# Place the nursing actions in order for a hospice client who develops distressing shortness of breath.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395540&lang=en  
> language: en  
> subject: Nonpharmacological Comfort  
> category: BCC

## Question

Place the nursing actions in order for a hospice client who develops distressing shortness of breath.

Raise the head of the bed, support the arms, loosen restrictive clothing, and reduce exertion

Stay with the client and assess dyspnea severity, respiratory effort, distress, goals, and reversible comfort barriers

Administer prescribed symptom-relief medication and oxygen when included in the plan or indicated for hypoxemia

Reassess comfort and adverse effects, document the response, and teach the caregiver whom to call if distress persists

Use a cool fan toward the face, provide calm brief coaching, and offer frequent gentle mouth care

## Explanation

First remain present and assess the symptom in the context of the client's goals. Position upright and reduce effort, then add simple nonpharmacological comfort measures. Give prescribed medication and oxygen according to the plan and clinical indication. Reassess the client's comfort and the caregiver's ability to continue the plan.

## In-depth explanation

Correct sequence
Assess distress and goals → position and conserve energy → fan, calm coaching, and mouth care → prescribed medication or oxygen → reassess comfort and support the caregiver.

Why this is correct
At end of life, the outcome is the client's comfort, not a normal monitor value at any cost. Upright positioning, airflow, reduced exertion, mouth care, and prescribed therapy can be combined while the nurse remains present and watches for burden or adverse effects.

NCLEX decision rule
Confirm goals, relieve distress with the least burdensome effective measures, and judge success by the client's response.References
1CMS Hospice and End-of-Life Critical Element Pathway
2NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Goal-concordant comfort care
The client is awake, has a comfort-focused plan, and does not want hospital transfer. Prescribed symptom-relief medications are available. Follow the individualized hospice plan and reassess the client's expressed comfort.

## Key concepts

- **Goal-Concordant Care** — Care whose interventions and burdens align with the informed values and treatment goals of the client.
- **Dyspnea** — A subjective experience of uncomfortable or difficult breathing that may not match a single oxygen value.
- **Energy Conservation** — Reducing unnecessary activity and supporting posture to lower work and symptom burden.

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