A nurse is caring for a client who has a prescription for metoprolol. The nurse measures the client's vital signs and notes that the client's apical heart rate is 49/min. The nurse should prepare to administer which of the following medications?

(A) Increase the heat in the client’s room: Increasing the heat in the client’s room is not typically recommended for a client experiencing dyspnea. Heat can sometimes make breathing more difficult, and it does not address the underlying cause of the dyspnea.

(B) Perform nasotracheal suctioning for the client: Nasotracheal suctioning can be used to clear the airway in certain situations, but it is not typically the first-line treatment for dyspnea in a client at the end of life. It can be uncomfortable and distressing for the client.

(C) Place the head of the client’s bed flat: Placing the head of the bed flat can actually make breathing more difficult for a client experiencing dyspnea. It is generally more helpful to elevate the head of the bed to facilitate easier breathing.

(D) Administer an opioid narcotic to the client: This is the most appropriate answer. Opioid narcotics can help to relieve dyspnea in clients at the end of life by reducing anxiety, decreasing the sensation of breathlessness, and improving the client’s overall comfort level. The use of opioids in this context should be carefully monitored to manage potential side effects.

(A) Increased bowel sounds
At the end of life, decreased bowel sounds or even absent bowel sounds are more common due to reduced gastrointestinal activity as the body begins to shut down. Increased bowel sounds are not typically expected.

(B) Hypertension
Hypertension is not typically expected at the end of life. Instead, hypotension (low blood pressure) is more common as the heart and other systems begin to fail.

(C) Moist mucous membranes
At the end of life, mucous membranes are often dry due to decreased fluid intake and systemic dehydration. Moist mucous membranes would not be an expected finding.

(D) Mottled skin
Mottled skin is a common and expected finding at the end of life. It occurs as circulation diminishes and the skin takes on a blotchy, purplish appearance, typically starting in the extremities and moving centrally. This is a sign that the body is shutting down and approaching death.