After learning of a terminal illness and life expectancy, the client b

After learning of a terminal illness and life expectancy, the client begins to hyperventilate and complains of being light-headed with the fingers, toes, and mouth tingling. What action should be taken by the nurse?

1. Prepare to resuscitate the client.
2. Have the client concentrate on slowing down respirations.
3. Place the client in Trendelenburg’s position and ask him to cough forcefully.
4. Administer 25 mg of meperidine (Demerol) according to the prn pain order.

ANSWER

Correct Answer: 2
Rationale 1: There is no indication that this client needs resuscitation.
Rationale 2: This client is hyperventilating and should be assisted to slow down respirations. Techniques to slow respirations include counting respirations or having the client match respirations with the nurse, who then slows down the respiratory rate.
Rationale 3: There is no need to place the client in Trendelenburg’s position for coughing.
Rationale 4: Demerol may slow breathing, but is not necessary at this time.