A client who has a terminal illness and is receiving hospice care at home has a prescription for morphine sulfate 10 mg PO every 4 hr PRN for pain. The client's family member tells the nurse that the client is experiencing increased pain and asks if he can give him more morphine.
Which of the following responses should the nurse make?
"Yes, you can give him more morphine, but only if his respiratory rate is above 12 breaths/min."
"No, you cannot give him more morphine, because it can cause respiratory depression and hasten his death."
"Yes, you can give him more morphine, but you need to call the hospice nurse first to get an order for a higher dose."
"No, you cannot give him more morphine, because he may develop tolerance and dependence on the drug."
The Correct Answer is C
The nurse should instruct the family member to call the hospice nurse first to get an order for a higher dose of morphine, if needed. The hospice nurse can assess the client's pain level, vital signs, and response to the medication, and adjust the dose accordingly.
Option A is incorrect because although respiratory rate is one of the factors to monitor when administering opioids, it is not the only one; other factors include level of consciousness, oxygen saturation, and presence of adverse effects. Moreover, the family member should not increase the dose of morphine without consulting the hospice nurse.
Option B is incorrect because although respiratory depression is a potential side effect of opioids, it is not a common cause of death in clients receiving palliative care; rather, opioids are considered safe and effective for managing pain and dyspnea in dying clients, as long as they are prescribed and administered appropriately.
Option D is incorrect because tolerance and dependence are not major concerns in clients receiving palliative care; rather, the goal is to provide adequate pain relief and comfort for the client.
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Correct Answer is D
Explanation
The nurse should continue to provide comfort measures and emotional support to the client, as well as respect his DNR order, which means that no resuscitation measures should be attempted if he experiences cardiac or respiratory arrest.
Option A is incorrect because initiating CPR and calling a code blue would violate the client's DNR order and his right to refuse treatment.
Option B is incorrect because administering oxygen via nasal cannula may be considered a form of resuscitation, depending on the client's wishes and goals of care; moreover, monitoring his vital signs may not be necessary or beneficial at this stage of his illness. Option C is incorrect because notifying the health care provider and the client's family of his status may not be a priority at this time; rather, the nurse should focus on providing compassionate care to the client until he dies.
Correct Answer is B
Explanation
End-of-life care is based on the ethical principles of beneficence (doing good) and nonmaleficence (doing no harm), which guide the health care team in providing compassionate and respectful care that alleviates suffering and promotes dignity for dying clients.
Option A is incorrect because end-of-life care can be provided in various settings, such as hospitals, nursing homes, or home health agencies, depending on the client's needs and preferences.
Option C is incorrect because informed consent is not required for end-of-life care; however, it may be needed for specific treatments or procedures that are part of end-of-life care, such as pain medication, blood transfusions, or organ donation.
Option D is incorrect because end-of-life care does not necessarily include interventions such as artificial nutrition and hydration, which may be considered futile or burdensome for some clients; rather, the decision to use or withhold these interventions should be based on the client's wishes, values, and goals of care.
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