A nurse is caring for a client whose partner has a terminal diagnosis. Which of the following statements made by the client indicates effective coping?

"I cook my partner's favorite foods."

"I make a list of all the things I need to do."

"I have lunch with my friends once a week."

"I am unable to fall asleep right away."

Answer and Explanation

The Correct Answer is C

A. "I cook my partner's favorite foods.": Preparing meals can be a way to show love and care, but it does not necessarily indicate effective coping. It may serve as a distraction, but it does not address emotional or social well-being.

B. "I make a list of all the things I need to do.": Creating lists can help with organization, but it does not directly reflect emotional coping. It may indicate a focus on tasks rather than emotional processing or seeking support.

C. "I have lunch with my friends once a week.": Maintaining social connections is a sign of effective coping, as it provides emotional support and an opportunity to share feelings. Engaging in enjoyable activities outside of caregiving responsibilities helps reduce stress.

D. "I am unable to fall asleep right away.": Difficulty sleeping is a common response to stress but suggests ongoing emotional distress rather than effective coping. Persistent sleep disturbances may require further assessment and support.

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Correct Answer is B

Explanation

A. Wears an N95 mask when providing wound care: MRSA is transmitted via direct contact rather than airborne particles, so an N95 mask is unnecessary unless the client has a secondary airborne infection like tuberculosis. Standard contact precautions, including gloves and gowns, are sufficient to prevent transmission.

B. Wears clean gloves when caring for the client: MRSA requires contact precautions, which include wearing gloves when touching the client or contaminated surfaces. Gloves help prevent the spread of bacteria, particularly from wound drainage, body fluids, or contaminated equipment.

C. Remains 3 feet away from the client: MRSA does not require droplet precautions, which would necessitate maintaining a distance of 3 feet. Instead, direct skin-to-skin contact or contact with contaminated surfaces is the primary mode of transmission, requiring gloves and gowns rather than distance.

D. Disposes of isolation gown outside of the client's room: Isolation gowns should be removed inside the client’s room to prevent cross-contamination. Removing the gown before exiting the room reduces the risk of spreading MRSA to other areas and healthcare personnel.

A. Increase in urinary output B. Crackles on auscultation C. Intracranial pressure reading of 12 mm Hg D. Glasgow coma scale rating of 15

Correct Answer is B

Explanation

A. Increase in urinary output: Mannitol is an osmotic diuretic that promotes diuresis to reduce intracranial pressure (ICP). Increased urinary output is an expected effect and indicates the medication is working as intended.

B. Crackles on auscultation: Mannitol can lead to fluid overload, especially in clients with compromised renal or cardiac function. Crackles in the lungs suggest pulmonary edema, a serious adverse effect that should be reported immediately to prevent respiratory distress.

C. Intracranial pressure reading of 12 mm Hg: Normal ICP ranges from 5 to 15 mm Hg. A reading of 12 mm Hg is within the expected range and does not indicate an adverse effect of mannitol.

D. Glasgow coma scale rating of 15: A score of 15 indicates full consciousness and normal neurological function. This finding does not suggest an adverse reaction to mannitol.

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A nurse is caring for a client whose partner has a terminal diagnosis. Which of the following statements made by the client indicates effective coping?

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