test for a client who has COPD and develops signs of a respiratory infection, as this is not necessary or appropriate in palliative care. The goal of palliative care is to relieve symptoms and improve quality of life, not to diagnose or cure diseases. A sputum culture and sensitivity test may cause discomfort or distress for

the client, and delay treatment.

B) The nurse should not administer acetaminophen as prescribed for a client who has COPD

and develops signs of a respiratory infection, as this is not sufficient or effective in managing

the condition. Acetaminophen may help reduce fever, but it does not address the underlying cause of infection or relieve other symptoms such as cough or dyspnea.

D) The nurse should not increase fluid intake as tolerated for a client who has COPD and develops signs of a respiratory infection, as this may worsen dyspnea or cause fluid overload. Fluid intake should be individualized

The nurse should explore the reasons for the family's reluctance and provide education and support, as this can help address their concerns and fears, and facilitate decision-making that respects the client's wishes and values. The nurse should also inform the family about the availability and benefits of home hospice care, which can provide medical, nursing, social, spiritual, and bereavement services for the client and the family at home.

Incorrect answers:

A) The nurse should not respect the client's wish and arrange for home hospice care without involving the family in the decision, as this may cause conflict and resentment among the family members, and compromise the quality of care and comfort for the client. The nurse should respect the client's autonomy, but also consider the family's perspectives and needs, and promote effective communication and collaboration among all parties.

C) The nurse should not suggest a compromise and recommend a palliative care unit in a hospital or facility without exploring the client's preferences and goals of care, as this may disregard

the client's autonomy and dignity. The nurse should respect the client's wish to die at home, unless there are compelling reasons to suggest otherwise, such as safety issues or lack of resources.

D) The nurse should not refer the client and the family to a social worker or a chaplain for counseling without first assessing their needs and preferences, as this may imply that the nurse is avoiding or delegating the issue, or imposing unwanted services on them. The nurse should provide emotional support and reassurance to the client and the family, and offer referrals to other professionals or resources as appropriate.