A hospice nurse is caring for a patient who has terminal cancer and is receiving hospice care for stage 4 metastatic breast cancer.
The patient experiences excruciating pain and is scheduled for morphine 10mg IM every 6 hours. The patient is sleeping, and the medication is due.
What action should the nurse take?
Hold the pain medication until the patient wakes up.
The patient should be given the scheduled pain medication.
Call the family and ask if the patient would like to be woken up to have their pain medication.
The patient has become addicted to the medication and is sleeping the last dose off.
The Correct Answer is B
Choice A rationale
Holding the pain medication until the patient wakes up is not the best choice. Pain can disrupt sleep, and it’s important to keep the patient as comfortable as possible. If the patient is sleeping, it may be because the pain is well-controlled, and delaying the medication could lead to a return of pain.
Choice B rationale
The patient should be given the scheduled pain medication. This is the best choice because it ensures that the patient’s pain is managed effectively. Even if the patient is sleeping, the medication should be given to prevent the pain from returning.
Choice C rationale
Calling the family and asking if the patient would like to be woken up to have their pain medication is not the best choice. The nurse should make this decision based on the patient’s pain level and the medication schedule, not on the family’s preferences.
Choice D rationale
The statement that the patient has become addicted to the medication and is sleeping the last dose off is not accurate. Addiction is a complex condition characterized by compulsive drug use despite harmful consequences. In this case, the patient is receiving the medication for a legitimate medical reason, and there is no indication of addiction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
While the thickness of the tympanic membranes can indeed change with age, it typically increases rather than decreases. Thickening of the tympanic membranes can contribute to hearing loss by reducing the ability of the ear to transmit sound vibrations.
Choice B rationale
Tinnitus, or ringing in the ears, is not typically decreased in older adults. In fact, tinnitus is often more common in older individuals and can be a sign of age-related hearing loss.
Choice C rationale
A decreased ability to hear high-frequency sounds is a common physiological change associated with aging. This is often one of the first signs of age-related hearing loss.
Choice D rationale
Decreased ear wax is not typically associated with aging. In fact, some older adults may produce more ear wax, which can contribute to hearing problems if it becomes impacted.
Correct Answer is D
Explanation
Choice A rationale
Skeletal muscles do not enable the heart to contract with each heartbeat. The heart has its own specialized muscle tissue known as cardiac muscle, which allows it to contract and pump blood throughout the body.
Choice B rationale
Skeletal muscles do not enable the bladder to contract during voiding. The detrusor muscle, a smooth muscle found in the wall of the bladder, contracts during urination to expel urine from the body.
Choice C rationale
Skeletal muscles do not enable the bronchioles to dilate in the lungs. The dilation and constriction of the bronchioles are controlled by the autonomic nervous system and the smooth muscles in the walls of the bronchioles.
Choice D rationale
Skeletal muscles do enable a hand to contract and form a fist. Skeletal muscles are responsible for all voluntary movements, including making a fist. When you want to make a fist, your brain sends a signal to the skeletal muscles in your hand and forearm, telling them to contract. This pulls on the tendons connected to your fingers, causing them to move and form a fist.
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