A nurse is developing a care plan for Mrs. Thompson who is in the end-of-life stage. After assessing the client, the nurse has identified several potential problems. Which of the following hypotheses should the nurse prioritize when planning care for this client?

The client may benefit from additional laboratory tests to monitor disease progression.

The client may experience pain and discomfort due to the progression of their illness.

The client may need increased physical therapy sessions to maintain mobility.

The client may have elevated blood pressure due to an acute exacerbation of their condition.

Answer and Explanation

The Correct Answer is B

A. Additional laboratory tests: While monitoring is essential, at this stage, the priority is comfort, not disease progression.

B. Pain and discomfort: Mrs. Thompson is nearing the end of life and likely experiencing pain due to her advanced metastatic cancer. Pain management should always be a priority in palliative care.

C. Physical therapy: Physical therapy is not typically a priority in the end-of-life stage where the focus is on comfort rather than mobility.

D. Elevated blood pressure: This is unlikely to be the primary concern at this stage. Blood pressure is usually low, and interventions should be focused on comfort and symptom relief.

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Correct Answer is C

Explanation

A. Spirituality can increase depression: Spirituality often alleviates, rather than increases, depression.

B. Spirituality can increase feelings of hopelessness: Spirituality typically fosters hope and comfort.

C. Spirituality can increase emotional and psychological comfort. Spirituality often helps individuals find meaning, peace, and connection during end-of-life care, improving emotional and psychological well-being.

D. Spirituality can increase the desire to hasten death: Spirituality generally supports coping and a peaceful end-of-life experience rather than a desire to hasten death.

A. Vital sign measurement B. The nature and invasiveness of the surgical procedure C. Visual observation for nonverbal signs of pain D. The client's self-report of pain severity

Correct Answer is D

Explanation

A. Vital sign measurement: While vital signs may change due to pain, they are not specific indicators of pain intensity and should not be the primary basis for pain management.

B. The nature and invasiveness of the surgical procedure: The type of procedure may influence pain, but it is still essential to rely on the client's self-report for pain management.

C. Visual observation for nonverbal signs of pain: While helpful in some cases, nonverbal signs are not as reliable as the client's own report of pain.

D. The client's self-report of pain severity. The most accurate method to assess pain is through the client's self-report. This allows the nurse to understand the severity and nature of the pain, which helps guide treatment.

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A nurse is developing a care plan for Mrs. Thompson who is in the end-of-life stage. After assessing the client, the nurse has identified several potential problems. Which of the following hypotheses should the nurse prioritize when planning care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a class about spirituality in clients who are near the end of life. Which of the following information should the nurse include?

Correct Answer is C

Explanation

A nurse is caring for a client who is postoperative. The nurse should base their pain management interventions primarily on which of the following methods of determining the intensity of the client's pan?

Correct Answer is D

Explanation

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