A client is requesting medicine for pain 30 minutes after receiving morphine sulfate 5 mg intravenously. Which intervention should the nurse implement next?

Ask the UAP to offer a backrub to the client.

Reassess the client and the level of pain.

Tell the client the medication needs more time to work.

Encourage the client to focus on taking deep breaths.

Answer and Explanation

The Correct Answer is B

A. Asking a UAP to offer a backrub is not appropriate if the pain assessment indicates that the current pain management strategy is insufficient. The nurse needs to reassess the pain to determine the effectiveness of the medication and whether additional interventions are needed.
B. Reassessing the client and the level of pain is essential to evaluate the effectiveness of the morphine sulfate administered and to guide further pain management decisions. This step is crucial for understanding the client's current pain status and determining the next steps in pain management.
C. Telling the client that the medication needs more time to work does not address the client's immediate concern or pain relief. Reassessing pain and potentially adjusting the treatment plan is more appropriate.
D. Encouraging deep breathing may help with pain management but does not address the need for further assessment of the pain level or potential adjustment in medication. Reassessing pain is the priority.

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Correct Answer is A

Explanation

A. Acknowledging that this is a difficult time for the mother is empathetic and supportive. It provides an opportunity for the mother to express her feelings and concerns without placing blame, which can be helpful in managing emotional distress.
B. While reassuring the mother that she did nothing wrong is important, it does not fully address her emotional needs or allow her to express her feelings. It may be perceived as dismissive if not accompanied by empathy.
C. Reassuring the mother about the outcome of surgery is important, but it does not address the emotional impact of her feelings of guilt or responsibility.
D. Asking why the mother thinks it is her fault may not be as supportive or helpful as providing empathy and reassurance. It could potentially lead to further distress rather than addressing the emotional support she needs.

A. Consult the palliative care team about the client's care. B. Set up a family conference to discuss the client's wishes. C. Discuss with the client her meaning of heroic measures. D. Obtain a "do not resuscitate" (DNR) prescription.

Correct Answer is C

Explanation

A. While consulting the palliative care team is appropriate for end-of-life care, it is essential first to clarify the client's understanding and wishes regarding "heroic measures" to ensure her preferences are fully understood and respected.
B. Setting up a family conference is important for discussing the client’s wishes with her loved ones, but this should occur after the nurse understands the client's specific desires.
C. The nurse should first discuss with the client what she means by "heroic measures" to ensure that her wishes are clearly understood. This conversation is essential to ensure that any subsequent actions, such as obtaining a DNR order, align with the client’s specific wishes.
D. A DNR prescription is an important step in respecting the client's wishes, but it should only be obtained after confirming exactly what the client means by "heroic measures" and ensuring that she fully understands the implications of a DNR order.

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A client is requesting medicine for pain 30 minutes after receiving morphine sulfate 5 mg intravenously. Which intervention should the nurse implement next?

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