A nurse is instructing the caregiver of a toddler who has bacterial conjunctivitis and a new prescription for an ophthalmic ointment. Which of the following instructions should the nurse provide?

Choice A rationale

Suggesting an antidepressant is inappropriate because wanting to die at home during the terminal stage of lung cancer is a rational preference for comfort and autonomy, not necessarily a sign of clinical depression. Pathologizing a client's end of life wishes ignores their right to self-determination. Furthermore, antidepressants take weeks to reach therapeutic levels, which may not align with the client's immediate terminal prognosis and the urgent need for a discharge plan focused on comfort.

Choice B rationale

Informing a patient that their wish to go home is not in their best interest is a paternalistic approach that violates the ethical principle of autonomy. A nurse's role is to support the client's informed decision-making process rather than imposing personal or professional biases. In end stage lung cancer, the focus shifts from curative care to quality of life. Denying the client's request can cause moral distress and prevent a peaceful death in their preferred environment.

Choice C rationale

Transferring a client to a long term care facility does not honor the client's specific request to go home. While long term care provides nursing assistance, it is still an institutional setting and may not provide the specialized end of life care required for a terminal diagnosis. This action bypasses the client's expressed wish for a home environment. The nurse should focus on resources that facilitate the client's transition to their own residence with appropriate medical support.

Choice D rationale

Discussing hospice services is the most important action because hospice provides palliative care for clients with a terminal illness and a life expectancy of six months or less. Hospice focuses on pain management, symptom control, and emotional support for both the client and family in the home setting. By coordinating this referral, the nurse ensures the client's wish to die at home is honored while maintaining safety and professional care standards during the dying process.

Choice D rationale

Middle-stage Alzheimer's disease is characterized by increasing confusion, memory loss, and disorientation. Keeping familiar personal items at the bedside, such as family photographs or a favorite blanket, provides a sense of security and helps orient the patient to their identity. These "anchors" can reduce anxiety and "sundowning" behaviors by making the environment feel less clinical and more recognizable. This approach supports the patient's emotional well-being and helps maintain a connection to their past.

Choice A rationale

While providing activities is generally good, complex puzzles may be frustrating for a patient in the middle stage of Alzheimer's. At this stage, cognitive deficits often impair problem-solving skills and fine motor coordination. If a task is too difficult, it can lead to agitation and a sense of failure. The nurse should instead suggest simpler, failure-free activities that focus on sensory engagement or repetitive motions rather than complex cognitive challenges that require high levels of concentration.

Choice B rationale

Keeping lights on at all times is counterproductive and can disrupt the patient's circadian rhythm. Sleep-wake cycle disturbances are common in Alzheimer's patients, and constant light can lead to sleep deprivation and increased delirium. The environment should be bright during the day to encourage alertness and dimmed at night to signal that it is time for rest. Maintaining a natural light cycle is essential for reducing confusion and managing the behavioral symptoms of the disease.

Choice C rationale

Increasing the volume on the television can create an environment of sensory overload. Patients with Alzheimer's often have difficulty processing multiple or loud stimuli, which can lead to agitation, fear, or "noise-induced" confusion. A calm, quiet environment is generally preferred to minimize triggers for behavioral outbursts. The nurse should ensure that noise levels are kept at a comfortable, low level to promote a soothing atmosphere and help the patient remain calm and focused.