A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client's family wants the client to have life-sustaining measures. Which of the following actions should the nurse take?

Rationale:

A. Ketorolac: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal irritation and increase the risk of bleeding, especially in clients with a history of peptic ulcer disease. It should be avoided in this population.

B. Acetaminophen: Acetaminophen is the safest option for relieving headache in clients with a history of peptic ulcers because it lacks the gastrointestinal side effects associated with NSAIDs. It provides effective pain relief without increasing ulcer risk.

C. Ibuprofen: Ibuprofen, another NSAID, also carries a high risk of gastric irritation and peptic ulcer exacerbation. Chronic or even short-term use can worsen ulcers and lead to GI bleeding.

D. Aspirin: Aspirin has strong antiplatelet effects and is highly ulcerogenic. It increases the risk of gastric mucosal damage and should be avoided in clients with known peptic ulcer disease.

Rationale:

A. Place the client in a supine position: The supine position may impair respiratory function and increase discomfort, especially in terminal clients who may experience dyspnea. A semi-Fowler’s or side-lying position is often preferred for comfort and easier breathing.

B. Remind the client to eat scheduled meals daily: For clients nearing end of life, appetite naturally decreases, and forcing meals can cause distress. Care should focus on comfort, allowing the client to eat only if and when they desire rather than adhering to structured meal times.

C. Speak in a loud tone when addressing the client: Loud speech is not appropriate unless the client has documented hearing impairment. A calm, soft tone is more comforting and respectful, especially in the emotionally sensitive context of end-of-life care.

D. Offer the client a blanket to keep warm: Clients nearing the end of life often experience poor circulation and may feel cold. Providing a blanket is a comfort-focused, non-invasive intervention that promotes warmth and dignity during this phase.