# A nurse is supporting a family meeting where the medical team is discussing transition to comfort-focused care for a client with metastatic cancer and worsening multi-organ failure. Which nursing actions reflect best practice? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374987&lang=en  
> language: en  
> subject: Basic Care and Comfort  
> category: BCC

## Question

A nurse is supporting a family meeting where the medical team is discussing transition to comfort-focused care for a client with metastatic cancer and worsening multi-organ failure. Which nursing actions reflect best practice? Select all that apply.

1

Allow silence after difficult information and avoid filling pauses with reassurance

2

Offer a chaplain or spiritual care referral aligned with the family preferences

3

Use a certified medical interpreter rather than a family member to translate

4

Document specific symptom-management goals and decision-maker as agreed

5

Tell the family that any continued aggressive treatment would be futile and unethical

## Explanation

Goals-of-care meetings require a certified interpreter (family interpreters introduce bias and emotional burden), comfort with silence so families can process, clear documentation of decision-maker and symptom goals, and offering culturally-aligned spiritual care. Telling the family that continued treatment is futile or unethical is judgmental and undermines shared decision-making — the team explores values, prognosis, and trade-offs, then recommends a plan.

## In-depth explanation

Use SPIKES or NURSE statements: Name the emotion, Understand, Respect, Support, Explore. Avoid premature reassurance and value-laden labels like futile.

## Clinical scenario

Client unable to participate; designated health care proxy is present with three adult children. Spanish primary language; certified medical interpreter on phone.

## Key concepts

- **goals of care** — Patient-centered framework aligning treatment with values and prognosis.
- **palliative care** — Specialty focused on serious-illness symptom management and quality of life at any stage.
- **health care proxy** — Designated decision-maker when the client lacks capacity.

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