A nurse is caring for a client who is near death. Which of the following actions should the nurse take?
Administer scheduled pain medications.
Provide oral care every 6 hr.
Administer liquids using a syringe.
Whisper when talking to family members.
The Correct Answer is A
A. Administer scheduled pain medications is appropriate because providing comfort is a priority in end-of-life care. Administering scheduled pain medications helps alleviate any discomfort or pain the client may be experiencing.
B. Providing oral care every 6 hr may not be necessary in the end-of-life stage, as the client's ability to tolerate oral care may decrease, and excessive oral care may cause discomfort.
C. Administering liquids using a syringe may not be appropriate if the client is unable to swallow or if there are concerns about aspiration.
D. Whispering when talking to family members is not necessary; instead, the nurse should communicate in a calm and clear manner, adjusting the volume and tone as needed to accommodate the client's condition and preferences.
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Related Questions
Correct Answer is C
Explanation
A. While reassurance is important, simply telling the client that she will adjust to changes to her body may minimize her concerns and not adequately address her emotional needs. It's important to offer support and provide resources to help the client cope with potential changes.
B. While an occupational therapist may be able to provide valuable support, their role may not specifically address the client's concerns about body image changes related to breast cancer treatment.
C. Reach to Recovery is a program offered by the American Cancer Society that connects newly diagnosed breast cancer patients with trained volunteers who have experienced breast cancer themselves. These volunteers can offer support, guidance, and practical tips for coping with the physical and emotional challenges of breast cancer diagnosis and treatment. Initiating a referral to this program can provide the client with valuable support from someone who has been through a similar experience.
D. While surgery may be an option for restoring the appearance of the breast, it may not fully address the client's concerns about potential changes to her body image. Additionally, not all breast cancer patients undergo surgery or choose reconstructive procedures, so it's important to provide support and resources regardless of the treatment chosen.
Correct Answer is D
Explanation
A. Tachycardia is not typically associated with opioid intoxication. Instead, bradycardia or normal heart rate may occur due to the depressant effects of opioids on the central nervous system.
B. Opioid intoxication often results in decreased mental alertness, leading to symptoms such as drowsiness, confusion, or even unconsciousness.
C. Hyperreflexia, or exaggerated reflexes, is not a common manifestation of opioid intoxication. Instead, hyporeflexia or depressed reflexes may occur due to the central nervous system depression caused by opioids.
D. Pinpoint pupils are a classic sign of opioid intoxication. Opioids bind to receptors in the brainstem, causing pupillary constriction. This effect is so characteristic that pinpoint pupils are often referred to as "opioid pupils."
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