Question 1

An 8-year-old female client complains of chronic fatigue that has persisted for several months despite an adequate amount of sleep each night.The nurse plans the care based on a nursing diagnosis of Fatigue.What intervention is the nurse most likely to try first?

Accepted Answer

The nurse's initial intervention should be to focus on promoting a healthy lifestyle by recommending a balanced diet with adequate hydration. Adequate nutrition and hydration are essential to maintain energy levels and prevent fatigue. A sleep study, journaling, or cognitive-behavioral therapy may be appropriate interventions if fatigue persists after lifestyle modifications are implemented. However, these interventions are not the first-line interventions for chronic fatigue in an otherwise healthy child.

Question 2

What best explains the reason that a nurse should be responsible for communicating any changes in the condition of a client at the end of life that would warrant a change in the care plan?

Accepted Answer

Nurses are the healthcare providers who tend to have the greatest amount of contact with clients at the end of life, therefore they have the best opportunity to communicate any changes in the client's condition and update the care plan accordingly. It is not their responsibility to definitively diagnose patient conditions, clients may or may not prefer to talk to physicians about problems, and there is no legal mandate that nurses are solely responsible for communicating changes in the care plan.

Question 3

A competent older adult client has a living will that expresses the client's desire to avoid resuscitation and heroic life support measures.The family members are not supportive of this directive and plan to contest the living will.Which nursing action is the most appropriate?

Accepted Answer

A) The client is competent. The wishes of the client must take priority. The document should first be placed on the chart and the physician notified. If there are concerns about the authenticity of the document, the Social Services department or the unit supervisor will need to be contacted. There is no need to notify the hospital attorney at this time. A lack of support by the family, or a plan to contest, does not invalidate the document legally.
B) The client is competent. The wishes of the client must take priority. The document should first be placed on the chart and the physician notified. If there are concerns about the authenticity of the document, the Social Services department or the unit supervisor will need to be contacted. There is no need to notify the hospital attorney at this time. A lack of support by the family, or a plan to contest, does not invalidate the document legally.
C) The client is competent. The wishes of the client must take priority. The document should first be placed on the chart and the physician notified. If there are concerns about the authenticity of the document, the Social Services department or the unit supervisor will need to be contacted. There is no need to notify the hospital attorney at this time. A lack of support by the family, or a plan to contest, does not invalidate the document legally.
D) The client is competent. The wishes of the client must take priority. The document should first be placed on the chart and the physician notified. If there are concerns about the authenticity of the document, the Social Services department or the unit supervisor will need to be contacted. There is no need to notify the hospital attorney at this time. A lack of support by the family, or a plan to contest, does not invalidate the document legally.

Question 4

A client reports feeling tired and not refreshed after sleeping.The client also tells the nurse that family members have been making comments about the client's loud snoring at night.What should the nurse suspect as being the cause of this client's fatigue?

Accepted Answer

The client's symptoms of feeling tired and not refreshed after sleeping, along with loud snoring at night, suggest the possibility of sleep apnea, a condition where breathing stops and starts during sleep. This can lead to poor quality sleep and daytime fatigue. Insomnia, depression, and thyroid disorder are possibilities, but the loud snoring is a key indicator for sleep apnea.

Question 5

An older adult client with terminal lung cancer is not breathing well and has cold and mottled skin.The client has a living will and requests comfort measures only.What should the nurse do to help this client?

Accepted Answer

Providing the client with pain medication as ordered is the best choice as it aligns with the client's request for comfort measures only. The nurse should also closely monitor the client and provide supportive care to ensure their comfort. Asking the family what they want to be done for the client is not necessary as the client has a living will and has already made their wishes known. Withholding all care until the client dies is not appropriate as the client still requires comfort measures. Contacting the provider for orders to control the client's breathing may not align with the client's wishes for comfort measures only, and may not be necessary if the client's primary concern is pain management.

Question 6

The parents of a child with terminal cancer ask the nurse that the child not be told that he will not recover.The nurse anticipates that the child might ask the nurse if he is dying.What would be most appropriate for the nurse to do?

Accepted Answer

Suggesting a meeting with the healthcare team and the parents would be the most appropriate action for the nurse to take. It is important for the healthcare team and the parents to discuss how they want to approach the topic of the child's prognosis and end-of-life care. This will ensure that everyone is on the same page and can provide consistent and appropriate support to the child and family. It is not appropriate to lie to the child or ignore their questions. Bringing in a child life therapist can be helpful, but it should be done in conjunction with a meeting with the healthcare team and parents.

