Rationale: The nurse's priority action in this situation is to review the client's advance directives and code status with the family, as these documents indicate the client's preferences and wishes regarding end-of-life care and resuscitation measures. The nurse should ensure that the family understands and respects the client's choices and that they have a copy of these documents available at home.

Incorrect options:

B) Assess the client's pain level and administer analgesics as prescribed. - This is an important action, but not the priority in this situation. The nurse should assess and manage the client's pain and other symptoms as part of palliative care, but this should be done after reviewing the advance directives and code status with the family.

C) Provide emotional support and counseling to the client and the family. - This is an important action, but not the priority in this situation. The nurse should provide emotional support and counseling to the client and the family as part of holistic care, but this should be done after reviewing the advance directives and code status with the family.

D) Educate the client and the family about the signs and symptoms of impending death. - This is an important action, but not the priority in this situation. The nurse should educate the client and the family about what to expect as death approaches, such as changes in breathing, circulation, consciousness, and skin color, but this should be done after reviewing the advance directives and code status with the family.

Rationale: The best response by the nurse is to inform the spouse that they cannot give any ice chips or water to the client, as this would constitute artificial hydration and nutrition, which is against the client's living will. However, the nurse should also offer an alternative way of providing comfort to the client, such as using a moist sponge or swab to gently clean their mouth. This would help to relieve dryness and prevent cracking of the lips and tongue.

Incorrect options:

A) "Yes, you can give them some ice chips or water, as this will not prolong their life or interfere with their decision." - This is an incorrect response, as giving ice chips or water to a terminally ill client who has refused artificial hydration or nutrition would be unethical and potentially harmful. Ice chips or water could cause aspiration pneumonia, fluid overload, electrolyte imbalance, or increased blood pressure in a client who has end-stage renal disease.

B) "No, you cannot give them any ice chips or water, as this will violate their living will and cause them more discomfort." - This is a partially correct response, as giving ice chips or water to a terminally ill client who has refused artificial hydration or nutrition would violate their living will. However, this response does not offer any alternative way of providing comfort to the client, such as using a moist sponge or swab to gently clean their mouth.

C) "Yes, you can give them some ice chips or water, but only if they ask for it or indicate that they are thirsty." - This is an incorrect response, as giving ice chips or water to a terminally ill client who has refused artificial hydration or nutrition would be unethical and potentially harmful, regardless of whether they ask for it or not. Ice chips or water could cause aspiration pneumonia, fluid overload, electrolyte imbalance, or increased blood pressure in a client who has end-stage renal disease.

Rationale: The appropriate action by the nurse in this situation is to confirm the DNR order with

the client and document the conversation in the medical record. The nurse should ensure that

the client understands what a DNR order means and that they agree with it. The nurse should

also respect the client's right to change their mind at any time and revoke the DNR order if they wish.

Incorrect options:

B) Contact the physician and request that the DNR order be revoked, as the client has not given consent. - This is an inappropriate action, as it would violate the client's autonomy and dignity. The nurse should not assume that the client has not given consent, as they may have discussed their wishes with their health care proxy or physician beforehand. The nurse should confirm the DNR order with the client instead of requesting its revocation.

C) Respect the DNR order and provide palliative care to the client, as the health care proxy has authority to make decisions. - This is a partially correct action, as the nurse should respect the DNR order and provide palliative care to the client. However, the nurse should not rely solely on the health care proxy's authority to make decisions, asthe client is alert and oriented and may have their own preferences and opinions. The nurse should confirm the DNR order with the client as well.

Rationale: The nurse should respect the client's autonomy and right to self-determination, and ask the client to confirm their wishes regarding the DNR order. The client has the right to change or revoke their DNR order at any time, as long as they are competent and able to communicate.

Incorrect options:

A) Inform the spouse that the nurse is legally obligated to follow the DNR order. - This is an incorrect action, as it does not address the client's wishes or involve them in the decision-making process. The nurse should not assume that the spouse has the authority to make decisions for the client, unless there is evidence of a durable power of attorney for health care.

C) Notify the health care provider of the spouse's request. - This is an incorrect action, as it does not respect the client's autonomy or involve them in the decision-making process. The health care provider cannot change or revoke the DNR order without the client's consent, unless there is evidence of a court order or an advance directive that states otherwise.

D) Suggest the spouse to contact a lawyer to revoke the DNR order. - This is an incorrect action, as it does not respect the client's autonomy or involve them in the decision-making process. The spouse does not need a lawyer to revoke the DNR order, as long as the client is competent and able to communicate.

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.

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 empathize with the client's situation, but refuse to help them with their request to end their life by taking an overdose of medication. The nurse should explain that it is against their scope of practice and code of ethics to assist the client in ending their life, as this violates the principle of nonmaleficence, which states that nurses should do no harm or allow harm to occur.

Incorrect options:

A) "I understand that you are suffering, but I cannot help you with that. It is illegal and unethical for me to assist you in ending your life." - This is an incorrect response, as it does not show empathy or compassion for the client's situation. The nurse should not use legal or ethical terms that may sound harsh or judgmental to

the client.

B) "I respect your decision, but I cannot help you with that. It is against my personal and professional values to assist you in ending your life." - This is an incorrect response, as it does not show empathy or compassion for the client's situation. The nurse should not use personal or professional values that may sound biased or insensitive to

the client.

D) "I appreciate your honesty, but I cannot help you with that. It is against my moral and religious beliefs to assist you in ending your life." - This is an incorrect response, as it does not show empathy or compassion for the client's situation. The nurse should not use moral or religious beliefs that may sound intolerant or disrespectful to

the client.