A client with terminal cancer reports increasing pain that occurs 1 to 2 hours before the next scheduled dose of a prescribed opioid analgesic. Which action should the practical nurse (PN) implement?

Consult with the charge nurse about the need to increase the medication dosage

Notify the healthcare provider that the medication dosage has been increased

Withhold further doses of the medication until the healthcare provider is notified

Administer the medication when the report of pain exceeds 5 on a 0 to 10 scale

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is B

Explanation

Choice A reason: Stopping disulfiram for nausea or vomiting is incorrect, as these are expected in alcohol reactions, not side effects warranting discontinuation. Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde buildup if alcohol is consumed, leading to these symptoms, which reinforce alcohol avoidance.

Choice B reason: Avoiding all alcohol, including in cough syrups, is critical, as disulfiram causes severe reactions (flushing, nausea) by blocking acetaldehyde metabolism. Even small amounts trigger symptoms, reinforcing abstinence in alcohol dependence treatment, making this the most important instruction for safety and efficacy.

Choice C reason: Taking disulfiram at the same time daily promotes adherence but is less critical than avoiding alcohol, which directly prevents severe reactions. Consistency aids therapeutic levels, but alcohol exposure poses immediate health risks, making this instruction secondary.

Choice D reason: Weekly blood tests are not standard for disulfiram, as therapeutic levels are not routinely monitored, and sodium is unaffected. Liver function may be checked periodically, but alcohol avoidance is the priority to prevent acute reactions, making this choice incorrect.

A. Palpitations B. Nervousness C. Nausea D. Anorexia

Correct Answer is A

Explanation

Choice A reason: Palpitations may indicate electrolyte imbalances, like hypokalemia, a serious side effect of hydrochlorothiazide, a thiazide diuretic. It increases potassium excretion, disrupting cardiac electrical activity, potentially causing arrhythmias. Withholding the dose and notifying the provider is critical to prevent life-threatening cardiac complications, requiring urgent electrolyte assessment.

Choice B reason: Nervousness is a vague symptom not typically linked to hydrochlorothiazide’s side effects. It may reflect anxiety or other unrelated issues, not necessitating immediate drug cessation. Electrolyte imbalances or hypotension are more concerning, making this choice less urgent for withholding the medication.

Choice C reason: Nausea is a common, non-specific side effect of many medications, including hydrochlorothiazide, but is not severe enough to warrant withholding the dose. It may resolve or be managed symptomatically. More critical side effects, like electrolyte imbalances, take precedence, making this choice incorrect.

Choice D reason: Anorexia is not a primary concern with hydrochlorothiazide. While it may occur with diuretic-induced dehydration, it is less urgent than cardiac symptoms like palpitations. This symptom does not directly indicate a life-threatening side effect, so withholding the drug is not immediately necessary.

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A client with terminal cancer reports increasing pain that occurs 1 to 2 hours before the next scheduled dose of a prescribed opioid analgesic. Which action should the practical nurse (PN) implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) is reviewing the discharge medication instructions with a client for disulfiram. Which instruction should the PN reinforce with the client?

Correct Answer is B

Explanation

Which symptom reported by a client alerts the practical nurse (PN) to withhold a scheduled dose of hydrochlorothiazide and notify the healthcare provider?

Correct Answer is A

Explanation

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