A home health nurse is verifying a client's prescribed medications and notes that one medication dose was decreased by half. The client asks the nurse if they can cut the tablets in half. Which of the following actions should the nurse take?

Rationale:

A. Remind the client to eat scheduled meals daily.: As clients near the end of life, appetite naturally decreases due to metabolic changes and reduced physiologic demand. Encouraging scheduled meals can create discomfort or distress and does not improve outcomes. Supportive care focuses on comfort rather than forcing nutritional intake.

B. Place the client in a supine position.: A supine position can worsen respiratory effort, increase the sensation of breathlessness, and promote secretion pooling. Terminal clients often breathe more comfortably in semi-Fowler’s or side-lying positions, which help ease ventilation and support comfort-based care.

C. Offer the client a blanket to keep warm.: Clients at the end of life commonly experience decreased body temperature due to reduced circulation and metabolic slowing. Gently providing a blanket supports comfort without invasive measures. Maintaining warmth helps ease physical distress and aligns with palliative goals focused on dignity and relief.

D. Speak in a loud tone when addressing the client.: Hearing is often the last sense to diminish, so speaking loudly is unnecessary and may startle or distress the client. A calm, soft voice preserves a peaceful environment and promotes emotional comfort, supporting both the client and family during end-of-life care.

Rationale:

A. Check the client for indications of bleeding: The priority action following a heparin overdose is to assess the client for signs of active or internal bleeding, such as hematuria, melena, bruising, or hypotension. Immediate assessment guides urgent interventions to prevent life-threatening complications.

B. Monitor the client's aPTT levels: Monitoring aPTT is important to evaluate the anticoagulant effect and guide treatment, but it is secondary to assessing for actual bleeding. Assessment of clinical signs takes precedence over laboratory monitoring in urgent situations.

C. Complete an incident report: Documenting the medication error is necessary for legal and quality improvement purposes, but it is not the first action. Patient safety and immediate clinical assessment come before reporting.

D. Notify the risk manager: Informing the risk manager is part of the incident reporting process, but addressing the client’s immediate safety needs comes first. Notification can occur after urgent assessment and stabilization.