Question 7

The nurse is taking care of a client with terminal lung cancer who is showing signs of imminent death.What change should the nurse most expect the client to exhibit first?

Accepted Answer

In the dying process, the cardiovascular system is the first to be affected. As the body begins to shut down, there is a decrease in blood pressure as the heart begins to fail. This can lead to a decrease in perfusion to vital organs, causing them to fail as well. Blurry vision, confusion, and irregular pulse rate may be seen in later stages of the dying process.

Question 8

What word best describes the pain a client experiences at the end of life?

Accepted Answer

A)The most common symptom at the end of life is pain, so end-of-life care must include pain management. Client pain will likely be chronic with acute episodes, and it won't necessarily be unmanageable or unpredictable.
B)The most common symptom at the end of life is pain, so end-of-life care must include pain management. Client pain will likely be chronic with acute episodes, and it won't necessarily be unmanageable or unpredictable.
C)The most common symptom at the end of life is pain, so end-of-life care must include pain management. Client pain will likely be chronic with acute episodes, and it won't necessarily be unmanageable or unpredictable.
D)The most common symptom at the end of life is pain, so end-of-life care must include pain management. Client pain will likely be chronic with acute episodes, and it won't necessarily be unmanageable or unpredictable.

Question 9

Which of the following triggers pain?

Accepted Answer

Pain is triggered by the peripheral nervous system through specialized receptors called nociceptors that detect tissue damage or potential damage. The central nervous system processes this information and creates the sensation of pain. The musculoskeletal and cardiovascular systems may contribute to pain indirectly, but they do not directly trigger pain.

Question 10

A participant in a seminar given by a nurse asks for information about lifestyle situations that might contribute to chronic fatigue.Which examples might the nurse identify in response to this request? Select all that apply.

Accepted Answer

Thyroid problems, chronic pain, and marijuana use all have been associated with chronic fatigue. Vigorous exercise three times a week can actually improve energy levels, and swimming after a meal is unlikely to contribute to chronic fatigue unless the individual experiences discomfort.

Question 11

An older school-age child is brought to the emergency department after a car accident.The parents witness and stare at the resuscitation scene unfolding before them.The child is not responding to the resuscitative efforts after 30 minutes.Which is the best communication strategy for the nurse to use in this situation?

Accepted Answer

The nurse should inform the parents that resuscitative efforts have not been effective and are not beneficial to the child. The parents have already witnessed the resuscitation scene for 30 minutes and it is important to be honest with them about the situation. Asking them whether they would like resuscitative efforts to be continued may put them in a difficult position and prolong the child's suffering. Asking them to stand at the foot of the cart to watch or asking them to leave may not be appropriate in this situation as it may cause more distress for the parents.

Question 12

Which of the following statements best describes the body's adaptation to pain?

Accepted Answer

As the body adapts to pain, the observation of pain's effects may become more difficult. This means that the individual may not be as aware of the pain or its effects as they were initially. It does not necessarily mean that the pain has ceased or that the sympathetic response has increased.

Question 13

During an assessment,an adolescent reports: "I get up at 6 a.m. ,I attend early-morning band classes three times each week,I play sports for 2 hours each day after school,and homework takes me 3 hours each night.I always feel tired." Based on these data,which question will the nurse ask while continuing the client's history?

Accepted Answer

The adolescent reports always feeling tired and their schedule indicates they may not be getting enough sleep. Therefore, asking about their sleep habits is the most relevant question to ask at this point.

Question 14

Which of the following statements describes all pain?

Accepted Answer

Pain may result from tissue damage or other causes, but not all pain is directly correlated to tissue damage. Pain can also be influenced by mental and emotional factors. Pain can be localized to a specific area of the body, but it can also be referred or widespread. Verbalization of pain is a commonly used method for patients to communicate their experience to healthcare providers. Therefore, statement D is the most accurate description of all pain.

Question 15

The nurse is caring for a dying child.Which nursing action supports the primary goal for a dying child?

