A nurse is caring for a client who has a new diagnosis of lung cancer. The client states they do not want to tell their partner their diagnosis. Which of the following statements should the nurse make?

"Would you the to talk about your concerns? "

"Why don't you went to tell your partner your diagnosis? "

"If I were you, I would tell my partner."

"Most people find a helpful to talk to their partner"

Answer and Explanation

The Correct Answer is A

A) "Would you like to talk about your concerns?": This response acknowledges the client's feelings and offers support and an opportunity to discuss their concerns further. It respects the client's autonomy and allows them to express their thoughts and feelings about the situation.
B) "Why don't you want to tell your partner your diagnosis?": This response may come across as confrontational and judgmental, potentially making the client feel defensive. It does not facilitate open communication or address the client's concerns in a supportive manner.
C) "If I were you, I would tell my partner.": This response imposes the nurse's values and beliefs on the client, which may not be helpful or appropriate. It undermines the client's autonomy and decision-making process.
D) "Most people find it helpful to talk to their partner.": While this statement may be true for some individuals, it assumes that the client's situation is the same as others and does not take into account the client's unique circumstances and preferences. It does not encourage open dialogue or address the client's concerns directly.

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Correct Answer is D

Explanation

A) Asking the client to cough while inserting the NG tube:
This action is not necessary and may not be appropriate during the insertion of an NG tube. Coughing can increase the risk of gagging and aspiration during the procedure.

B) Wearing sterile gloves to insert the NG tube:
While the nurse should maintain appropriate hand hygiene, wearing sterile gloves is not typically necessary for the insertion of an NG tube. Clean gloves are sufficient for this procedure.

C) Placing the client into a left lateral position before inserting the NG tube:
Positioning the client in a high Fowler's position (sitting upright) or semi-Fowler's position is generally preferred for NG tube insertion to facilitate tube passage into the esophagus and reduce the risk of aspiration. Placing the client in a left lateral position is not typically done for NG tube insertion.

D) Determining the length of the NG tube to be inserted prior to the procedure:
This is the correct action. Before inserting the NG tube, the nurse should measure the distance from the tip of the client's nose to the earlobe and then from the earlobe to the xiphoid process or the mark on the NG tube corresponding to the desired insertion length. This helps ensure that the tube is inserted to the appropriate depth and reaches the desired location within the gastrointestinal tract.

A. Turn the client on his side before starting oral care. B. Use the thumb and index finger to keep the client's mouth open C. Apply petroleum jelly to the client's lips after oral care. D. Use a stiff toothbrush to clean the client's teeth.

Correct Answer is A

Explanation

A. Turn the client on his side before starting oral care: This is the correct action. Turning the client on their side helps prevent aspiration of oral secretions or fluids during oral care, especially for an immobile client who may have difficulty swallowing or managing oral secretions effectively. Positioning the client on their side also facilitates better access to the oral cavity for oral care procedures.

B. Use the thumb and index finger to keep the client's mouth open: Using the thumb and index finger to keep the client's mouth open may cause discomfort or injury to the client. Instead, it's essential to encourage the client to open their mouth gently or use an appropriate oral device to keep the mouth open during oral care.

C. Apply petroleum jelly to the client's lips after oral care: Applying petroleum jelly to the client's lips after oral care can help keep the lips moisturized and prevent dryness. However, it is not the most immediate action necessary for oral care. Ensuring proper positioning and cleaning of the oral cavity take precedence during oral care for an immobile client.

D. Use a stiff toothbrush to clean the client's teeth: Using a stiff toothbrush can cause damage to the client's oral tissues, especially if the client has impaired oral hygiene or compromised oral health. It's essential to use a soft-bristled toothbrush or sponge swabs for oral care to prevent injury or trauma to the oral mucosa, especially in clients who are immobile.

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A nurse is caring for a client who has a new diagnosis of lung cancer. The client states they do not want to tell their partner their diagnosis. Which of the following statements should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is inserting an NG tube for a client. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse is providing oral care for a client who is immobile. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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