A hospice nurse is caring for a client who has a fentanyl patch applied. The client appears restless and agitated. Which of the following actions should the nurse take?

A) "Refusing the injection means you will not get better."
This may increase the client's anxiety. It comes across as coercive and does not respect the client's autonomy. The statement implies that the client has no choice, which can cause distress and reduce trust in the healthcare provider. It fails to address the client's fear of needles and does not offer a solution or alternative.

B) "You should not feel anything more than a minor sting from the injection."
This dismisses the client's fear of needles, which can be a significant phobia for some individuals. It minimizes the client's feelings and does not acknowledge their concern. This response does not offer an alternative or involve the client in the decision-making process, which is important for their comfort and cooperation.

C) "We will discuss other treatment options with your provider."
This is respectful of the client's concerns and involves them in their care plan. It acknowledges the client's fear and offers to explore alternative treatments. This respects the client's autonomy and helps to build trust between the client and the healthcare provider. By involving the provider in the discussion, the nurse ensures that all potential options are considered, which may include oral antibiotics or other forms of treatment that the client may be more comfortable with.

D) "You must take this medication because there is no other option to treat this infection."
This suggests that the client has no choice, which can make the client feel powerless and increase their anxiety. There are often multiple treatment options for infections, including different routes of administration (oral, intravenous) or different medications. This response does not respect the client's autonomy or involve them in the decision-making process

Answer: B. Keep the solution refrigerated until 1 hr before infusion.

Rationale:

A) Obtain the client's weight three times a week: While monitoring weight is essential to assess fluid balance and nutritional status in clients receiving TPN, daily weight measurements are more appropriate to detect rapid changes.

B) Keep the solution refrigerated until 1 hr before infusion: TPN solutions should be refrigerated to prevent bacterial growth and maintain stability. Removing the solution from refrigeration 1 hour before infusion allows it to warm to room temperature, reducing the risk of discomfort during administration.

C) Change the solution every 36 hr: TPN solutions should be changed every 24 hours to minimize the risk of bacterial contamination and infection, especially since the high glucose content is a favorable medium for bacterial growth.

D) Check the client's WBC count daily: While monitoring for infection is vital, checking the WBC count daily is not a routine requirement unless the client shows signs of infection or complications. Regular temperature checks and observing for clinical signs of infection are usually sufficient.