A hospice nurse is visiting with the son of a client who has terminal cancer. The son reports sleeping very little during the past week due to caring for his mother. Which of the following responses should the nurse make?

"I can give you information about respite care if you are interested."

"I am sure you're doing a great job taking care of your mother."

"You should consider taking a sleeping pill before bed each night."

"It is always difficult caring for someone who is terminally ill."

Answer and Explanation

The Correct Answer is A

A. Correct. Offering information about respite care provides the son with an option to take a break and get some rest while ensuring his mother's care is still managed by professionals.

B. Incorrect. While supportive, this statement does not offer a solution to the son's sleep deprivation.

C. Incorrect. Suggesting a sleeping pill might not address the underlying issue of the son's caregiving responsibilities.

D. Incorrect. While empathetic, this statement does not offer a practical solution or support for the son's situation.

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Correct Answer is C

Explanation

A. Incorrect. Family history of malignant hypertension is not a contraindication for alteplase.

B. Incorrect. COPD itself is not a contraindication for alteplase. While it can complicate overall management, it does not increase the immediate risk of bleeding associated with thrombolytics.

C. Correct. Recent surgery, especially orthopedic surgery like hip arthroplasty, is a contraindication for thrombolytic therapy due to the increased risk of bleeding and hematoma formation at the surgical site.

D. Incorrect. Acute renal failure from six months ago is not a contraindication for alteplase.

A. How to secure the tracheostomy tube with ties at the back of the neck B. How to change the tracheostomy dressing using clean technique C. How to operate the portable suction machine D. How to change the nondisposable tracheostomy tube daily

Correct Answer is C

Explanation

A. Incorrect. Securing the tracheostomy tube with ties is important, but this is a task that should be performed by healthcare professionals initially. It is not typically part of discharge teaching.
B. Incorrect. Changing the tracheostomy dressing using clean technique is also an essential skill but may not be suitable for discharge teaching. The partner should be educated on monitoring the stoma site and recognizing signs of infection or complications.
C. Correct. Teaching the partner how to operate the portable suction machine is crucial for maintaining a patent airway. Suctioning is often necessary to clear mucus and secretions from the tracheostomy tube, especially when the client is at home.
D. Incorrect. Changing a tracheostomy tube, particularly a nondisposable one, is a procedure that should be performed by healthcare professionals due to the risk of complications and the need for sterile technique. It is not typically part of discharge teaching to non-medical caregivers.

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A hospice nurse is visiting with the son of a client who has terminal cancer. The son reports sleeping very little during the past week due to caring for his mother. Which of the following responses should the nurse make?

Nursing Test Bank

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