A hospice nurse is caring for a client who is approaching death and has fecal incontinence. Which of the following actions should the nurse take?

Request a prescription for lactulose from the provider.

Place an occlusive dressing over the client's buttocks every 8 hr.

Insert a lubricated rectal tube gently.

Keep disposable undergarments clean and dry.

Answer and Explanation

The Correct Answer is D

A. Request a prescription for lactulose from the provider: Lactulose is a laxative commonly used to treat constipation, but it is not appropriate for managing fecal incontinence in a hospice client approaching death. It focuses on promoting bowel movements rather than managing incontinence.

B. Place an occlusive dressing over the client's buttocks every 8 hr: Occlusive dressings are not typically used for managing fecal incontinence. They may trap moisture and exacerbate skin breakdown, especially in a hospice client who may be immobile or bedridden.

C. Insert a lubricated rectal tube gently: Inserting a rectal tube is invasive and may cause discomfort or injury, especially in a client who is approaching death. It is not recommended for managing fecal incontinence in this situation.

D. Keep disposable undergarments clean and dry: This is the most appropriate action for managing fecal incontinence in a hospice client. Keeping disposable undergarments clean and dry helps maintain skin integrity and prevents skin breakdown and discomfort. It also promotes comfort and dignity for the client during this sensitive time.

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Correct Answer is A

Explanation

The patient's statement reflects the stage of bargaining in Kübler-Ross's model of the five stages of grief and dying. During the bargaining stage, individuals may negotiate with a higher power or express desires to postpone or mitigate the inevitable outcome, such as death. In this case, the patient is expressing a wish to live long enough to witness the birth of their first grandchild, indicating a form of negotiation or bargaining with fate or circumstances.

A. Bargaining: Bargaining is characterized by attempts to negotiate or make deals in an effort to postpone or change the outcome of a situation, often involving a plea for more time or specific circumstances. The patient's statement about wanting to live long enough to see their first grandchild born exemplifies this stage, as they are expressing a desire to prolong their life to experience a significant event.

B. Anger: Anger involves feelings of frustration, resentment, or rage directed towards oneself, others, or the situation. The patient's statement does not reflect anger but rather a hopeful desire to witness a significant life event, indicating a different stage of grieving and acceptance.

C. Denial: Denial involves refusing to accept the reality of a situation or diagnosis, often accompanied by disbelief or avoidance of the truth. The patient's statement does not suggest denial, as they are acknowledging their impending death but expressing a desire for a specific experience before it occurs.

D. Depression: Depression in the context of Kübler-Ross's model involves feelings of sadness, hopelessness, and withdrawal in response to the impending loss or death. While the patient's statement may evoke emotions related to the significance of the event, it does not necessarily reflect depression as the primary stage of grief being experienced. Instead, it aligns more closely with bargaining, as the patient is expressing a desire for a particular outcome before facing death.

A. "l can’t believe that doctor graduated from medical school! He doesn’t know a thing about treating cancer. B. "The doctor has been so good to me. know he has tried everything he can. It is just my time." C. "The doctor says I only have a few months to live, but know he is exaggerating to get me to take my medication,' D. "Even though I am not hurting right now, I don't feel like I have the energy to get Out Of bed."

Correct Answer is C

Explanation

A. "l can’t believe that doctor graduated from medical school! He doesn’t know a thing about treating cancer. This statement expresses frustration or disbelief towards the doctor's competence rather than denial of the terminal diagnosis.

B. "The doctor has been so good to me. know he has tried everything he can. It is just my time." This statement acknowledges the terminal nature of the illness and indicates acceptance rather than denial.

C. "The doctor says I only have a few months to live, but know he is exaggerating to get me to take my medication. This statement suggests denial by questioning the doctor's prognosis and attributing it to an ulterior motive, such as getting the patient to take medication. The client is unable to accept the reality of the limited life expectancy despite being informed by the doctor.

D. "Even though I am not hurting right now, I don't feel like I have the energy to get Out Of bed."

This statement reflects physical symptoms and lack of energy rather than denial of the illness.

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A hospice nurse is caring for a client who is approaching death and has fecal incontinence. Which of the following actions should the nurse take?

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