A hospice nurse is caring for a client who has a terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?
Continue the medication dosages that relieve the client’s pain
Contact the provider about replacing the opioid with an NSAID
Administer the benzodiazepine but withhold the opioid
Withhold the benzodiazepine but continue the opioid
The Correct Answer is A
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.
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Correct Answer is C
Explanation
a. Document in the client’s chart that an incident report has been filed:
Documenting that an incident report has been filed is an important step in the process of addressing the client's complaint. It ensures that there is a record of the incident and initiates the appropriate follow-up procedures.
b. Call risk management to interview the client:
In long-term care facilities, risk management departments are responsible for investigating incidents and ensuring that appropriate measures are taken to prevent future occurrences. In this situation, involving risk management may be necessary to conduct a thorough investigation.
c. Contact the nurse manager:
The nurse manager is responsible for overseeing the nursing staff and ensuring that quality care is provided to clients. Contacting the nurse manager allows for immediate notification of the incident and enables them to initiate the appropriate steps to address the situation.
d. Reassure the client that the staff is well trained:
While it's important to provide reassurance to the client, simply reassuring them without taking any further action may not adequately address their concerns or prevent similar incidents from occurring in the future.
Correct Answer is D
Explanation
a. Compromising:
Compromising involves finding a middle ground or mutually acceptable solution where both parties give up something to reach an agreement. It requires each party to make concessions to meet halfway and resolve the conflict. This approach aims to achieve a quick resolution by accommodating the needs and concerns of both sides to some extent.
b. Collaborating:
Collaborating involves working together cooperatively to find a solution that satisfies the interests and concerns of all parties involved. It requires open communication, active listening, and joint problem-solving to achieve a consensus and reach a win-win outcome. This approach values mutual respect, trust, and cooperation among team members, emphasizing shared decision-making and collective ownership of the resolution.
c. Cooperating:
Cooperating involves willingly assisting or supporting others to achieve a common goal or resolve a conflict. It emphasizes teamwork, mutual support, and shared efforts to address challenges or differences constructively. This approach promotes harmony, unity, and a supportive environment where individuals work together toward shared objectives.
d. Competing:
Competing, also known as forcing or dominating, involves pursuing one's own interests or preferences at the expense of others' concerns or viewpoints. It prioritizes assertiveness and control, with the goal of achieving one's desired outcome without considering the needs or perspectives of others. This approach can lead to conflict escalation, resentment, and strained relationships, as it disregards collaboration and mutual understanding in favor of imposing one's will.
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