45-year-old client with breast cancer which has metastasized is receiving hospice care. Client is at home and family is concerned about their loved one. The nurse determines the client is near death as evidenced by
1. Decreased Muscle tone, relaxed jaw muscles, sagging mouth.
2. Urine Output is clear yellow
3. Altered breathing (apnea, labored or irregular breathing, Cheyne-stokes pattern)
4. Decreased muscle tone, relaxed jaw muscles, sagging mouth