A client who has end-stage renal disease has decided to discontinue dialysis treatments. The client has a living will that states no artificial hydration or nutrition should be provided in case of a terminal condition. The client's spouse asks the nurse if they can give the client some ice chips or water to moisten their mouth. What is the best response by the nurse?

Rationale: The nurse should report the incident to the risk management department, as this is a serious breach of legal and ethical principles that could result in legal action or disciplinary measures. The risk management department is responsible for identifying, analyzing, and minimizing risks that could harm clients, staff, or the organization.

Incorrect options:

B) Document the incident in the client's medical record. - This is an incorrect action, as it does not address the issue or prevent further harm. The nurse should not document anything in the client's medical record that is not related to their care or treatment, as this could be used as evidence in a lawsuit or investigation.

C) Contact the health care provider who performed the procedure. - This is an incorrect action, as it does not address the issue or prevent further harm. The nurse should not confront or accuse the health care provider who performed the procedure, as this could create conflict or hostility. The nurse should report the incident to the appropriate authority, such as the risk management department or the nursing supervisor.

D) Notify the client's family members of the incident. - This is an incorrect action, as it does not address the issue or prevent further harm. The nurse should not disclose any information about the client's care or treatment to anyone who is not authorized to receive it, unless there is a legal obligation or a valid consent from the client.

Rationale: The nurse should refer the client to a hospice program that can provide them with palliative care at home, as this aligns with their wish to die at home and their advance directive that states they do not want any life-sustaining treatments. Hospice care focuses on improving the quality of life and comfort of clients who have a life expectancy of six months or less.

Incorrect options:

A) "I will make sure that your advance directive is followed by all members of your health care team." - This is a correct statement, but it does not indicate an understanding of legal and ethical principles related to end-of-life care. The nurse has a legal and ethical duty to follow the client's advance directive, but this does not address their wish to die at home or their need for palliative care.

B) "I will consult with your family members before making any decisions about your care." - This is an incorrect statement, as it violates the client's autonomy and right to self-determination. The nurse should respect the client's wishes and decisions regarding their end-of-life care, unless there is evidence of a durable power of attorney for health care or a court order that states otherwise.

C) "I will administer pain medication as needed, even if it may hasten your death." - This is an incorrect statement, as it implies that the nurse intends to cause or hasten the client's death, which is illegal and unethical. The nurse should administer pain medication as needed, following the principle of double effect, which states that an action that has both good and bad effects is morally permissible if the good effect is intended and outweighs

the bad effect.