A patient who is terminally ill has been unable to maintain good nutrition because of nausea and anorexia and has lost a great deal of weight. He is now unable to change his position in bed and needs frequent perineal care because of urinary incontinence. The nurse planning his care would include in the plan of care to:

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.

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.