A client with chronic back pain is scheduled to begin transcutaneous electrical nerve stimulation (TENS) therapy. The nurse explains that the electrical sensation produced by the TENS unit will most likely feel like:

Administering opioids to a terminally ill client with moderate to severe pain is both appropriate and ethical. At the end of life, the priority is comfort and pain relief, not concerns about long-term side effects such as addiction. Opioids are effective and commonly used to manage cancer pain and palliative symptoms, improving the quality of the client’s remaining life.

Rationale for Correct Answer:

C. Is an appropriate nursing action: Providing opioids for pain control is consistent with palliative and hospice care goals. Nurses play a vital role in relieving suffering and promoting dignity during the dying process.

Rationale for Incorrect Answers:

A. May cause addiction: In terminal care, addiction is not a concern. The focus is on adequate symptom management and comfort.

B. Will probably be ineffective: Opioids are among the most effective agents for managing moderate to severe pain, especially in cancer or end-of-life scenarios.

D. Will likely hasten the client’s death: When used correctly and titrated to pain, opioids do not hasten death. This myth is a common barrier to effective pain management.

Key Takeaways:

• Opioid use in terminally ill clients is safe, appropriate, and essential for comfort.
• Concerns about addiction or hastening death should not interfere with adequate pain control.
• The nurse’s role includes advocating for and administering pain relief in alignment with palliative care goals.

Patient-controlled analgesia (PCA) is a method that allows clients to self-administer small doses of opioid medication to manage pain. It provides a safe, controlled, and timely approach to pain relief. It is essential that clients understand how to use the PCA appropriately and recognize when to notify the nurse if the pain is not being effectively controlled.

Rationale for Correct Answer:

C. “I should tell the nurse if the pain doesn’t stop after I use this device.”: This shows appropriate understanding that PCA is intended to relieve pain, and persistent pain may require dose adjustment or reassessment by the healthcare team.

Rationale for Incorrect Answers:

A. “I’ll wait to use the device until it’s absolutely necessary.”: PCA works best when used early and consistently at the onset of pain. Waiting until pain becomes severe makes it harder to control.

B. “I’ll be careful about pushing the button so I don’t get an overdose.”: PCA devices have built-in safety limits (lockout intervals) to prevent overdose. This statement reflects unnecessary fear that may lead to underuse.

D. “I will ask my son to push the dose button when I am sleeping.”: This is unsafe and contraindicated. Only the client should activate the PCA to prevent oversedation or respiratory depression, a practice known as “PCA by proxy” is never appropriate.

Key Takeaways:

• Clients should notify the nurse if PCA is not relieving pain adequately.
• Only the client should press the PCA button to ensure safe use.
• PCA should be used proactively, not delayed until pain becomes severe.