A patient with metastatic cancer on a palliative care unit shows rapid pulse, mottled skin, labored breathing, and profuse perspiration. What is the nurse's most important action?

• A. Administer oxygen and monitor
• B. Call the physician and notify the family to be with her
• C. Begin CPR
• D. Increase analgesia

Answer: (B)

Imminent death in a palliative care setting calls for comfort-focused care and support for the patient and family. The signs described—rapid pulse, mottled skin, labored breathing, and profuse perspiration—signal that death is near. The nurse’s priority is to involve the physician to discuss goals of care and to prepare for the end-of-life transition, while encouraging the family to be present to provide comfort and support. Initiating resuscitation would not align with the goals in this context, as it would likely be futile and could cause additional distress.