A charge nurse is observing a licensed practical nurse assist a client who has dysphagia while eating. Which of the following actions by the LPN should the charge nurse identify as providing safe care?

a. Ask the client if she would like a sedative to help her relax:

Offering a sedative may not address the underlying reasons for the client's desire to leave. Moreover, administering a sedative without addressing the client's concerns or obtaining informed consent would not be appropriate.

b. Inform the client that she cannot leave without a discharge prescription from the provider:

While informing the client of the discharge process is important, presenting this information as a restriction may not be the most therapeutic approach. Additionally, in many healthcare settings, patients have the legal right to leave against medical advice, so presenting it as a requirement may not be accurate.

c. Have the client sign the Against Medical Advice form:

When a client decides to leave against medical advice, it is standard practice to have them sign an Against Medical Advice (AMA) form. This form documents the client's decision and acknowledges that they are leaving the hospital against the advice of the healthcare provider.

d. Assign a security officer to the client's room until the provider can speak with the client:

Assigning a security officer may be appropriate in situations where there are concerns for the safety of the client or others, such as if the client is agitated or threatening harm. However, in this scenario, the client has expressed a desire to leave, and assigning a security officer may escalate the situation unnecessarily.

A. Continue the medication dosages that relieve the client’s pain:
Opioids and benzodiazepines are commonly used for pain and anxiety management in terminally ill patients. Somnolence is an expected side effect and does not necessarily warrant withholding medication unless the client shows signs of respiratory depression.

B. Contact the provider about replacing the opioid with an NSAID: NSAIDs are not sufficient for severe pain in terminal illness. Opioids are the gold standard for palliative pain management, and switching to an NSAID would likely lead to uncontrolled pain and unnecessary suffering.

C. Administer the benzodiazepine but withhold the opioid: This would leave the client in severe pain, which is unethical in hospice care. Pain relief should not be withheld solely due to sedation.

D. Withhold the benzodiazepine but continue the opioid: Benzodiazepines are often used to relieve anxiety, dyspnea, and agitation in end-of-life care. Withholding it could cause increased distress for the client. Instead of discontinuing the medication, the nurse should monitor for respiratory depression and adjust doses only if necessary.