A hospice nurse is caring for a client who has 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 D
a. Continuing both medications may exacerbate the somnolence and difficulty arousing experienced by the client. It's essential to address the adverse effects promptly.
b. NSAIDs are not typically the first choice for severe pain management in terminal illness, especially when opioids are already prescribed. Moreover, replacing the opioid with an NSAID may not adequately address the pain.
c. Administering the benzodiazepine alongside the opioid may further potentiate the sedative effects and worsen the client's condition.
d. This is the most appropriate action. Withholding the benzodiazepine can help mitigate the sedation while continuing the opioid ensures ongoing pain relief for the client's comfort without introducing additional sedating medications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. “The client is in radiology department for a chest x-ray” Rationale:
a. The client's location in the radiology department is pertinent information for the oncoming nurse as they have to account for the patient’s whereabouts.
b. While family involvement is important, the timing of the partner's visit is not essential information for the oncoming nurse unless there were significant developments during the visit. c. This is expected of nursing practice.
d. The client's occupation or social status is not relevant to the immediate care needs and should not typically be included in a change-of-shift report.
Correct Answer is C
Explanation
a. Assault: Assault is the threat of harm to another individual, such as threatening to administer the injection against the client's will. However, since the nurse actually administers the injection, it does not constitute assault.
b. Libel: Libel refers to a false statement that is written and published, which is not relevant in this scenario.
c. Battery: Battery involves the unauthorized or harmful physical contact with another individual, such as administering the injection without the client's consent.
d. False imprisonment: False imprisonment occurs when an individual is unlawfully restrained or confined. While the client's movement may be restricted by administering the injection, the primary issue here is the unauthorized physical contact, making battery the more appropriate choice.
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