A hospice nurse is caring for a client who has a terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?

a. A client who is scheduled for an endoscopy later today and requires an enema:

Administering an enema involves basic nursing care, which falls within the scope of practice of an LPN. LPNs are trained to perform such tasks under the supervision of a registered nurse (RN).

b. A newly admitted client who has sickle cell anemia and requires the development of an initial plan of care:

Developing an initial plan of care involves comprehensive assessment, critical thinking, and the ability to formulate nursing diagnoses and interventions. This task typically falls within the scope of practice of the RN, who has advanced education and training in care planning and coordination.

c. A client who had a myocardial infarction and will be transferring to the unit from the CCU:

Transferring a client from one unit to another may involve coordinating care, ensuring continuity of care, and communicating with other members of the healthcare team. This task may be more appropriate for an RN, who has the knowledge and skills to manage such transitions safely and effectively.

d. A newly admitted client who has diabetes mellitus and requires initial teaching on self-administration of insulin:

Providing client education, especially on self-care management such as insulin administration, requires knowledge of disease processes, medication administration, and patient teaching techniques. This task is typically within the scope of practice of the RN, who can assess the client's learning needs, provide tailored education, and evaluate the client's understanding and competency.

a. "If you have the procedure now, you won’t have to deal with pain and disability later."

This response dismisses the client's concerns about pain and focuses solely on the potential benefits of the surgery. It fails to address the client's apprehension and does not provide support or empathy. Furthermore, it oversimplifies the situation and may come across as dismissive of the client's feelings.

b. “I understand, and it’s not too late to change your mind.”

This response demonstrates empathy and validation of the client's concerns. It acknowledges the client's autonomy and gives them the option to reconsider without judgment or pressure. It encourages open communication between the nurse and the client, fostering a supportive environment.

c. “Why didn’t you discuss your concerns with your provider?”

This response may come across as accusatory or blaming, which can further distress the client. It does not offer immediate support or validation of the client's concerns. While discussing concerns with the provider is important, this response fails to address the client's immediate distress and need for reassurance.

d. “You’ll be fine. You’ll receive a prescription for pain medication.”

This response minimizes the client's concerns by reassurance without addressing the underlying issue. It also assumes that pain medication will resolve all concerns related to pain, which may not be the case for the client. Additionally, it overlooks the client's emotional needs and autonomy in decision-making.