A nurse is contributing to the plan of care for a client who has had HIV for 10 years and is at the end of life. Which of the following interventions should the nurse recommend?

Encourage the client to increase participation in community social activities

Prepare the client to begin highly active antiretroviral therapy (HAART)

Provide routine analgesia to minimize episodes of breakthrough pain

Promote client weight gain of one to two pounds per week

Answer and Explanation

The Correct Answer is C

Explanation:

A. Encourage the client to increase participation in community social activities:

While social activities can be beneficial for overall well-being, including mental and emotional aspects, at the end of life for a client with HIV, the focus shifts towards palliative care and symptom management. Encouraging social activities may not directly address the client's immediate end-of-life needs.

B. Prepare the client to begin highly active antiretroviral therapy (HAART):

Starting or continuing highly active antiretroviral therapy (HAART) may not be appropriate at the end of life. HAART is typically used to manage HIV infection and prolong life expectancy by controlling viral replication. However, at the end of life, the focus shifts towards comfort care rather than aggressive treatment aimed at extending life.

C. Provide routine analgesia to minimize episodes of breakthrough pain:

This intervention is more aligned with the principles of end-of-life care. Providing routine analgesia helps manage pain effectively, which is crucial for improving the client's comfort and quality of life during this stage.

D. Promote client weight gain of one to two pounds per week:

Weight gain may not be a priority at the end of life, especially if the client is experiencing advanced HIV disease or complications. Instead of focusing on weight gain, the emphasis should be on optimizing comfort, managing symptoms, and enhancing quality of life.

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Correct Answer is D

Explanation

Explanation:

A. "There are 4 rights of delegation."

This statement is not entirely accurate. Delegation involves several principles, including the right task, right circumstances, right person, right direction/communication, and right supervision/evaluation. Therefore, simply stating "4 rights" does not fully encompass the principles of delegation.

B. “The nurse manager is responsible for delegating nursing tasks during each shift."

This statement is incorrect. While the nurse manager may have oversight and authority regarding delegation policies and procedures, it is typically the responsibility of the delegating nurse (the one assigning tasks) to delegate appropriate tasks to qualified individuals based on their competency and scope of practice.

C. "It is the duty of the delegatee to perform a task without asking questions when it is delegated."

This statement is not accurate and could lead to misunderstandings or errors. Effective delegation involves clear communication, which includes the opportunity for the delegatee to ask questions if they are unsure about any aspect of the delegated task. Encouraging questions helps ensure that the task is understood and performed safely and appropriately.

D. “I am responsible for ensuring that a delegated task is completed."

This statement demonstrates understanding of delegation principles. The delegating nurse (the one assigning tasks) is indeed responsible for ensuring that delegated tasks are appropriate, communicated effectively, and completed according to established standards. This includes providing necessary guidance, supervision, and follow-up to ensure task completion and quality of care.

A. Increased bowel sounds B. Hypertension C. Mottled skin D. Moist mucous membranes

Correct Answer is C

Explanation

Explanation:

A. Increased bowel sounds:

In end-of-life care, clients often experience a decrease in bowel sounds rather than an increase. Bowel sounds may diminish or become absent as the body's systems slow down.

B. Hypertension:

Hypertension is less commonly observed in clients at the end of life. Instead, blood pressure may decrease as the body's overall function declines.

C. Mottled skin:

Mottled skin, characterized by a blotchy or marbled appearance, is a common finding in clients approaching the end of life. It occurs due to changes in peripheral circulation and may indicate decreased perfusion.

D. Moist mucous membranes:

In contrast to moist mucous membranes, clients at the end of life may experience dry mucous membranes. Reduced oral intake and hydration levels can lead to dryness of the mouth and mucous membranes.

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A nurse is contributing to the plan of care for a client who has had HIV for 10 years and is at the end of life. Which of the following interventions should the nurse recommend?

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