A nurse is preparing a client's body for a postmortem family viewing.
Which of the following actions should the nurse take?

Remove the client's dentures to close their mouth.

Place medical equipment to the side of the client's bed.

Lie on the head of the client's bed flat.

Ask the family if they want to participate in postmortem care.

Answer and Explanation

The Correct Answer is D

Answer is d. Ask the family if they want to participate in postmortem care.

a. Remove the client's dentures to close their mouth: This option is incorrect because removing the client's dentures may not be necessary and can alter the client's appearance, causing unnecessary distress to the family during the viewing. Dentures should generally be left in place to maintain the natural shape of the client's face and preserve their appearance as closely as possible. However, if the family expresses a preference for removing the dentures or if it is medically necessary, the nurse should discuss this option with them and follow facility protocols accordingly.

b. Place medical equipment to the side of the client's bed: While it is essential to create a serene and comfortable environment for the family during the viewing, simply placing medical equipment to the side of the client's bed may not be sufficient. Medical equipment should be removed from the room entirely to minimize distractions and create a more peaceful atmosphere for the family. This ensures that the focus remains on the client and their loved ones during this sensitive time.

c. Lie on the head of the client's bed flat: This option is incorrect because lying the head of the client's bed flat is not appropriate for postmortem care. Elevating the head of the bed is essential to prevent blood pooling and discoloration of the client's face and neck, which can occur when the body is in a supine position for an extended period. Maintaining proper positioning also helps preserve the dignity and appearance of the deceased individual during the family viewing. Therefore, the nurse should ensure that the bed is appropriately positioned based on facility protocols and the client's condition.

d. Ask the family if they want to participate in postmortem care: Correct. Involving the family in postmortem care can be an important part of the grieving process and is considered a respectful practice if they wish to participate. By asking the family for their preferences and offering them the opportunity to participate in caring for their loved one, the nurse demonstrates sensitivity and respect for their cultural and personal beliefs. This approach allows the family to be actively involved in the final moments of their loved one's care and helps facilitate closure and acceptance during the grieving process.

In summary, the correct answer is d because asking the family if they want to participate in postmortem care ensures that their preferences and cultural beliefs are respected and accommodated during the family viewing. This approach fosters a supportive and dignified environment for the family as they say goodbye to their loved one.

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Correct Answer is C

Explanation

Choice A rationale:

Increasing the client's intake of oral fluids may not address the underlying issue of crackles in the bases of the lungs, shortness of breath, and a respiratory rate of 24/min. This client likely has fluid accumulation in the lungs, and simply increasing fluid intake could exacerbate the problem. It's important to assess and manage the client's fluid balance carefully.

Choice B rationale:

Instructing the client to cough every 4 hours may not be sufficient for managing the client's symptoms, especially if there is fluid in the lungs. Coughing alone may not adequately clear the airways. More intensive interventions are needed.

Choice C rationale:

The correct action is to "Maintain the client in high-Fowler's position." High-Fowler's position helps improve lung expansion and oxygenation by allowing the client to sit up at an angle, which reduces pressure on the diaphragm and improves lung mechanics. This position can help alleviate symptoms such as crackles and shortness of breath in clients with heart failure.

Choice D rationale:

Encouraging the client to ambulate to loosen secretions may not be appropriate in this case. Ambulation is generally encouraged for clients with adequate oxygenation and mobility. If the client has severe respiratory distress, it's crucial to address that issue first before considering ambulation.

A. Uncapped sharps are put in a puncture-resistant container. B. Soiled linens are placed on the floor. C. Waste containers are lined with single bags. D. Dampened cloths are used for dusting the area.

Correct Answer is B

Explanation

Choice A rationale:

Uncapped sharps being put in a puncture-resistant container (choice A) is a safe and appropriate practice for the disposal of sharp objects, such as needles. This choice demonstrates adherence to infection control principles and minimizes the risk of accidental needlestick injuries.

Choice B rationale:

Soiled linens being placed on the floor (choice B) is not a safe or acceptable practice. Placing soiled linens on the floor can lead to contamination of the environment and pose a risk of spreading infection. Proper linen disposal protocols should be followed, which may include using designated linen hampers or containers.

Choice C rationale:

Waste containers being lined with single bags (choice C) is a standard practice for waste disposal. Using single bags makes it easier to handle and dispose of waste materials safely. It is a recommended infection control measure.

Choice D rationale:

Dampened cloths being used for dusting the area (choice D) is generally a safe practice for cleaning and dusting surfaces. Dampened cloths can help prevent the spread of dust and allergens. However, it's essential to ensure that the cloths are cleaned and disinfected regularly to prevent bacterial growth.

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A nurse is preparing a client's body for a postmortem family viewing. Which of the following actions should the nurse take?

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A nurse is preparing a client's body for a postmortem family viewing.
Which of the following actions should the nurse take?