PrepU Quiz 14

A medical nurse is providing end-of-life care for a client with metastatic bone cancer. The nurse notes that the client has been receiving oral analgesics for pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?

Request the health care provider to prescribe analgesics by an alternative route. A change in medication route is indicated and must be made by a health care provider's prescription. Many pain medications cannot be crushed and given to a client. Giving the medication with a meal is not going to make it any easier to swallow. Rectal administration may or may not be an option.

Which of the following assessment tools will be most effective when assessing for pain in a four-year-old client?

A FACES scale FACES scales are best for assessing pain in very young clients because these scales use pictures and short descriptive phrases. Although a numeric scale, a word scale, or a linear scale may be used, a child may find them difficult to understand.

Which is a sign of approaching death?

Irregular breathing patterns Irregular breathing patterns are a sign of impending death. Other signs of approaching death include decreased urinary output, mental confusion, and sleeping for longer periods of time.

A client has been using NSAIDs daily over an extended period. Which of the following effects should the nurse carefully monitor for in this client?

Gastrointestinal bleeding NSAIDs when used daily over an extended period may cause undesirable side effects such as gastrointestinal bleeding. Use of analgesics does not increase the risk for developing cardiac disorders, urinary tract infections, or hypothyroidism.

Which of the following nursing interventions is appropriate with regard to pain control in the dying client?

Give pain medications on a routine schedule. The nurse usually gives pain medication on a routine schedule around the clock to avoid causing intense discomfort followed by a period of heavy sedation. Morphine may be used. Oxygen eventually may be used.

Which intervention is appropriate for a nurse caring for a client in severe pain receiving a continuous I.V. infusion of morphine?

Obtaining baseline vital signs before administering the first dose The nurse should obtain the client's baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using an opioid antagonist, not an opioid agonist. The nurse shouldn't discontinue an opioid agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.

The nurse is admitting a 52-year-old father of four into hospice care. The client has a diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear his preference to receive care at home. What intervention should the nurse prioritize in the plan of care?

Supporting the client's and family's values and choices Nurses need to develop skill and comfort in assessing clients' and families' responses to serious illness and planning interventions that support their values and choices throughout the continuum of care. To be admitted to hospice care, the client must have come to terms with the fact that he is dying. The scenario states that the client wants to be cared for at home, not in a long-term care setting. The children may be able to participate in their father's care, but they should not be assigned responsibility for planning it.

When a client who has been taking opioids becomes less sensitive to the drug's analgesic properties, that client is said to have developed a(n)

Tolerance Tolerance is a normal response that occurs with regular administration of a drug and is characterized by the need for higher doses to maintain the same level of pain relief. Addiction refers to a behavioral pattern of substance use characterized by a compulsion to take the drug primarily to experience its psychic effects. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued. Balanced analgesia occurs when the client is using more than one form of analgesia concurrently to obtain more pain relief with fewer side effects.

During unplanned, spontaneous moments, dying clients usually discuss fears or concerns that nurses should not ignore or rush. What is the nurse's best response in such situations?

Communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact. The nurse can communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact. Nodding, responsive comments such as "Yes" or brief periods of silence encourage the client to continue verbalizing. Calling out to the client's family members and asking them to sit next to the client may not be the best intervention. It is important for nurses to be flexible and to interrupt physical care if and when the client indicates a need for companionship, support, and communication. This client is seeking companionship and communication, not rest.

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome?

Emotional Exhaustion Well before the nurse exhibits symptoms of stress or burnout, he or she should acknowledge the difficulty of coping with others' pain on a daily basis and put healthy practices in place that guard against emotional exhaustion. Emotional exhaustion is more likely to have deleterious effects than inefficiency, social withdrawal, or illness, though these may signal emotional exhaustion.