A client with emphysema who is receiving a bronchodilator reports to the practical nurse (PN) feelings of jitters and dry mouth. Which finding should the PN record as a measure of the medication’s effectiveness?

Choice A reason: Rivaroxaban, a direct oral anticoagulant, inhibits factor Xa, increasing bleeding risk. Bruising on arms and legs may indicate excessive anticoagulation, potentially leading to severe hemorrhage. Immediate reporting is critical to assess bleeding risk, adjust dosing, or initiate interventions to prevent life-threatening complications.

Choice B reason: Genital itching and burning with discharge suggest a possible infection or allergic reaction, not a direct adverse effect of rivaroxaban. These symptoms are unrelated to its anticoagulant mechanism, which primarily affects hemostasis, making this choice incorrect for immediate reporting.

Choice C reason: Diminished taste and smell are not recognized side effects of rivaroxaban. These symptoms may relate to other conditions, like neurological or infectious issues, but do not reflect the drug’s anticoagulant effects. This choice is irrelevant to rivaroxaban’s adverse effect profile.

Choice D reason: Hard, dry stools indicate constipation, a non-urgent side effect not typically associated with rivaroxaban. While gastrointestinal issues may occur, bleeding risks are more critical. This symptom does not warrant immediate reporting compared to bruising, which signals potential hemorrhage.

Choice A reason: Increasing pain before the next opioid dose suggests inadequate analgesia, possibly due to tolerance or disease progression. Consulting the charge nurse facilitates dosage adjustment or schedule changes, ensuring effective pain control in terminal cancer, where maintaining comfort is critical for quality of life.

Choice B reason: Notifying the provider that the dosage has been increased is incorrect, as the PN cannot unilaterally adjust controlled substances. Pain management requires collaboration, and premature notification without consultation risks legal and clinical errors, making this choice inappropriate.

Choice C reason: Withholding opioid doses risks uncontrolled pain, which is unethical in terminal cancer care. The client’s increasing pain indicates a need for dosage review, not cessation, as opioids are essential for palliation, making this choice harmful and contrary to care goals.

Choice D reason: Administering opioids only when pain exceeds 5 is arbitrary and delays relief. Breakthrough pain before scheduled doses requires proactive dosage or interval adjustments, not reactive thresholds, to maintain consistent analgesia, making this choice inadequate for managing terminal cancer pain.