An older adult receiving hospice care has dementia as a result of ...

[tuffie]

An older adult receiving hospice care has dementia as a result of metastasis to the brain. His bone cancer has progressed to an advanced stage. Why might the client fail to request pain medication as needed? The client:
 
  a. Experiences less pain than in earlier stages of cancer
  b. Cannot communicate the character of his pain effectively
  c. Knowledges pain at a later time than when it occurs
  d. Relies on caregiver to provide pain relief without asking

Question 2

The nurse is inserting an indwelling urinary catheter for a female patient. Upon insertion of the catheter the nurse accidently touches the patient's leg and bed sheet with the tip of the catheter.
 
  What is the most appropriate action by the nurse?
  a. Cleanse the tip of the catheter with povidone iodine before proceeding with the insertion.
  b. Cleanse the tip of the catheter with alcohol before proceeding with the insertion.
  c. Obtain a new catheter and reinsert it using sterile technique.
  d. Continue with the procedure as the nurse only lightly touched the surfaces.

[C.mcnichol98]

Answer to Question 1

B
There is no evidence to suggest that patients with dementia and other forms of cognitive impairment do not experience pain. It is most likely that they cannot effectively communicate the intensity or quality of pain and are therefore at risk for underassessment of pain and inadequate pain relief. Be aware of behavioral cues indicating pain rather than relying on verbal report. Failure to request pain medication is not likely a result of hesitation to habitually ask for it or reliance on others; rather, it is likely owing to inability to effectively express to the caregiver that analgesia is needed.

Answer to Question 2

C
Insertion of an indwelling urinary catheter is a sterile procedure for all patients. If the catheter upon insertion touches the labia or vagina (female), unsterile bed linens, or any part of the patient's body, it is contaminated. The nurse must obtain and insert a new, sterile catheter. Cleansing a catheter with povidone-iodine (Betadine) or alcohol is not acceptable, as this does not sterilize the catheter. The nurse should not continue the procedure without obtaining a new catheter.

[tuffie]

Excellent

[rleezy04]

TYSM