A client who has advanced cancer has been placed on hospice care, and the nurse is helping the client to understand what that means. Which statement made by the client indicates that teaching was effective? "I will:

stop aggressive treatment for my cancer

call 911 if my symptoms worsen

make an appointment for home physical therapy

have a prolonged life expectancy

Answer and Explanation

The Correct Answer is A

A. This statement indicates an understanding of hospice care because hospice typically involves discontinuing aggressive treatments such as chemotherapy, radiation, or surgeries that are aimed at curing the cancer. Instead, the focus shifts to palliative care to manage symptoms and improve quality of life.

B. This statement suggests the client may not fully understand hospice care. In hospice, the emphasis is on managing symptoms in the home setting with the support of hospice nurses and caregivers. Calling 911 for symptom management contradicts the philosophy of hospice, which is to avoid aggressive interventions and hospitalizations.

C. This statement indicates a misunderstanding of hospice care. Hospice care focuses on comfort and quality of life rather than rehabilitative services such as physical therapy. In hospice, the care provided is primarily palliative and supportive rather than rehabilitative.

D This statement would indicate a misunderstanding of hospice care. In hospice, the prognosis is typically a life expectancy of six months or less if the disease follows its natural course. Hospice care is provided when curative treatments are no longer effective or desired, and the focus is on comfort rather than prolonging life.

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Correct Answer is A

Explanation

A. Establishing a trusting relationship is crucial in nursing care, including when addressing spiritual distress. This intervention allows the nurse to create a safe space for the client to express their feelings, concerns, and spiritual beliefs. It fosters open communication and helps the nurse understand the depth of the client's distress, which is essential for providing effective support and care.

B. Understanding the client's belief system, including their beliefs in a Supreme Being or higher power, is important in addressing spiritual distress. This information helps the nurse provide culturally and spiritually sensitive care that aligns with the client's values and preferences. However, while important, this would typically follow establishing a trusting relationship as it involves a deeper understanding of the client's spiritual perspective.

C. This response may come from a well-intentioned desire to reassure the client, but it oversimplifies the client's concerns and does not address the root of spiritual distress. Spiritual distress is often complex and may involve existential questions, fears, or conflicts related to beliefs, meaning, and purpose.

Offering simplistic reassurances without addressing these deeper issues may not effectively alleviate the client's distress.

D. Spiritual distress is distinct from physical problems, although it can manifest with physical symptoms. Focusing solely on the physical aspects may overlook the spiritual and existential concerns that underlie the client's distress. While it's important to assess physical symptoms comprehensively, this approach does not directly address the spiritual distress identified by the nurse.

A. count the radial pulse for two minutes." B. put my fingers on the "pinky" finger side of the wrist." C. use my thumb to count the pulse." D. count the pulse for 30 seconds and multiply the number by two

Correct Answer is D

Explanation

D. Counting the radial pulse for 30 seconds and then multiplying the count by two gives an estimate of the client's heart rate per minute (bpm). This method is efficient and commonly used in clinical practice, especially if the client's pulse is regular.

A. Counting the radial pulse for two minutes is unnecessarily long and not standard practice. Typically, the radial pulse is counted for either 30 seconds or 60 seconds (one minute) to determine the client's heart rate. Multiplying the count by two for a 30-second count or directly using the count for a 60- second count provides the client's beats per minute (bpm).

B. The radial pulse is assessed by palpating the radial artery on the thumb side (or lateral side) of the client's wrist. The nurse places the index and middle fingers gently over the radial artery and applies light pressure to feel the pulse rhythm and rate.

C. Using the thumb to count the pulse is not recommended because the thumb has its own pulse, which could interfere with accurately assessing the client's radial pulse.

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A client who has advanced cancer has been placed on hospice care, and the nurse is helping the client to understand what that means. Which statement made by the client indicates that teaching was effective? "I will:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse assesses that a client is experiencing spiritual distress. What should be the nurse's primary intervention?

Correct Answer is A

Explanation

The nurse prepares to assess the client's radial pulse. Which statement made by the nurse reflects a correct understanding of the procedure? "I will:

Correct Answer is D

Explanation

The nurse understands that motivation to learn is strongest when the client:

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