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In malignant bowel obstruction where surgery is not feasible, symptom control focuses on reducing gastrointestinal secretions and edema and relieving nausea/vomiting. Octreotide (or lanreotide) decreases splanchnic secretions and NG output; dexamethasone reduces inflammatory edema and may transiently improve patency; antiemetics (haloperidol, olanzapine, serotonin antagonists) relieve nausea. NG decompression is useful acutely; a venting gastrostomy provides longer-term relief and discharge feasibility. Prokinetics like metoclopramide (Option A) can worsen colicky pain and are avoided in complete obstruction. TPN alone (Option C) does not palliate symptoms and is reserved for selected patients with potential for benefit. Declining to treat symptoms (Option D) is inconsistent with palliative goals; hospice can be combined with active symptom management. APRNs align plans with patient goals, address mouth care and fluid balance, manage opioids/anticholinergics for colic, assess for delirium due to dehydration/opioids, and coordinate home supports, ensuring frequent reassessment as disease evolves.

Any expression of suicidal ideation in cancer care warrants structured assessment of risk and protective factors. Using a validated tool (e.g., Columbia-Suicide Severity Rating Scale) helps stratify ideation, intent, plan, and means. Immediate actions include developing a safety plan (warning signs, coping strategies, crisis contacts), restricting access to lethal means (medications, firearms), and arranging urgent mental-health evaluation—same day if moderate risk, emergently if high risk or intent is present. Engage supportive others with the patient’s permission; ensure 24/7 crisis resources are provided. Pharmacotherapy alone without evaluation (Option C) is insufficient acutely. Reassurance and delay (Option A) risk harm. Involuntary hospitalization (Option D) is reserved for imminent danger when the patient refuses help; most can be managed collaboratively. APRNs should document the assessment, notify the oncology team, consider contributory factors (uncontrolled pain, delirium, depression), and address them in parallel. Regularly revisit safety, and coordinate with palliative care and psycho-oncology to integrate symptom control and counseling.