A hospice nurse is caring for a client who has 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?
Continue the medication dosages that relieve the client’s pain
Contact the provider about replacing the opioid with an NSAID
Administer the benzodiazepine but withhold the opioid
Withhold the benzodiazepine but continue the opioid
The Correct Answer is D
a. Continuing both medications may exacerbate the somnolence and difficulty arousing experienced by the client. It's essential to address the adverse effects promptly.
b. NSAIDs are not typically the first choice for severe pain management in terminal illness, especially when opioids are already prescribed. Moreover, replacing the opioid with an NSAID may not adequately address the pain.
c. Administering the benzodiazepine alongside the opioid may further potentiate the sedative effects and worsen the client's condition.
d. This is the most appropriate action. Withholding the benzodiazepine can help mitigate the sedation while continuing the opioid ensures ongoing pain relief for the client's comfort without introducing additional sedating medications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
a. Droplet precautions require healthcare workers to wear a surgical mask when within 3 feet of the client to prevent the transmission of respiratory droplets containing infectious agents like influenza.
b. While high-efficiency particulate air (HEPA) filtration systems can help improve air quality, they are not specifically required for implementing droplet precautions.
c. N95 respirators are typically reserved for airborne precautions, which are not indicated for influenza.
d. Assigning the client to a room with positive airflow is not necessary for implementing droplet precautions; standard precautions such as wearing a surgical mask are sufficient.
Correct Answer is B
Explanation
a. This response may come across as dismissive of the client's concerns and may not address the client's anxiety about pain adequately.
b. This response validates the client's feelings, acknowledges that it's okay to change their mind, and opens the door for further discussion or exploration of alternatives.
c. This response may sound accusatory and may not effectively address the client's immediate concerns.
d. This response does not address the client's worries about pain and may minimize their concerns.
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