A hospice nurse is caring for a client who has a terminal illness. Which of the following client statements should the nurse identify as an indication that the client is experiencing the bargaining stage of grief?

A. The formula infusion rate of the feeding was too slow: A slow infusion rate generally decreases the risk of diarrhea because the gastrointestinal tract has more time to absorb nutrients. Rapid administration is more commonly associated with osmotic diarrhea due to overwhelming intestinal absorption capacity, so a slow rate is an unlikely cause.

B. The formula was given immediately following removal from the refrigerator: Cold formula can irritate the gastrointestinal mucosa and disrupt normal digestive enzyme activity, leading to increased motility and diarrhea. Allowing the formula to reach room or body temperature before administration helps reduce gastric upset and osmotic diarrhea.

C. The feeding tube was partially obstructed during the infusion: Partial obstruction typically slows or interrupts the flow of formula, which may cause bloating or nausea but does not usually result in diarrhea. The decreased delivery rate reduces intestinal osmotic load rather than triggering loose stools.

D. The client is experiencing delayed gastric emptying: Delayed gastric emptying slows the passage of formula into the small intestine, which can cause nausea, vomiting, or reflux, but it does not commonly cause diarrhea. Diarrhea is more associated with rapid gastric emptying or malabsorption rather than delayed emptying.

A. Ask the client whether they have advance directives: Upon admission, the nurse is responsible for determining whether the client has completed any advance directives, such as a living will or durable power of attorney for health care. Directly asking the client ensures accurate, up-to-date information and respects client autonomy.

B. Refer to the client's identification card for their advance directives status: An identification card may indicate the existence of an advance directive, but it does not confirm current validity or specific wishes. Relying solely on an ID card does not ensure that documentation is available or accurately reflects the client’s present decisions.

C. Verify the client's advance directives with their health care surrogate: Contacting the health care surrogate is not the first step if the client is competent and able to communicate. The client remains the primary decision-maker unless deemed incapacitated. Verification with a surrogate is appropriate only when the client cannot provide information.

D. Check for a written do-not-resuscitate prescription in the client's medical record: A do-not-resuscitate (DNR) order is only one type of directive and may not reflect the presence of a broader advance directive. Additionally, a DNR must be written as a provider order and may not exist at admission even if the client has other advance directives in place.