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."
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"E"}
Explanation
Pyrexia, also known as fever, refers to an elevated body temperature that is above the normal range. The normal body temperature is typically around 37°C (98.6°F), and a temperature of 38.4°C (101.1°F) indicates a fever.
Alternative Choices:
1. "tachycardia" due to "heart rate of 92/min"
- Incorrect. Tachycardia refers to an abnormally high heart rate, usually above 100 beats per minute (bpm) in adults. A heart rate of 92/min is within normal limits and does not qualify as tachycardia.
2. "hypertension" due to "blood pressure of 130/78 mm Hg"
- Incorrect. Hypertension is defined as having a blood pressure reading consistently above 140/90 mm Hg. The reading of 130/78 mm Hg falls into the elevated category but does not reach the threshold for hypertension.
3. "respiratory distress" due to "respiratory rate of 18/min"
- Incorrect. A respiratory rate of 18 breaths per minute is considered normal for adults, so this finding does not indicate respiratory distress.
4. "obesity" due to "current BMI of 29.9"
- Partially correct. A BMI of 29.9 places the client in the "overweight" category, just below the threshold for obesity (BMI of 30 or higher). However, the presence of pyrexia is the more immediate clinical concern based on the provided vital signs.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"B"}}
Explanation
Anticipated actions for the client include:
- A. Administer nifedipine.
- B. Assess blood pressure every 15 minutes.
- D. Assess for urinary retention.
Contraindicated actions for the client include:
- C. Perform suctioning (since there is no indication or information suggesting the need for suctioning).
- E. Place client in supine position (as it might worsen the symptoms).
- F. Withhold pain medication for headache until other manifestations resolve (it's important to address the headache promptly, especially if acetaminophen is prescribed for pain relief).
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