# The home-care nurse reviews a palliative-care visit. Which findings require immediate follow-up? Highlight the findings that need prompt symptom or safety intervention.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=494055&lang=en  
> language: en  
> subject: Mobility/Immobility  
> category: BCC

## Question

The home-care nurse reviews a palliative-care visit. Which findings require immediate follow-up? Highlight the findings that need prompt symptom or safety intervention.

| Care area | Current finding |
| --- | --- |
| Pain | Pain remains 8/10 and prevents turning after both prescribed rescue doses. |
| Nutrition | The client eats smaller preferred meals, stops when comfortably full, and reports no nausea or swallowing difficulty. |
| Bowel function | No stool has passed for five days, and abdominal distention now occurs with vomiting. |
| Mouth care | Dry mouth improves with frequent ice chips and water-based oral moisturizer; the oral mucosa remains intact. |
| Breathing | Shortness of breath at rest makes the client pause repeatedly while speaking. |
| Sleep | The client sleeps two hours longer than last week but awakens easily to voice and remains oriented. |
| Goals | The client describes comfort goals, restates care choices in personal words, and participates in decisions. |
| Behavior | New agitation and visual misperceptions began suddenly during the afternoon. |
| Medication use | The caregiver crushes extended-release morphine tablets to make swallowing easier. |

## Explanation

Uncontrolled pain, obstruction-like constipation, severe dyspnea, new agitation, and unsafe crushing of extended-release morphine need prompt intervention. Expected appetite or sleep changes still receive comfort-focused monitoring.

## In-depth explanation

Quick answer
Promptly address pain despite rescue doses, five days without stool plus vomiting, breathlessness that interrupts speech, new agitation, and crushed extended-release morphine. These findings show uncontrolled symptoms or an immediate medication-safety hazard.

Why this is correct
Palliative care actively treats pain, constipation, nausea, shortness of breath, insomnia, and other distressing symptoms.[1] Opioids can contribute to constipation, and severe abdominal pain or vomiting can signal impaction or obstruction requiring clinical review.[2] New agitation also needs assessment for reversible distress, while extended-release medication must not be altered without verification.

Easy analogy or mental picture
Think of comfort care as four volume controls. One controls pain, one breathing, one bowel function, and one alertness. A control stuck at maximum needs prompt adjustment. The picture does not mean every expected end-of-life change should be aggressively treated.

Memory hook
Comfort crisis: pain, air, bowel, behavior, and medication safety.

NCLEX decision rule
When caring for a palliative client, think comfort plus safety; check whether symptoms are controlled, whether a new change has a reversible cause, and whether medicines are being given as prescribed.

Why the other choices are wrong
Smaller preferred meals, dry mouth relieved by ice chips, extra sleep with easy arousal, and continued participation in decisions may fit the client's goals and trajectory. They need ongoing support, but they do not require the same prompt reporting or intervention.References

- [1]NCI: Palliative Care in CancerNational Cancer Institute

- [2]NCI: Constipation and Cancer TreatmentNational Cancer Institute

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