A nurse is caring for a client who has just died. Which of the following actions should the nurse take?

Leave noninvasive equipment on the client's body.

Remove the client's dentures.

Turn the lights up in the client's room.

Close the client's eyes before the family views the body.

Answer and Explanation

The Correct Answer is B

A. Leave noninvasive equipment on the client's body. This is incorrect. Noninvasive equipment, such as oxygen tubing or blood pressure cuffs, should be removed before the family views the body to allow for a respectful presentation of the deceased.

B. Remove the client's dentures. This is the correct action. Dentures should be removed after death to preserve the appearance of the face. They should be cleaned and placed with the client’s belongings.

C. Turn the lights up in the client's room. This is not recommended. The lights should generally be dimmed to create a more peaceful and respectful environment for family members.

D. Close the client's eyes before the family views the body. While it is respectful to close the client’s eyes, this action should only be taken if the family has not yet viewed the body. If the family wishes to see the deceased with their eyes open, the nurse should respect that preference.

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Correct Answer is A

Explanation

A. "This must be very frightening for you. Let's talk more about it.": This response demonstrates empathy and validation of the client's feelings, which can help build trust. It acknowledges the client's emotional state while not challenging or confronting their delusion directly. This approach helps maintain rapport while encouraging the client to express themselves.

B. "What makes you think the staff is following you?": This response could be perceived as questioning the validity of the client's experience, which may feel confrontational or invalidating. It is not the best approach for engaging a client with paranoid delusions.

C. “Why do you feel the staff is the FBI?": This question could also challenge the client's delusion and inadvertently reinforce their sense of being persecuted. Asking such a question might escalate anxiety rather than calm the client.

D. "The psychiatric staff is not FBI. They are here to help you.": While this response is factually correct, it may be perceived as dismissive of the client's experience. Confronting the delusion directly is generally not helpful and can increase the client's feelings of mistrust.

A. "I can have a meal up to 2 hours before the procedure." B. "I will feel a warming sensation after the injection of the dye contrast." C. "I do not need to sign a consent form before this procedure." D. "I should limit my fluid intake for 2 days after the procedure."

Correct Answer is B

Explanation

A. "I can have a meal up to 2 hours before the procedure.": This is not correct. Clients are typically instructed to fast for at least 8 hours before an intravenous pyelogram to ensure clear imaging results and reduce the risk of complications from anesthesia or contrast media.

B. "I will feel a warming sensation after the injection of the dye contrast.": This is correct. It is common for clients to experience a warm sensation when the contrast dye is injected during the procedure.

C. "I do not need to sign a consent form before this procedure.": This is incorrect. A consent form is required before the procedure as it involves the use of contrast dye and potential risks, such as allergic reactions.

D. "I should limit my fluid intake for 2 days after the procedure.": This is not correct. After the procedure, clients are usually encouraged to drink plenty of fluids to help flush the contrast dye from the body and prevent potential kidney complications.

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A nurse is caring for a client who has just died. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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