Accepted Answer

Administering pain medication as ordered is important in ensuring the child's comfort and reducing any distress or discomfort they may be experiencing. This supports the primary goal for a dying child, which is to maintain their physical and emotional comfort during their end-of-life journey. While keeping the child entertained or maintaining a busy schedule may provide temporary distraction, it does not address their underlying needs and may even worsen their symptoms. Maintaining a good relationship with the family is also important, but it is not the primary goal for the dying child.

Question 16

An adolescent client with terminal cancer tells the nurse that she does not want any more treatment,even though her parents are planning for her to participate in a study trial that involves aggressive chemotherapy.Which action by the nurse is the most appropriate?

Accepted Answer

The most appropriate action for the nurse to take in this situation is to request a meeting between the adolescent, her parents, and the healthcare team so that they can discuss the implications of the different treatment options. This approach respects the client's wishes and also acknowledges the role of the parents in the decision-making process. As a minor, the adolescent may not have the legal authority to make medical decisions, but her wishes should still be taken into consideration. Option A is not appropriate because it dismisses the client's wishes and gives complete control to the parents. Option B is not accurate because, although some states do allow minors to make their own medical decisions under certain circumstances, a blanket statement cannot be made about the client's right to refuse treatment. Option D is dismissive of the client's concerns and does not address the issue at hand.

Question 17

The wife of a patient with end-stage chronic obstructive pulmonary disease (COPD)tells the nurse that she wishes her husband were eligible for hospice care but she thinks that hospice is only available for cancer patients.She is also concerned that,even if he were eligible for hospice care,they couldn't afford it,they'd have medical personnel constantly underfoot,and her husband would have to switch healthcare providers.Which responses by the nurse are appropriate? Select all that apply.

Accepted Answer

The nurse should inform the patient's wife that a diagnosis of cancer is not required for hospice care and that hospice care is intended to ease the burden of primary caregivers, not add to it by being in the way. The nurse should not state that hospice care is very expensive or that the patient is not eligible for it, as this may not be true in this case. The nurse should also not state that all hospice programs are provided 24/7 in long-term care facilities, as this may not be applicable in this situation.

Question 18

The nurse is caring for the family of a terminally ill client.The family members have been tearful and sad since the diagnosis was given.What is the best nursing diagnosis for this family?

Accepted Answer

A)Grieving prior to the actual loss is termed anticipatory grieving. There are no assessment findings that indicate compromised family coping or hopelessness. This reaction is typical of family members, so there is no indication that the family is exhibiting caregiver role strain.
B)Grieving prior to the actual loss is termed anticipatory grieving. There are no assessment findings that indicate compromised family coping or hopelessness. This reaction is typical of family members, so there is no indication that the family is exhibiting caregiver role strain.
C)Grieving prior to the actual loss is termed anticipatory grieving. There are no assessment findings that indicate compromised family coping or hopelessness. This reaction is typical of family members, so there is no indication that the family is exhibiting caregiver role strain.
D)Grieving prior to the actual loss is termed anticipatory grieving. There are no assessment findings that indicate compromised family coping or hopelessness. This reaction is typical of family members, so there is no indication that the family is exhibiting caregiver role strain.

Question 19

The nurse is caring for a client who has suffered a massive cerebral hemorrhage and is not expected to survive.The client's mother indicates the client is Catholic.Which intervention is most appropriate?

Accepted Answer

The best choice is to give the client and their family the opportunity to express their desires regarding religious rituals. It is not necessary to find a nurse with a specific faith, as the main priority is to provide compassionate care regardless of religious background. While contacting a priest may ultimately be necessary, it is important to get the client and their family's input first. Assuming the client's desired religious practices based on the nurse's own understanding could be inappropriate or inaccurate. Therefore, the best approach is to ask the client or their family what they want in terms of religious rituals.

Question 20

If nutrients and hydration are provided artificially for a client at the end of life because of the client's diminished muscle control,then what is another therapy that is likely to accompany this therapy?

Accepted Answer

When a client's muscle control is diminished, they may be unable to perform oral care effectively. Providing regular oral care can prevent discomfort, infections, and other complications. Mechanical ventilation may not be necessary in this situation as it is typically used to assist with breathing. Gently massaging the extremities can help improve circulation and comfort, but it may not necessarily accompany artificial nutrition and hydration. Maintaining client safety is important, but it may not be directly related to the therapy of providing artificial nutrition and hydration.

Quiz 3: Comfort