A nurse is providing postmortem care to a client who just died. Which of the following actions should the nurse take?

Ask the client's family about cultural or religious practices regarding postmortem care.

Remove the client's dentures from their mouth before rigor mortis begins.

Turn on all the lights in the room before the family views the client's body.

Position the client's bed flat without a pillow under their head.

Answer and Explanation

The Correct Answer is A

A. Ask the client's family about cultural or religious practices regarding postmortem care: Respecting the client's and family's cultural and religious preferences is an important aspect of providing dignified and individualized postmortem care. Some practices may have specific rituals that should be honored.

B. Remove the client's dentures from their mouth before rigor mortis begins: Dentures are usually placed back into the client's mouth, not removed, to maintain a natural facial appearance and support the facial structure before rigor mortis sets in.

C. Turn on all the lights in the room before the family views the client's body: Creating a calm, peaceful environment is preferred when the family views the body. Harsh lighting may feel overwhelming or intrusive during such an emotional time.

D. Position the client's bed flat without a pillow under their head: Elevating the head of the bed slightly and placing a pillow under the head can help prevent blood from pooling in the head and face, preserving a more natural appearance. Leaving the bed flat is not ideal.

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Correct Answer is ["C","D"]

Explanation

Hoarseness: Mild hoarseness is a common temporary effect after thyroid surgery due to irritation or swelling near the recurrent laryngeal nerve. While it needs monitoring, slight hoarseness alone is not necessarily a sign of a serious complication if it is not worsening or associated with airway compromise.
Drainage: A moderate amount of serosanguineous drainage from the incision site is expected after surgery. Although the drainage should continue to be monitored for increase or color change, the amount described here is not immediately concerning for a postoperative complication.
Sensation: The client reports tingling in the fingers, which suggests hypocalcemia due to accidental removal or damage to the parathyroid glands during surgery. Hypocalcemia is a serious complication of thyroidectomy that can progress to muscle cramps, tetany, and seizures if untreated.
Vital signs: The client’s rising temperature, tachycardia, hypertension, and increased respiratory rate are concerning for a developing thyroid storm, a rare but life-threatening complication after thyroid surgery. These vital signs warrant immediate intervention to prevent rapid deterioration.
Pain assessment: A pain score of 3 out of 10 is mild and expected following surgery. This level of discomfort is manageable and not indicative of a major complication, provided it does not rapidly escalate or localize severely around the surgical site.

A. The infant was born large for gestational age. B. The infant has otitis media C. The infant is younger than 1 year of age. D. The infant's guardians are both over the age of 30.

Correct Answer is C

Explanation

A. The infant was born large for gestational age: Being large for gestational age is not recognized as a risk factor for child maltreatment. Risk factors are more often related to family dynamics, age, and social stressors rather than birth weight alone.

B. The infant has otitis media: Otitis media, or a middle ear infection, is a common pediatric illness and is not itself a risk factor for maltreatment. It reflects normal childhood health issues rather than abuse or neglect.

C. The infant is younger than 1 year of age: Infants under 1 year are particularly vulnerable to maltreatment because of their total dependence on caregivers and inability to communicate effectively. This age group is at the highest risk for serious injury from abuse.

D. The infant's guardians are both over the age of 30: Parental age over 30 does not inherently increase the risk for child maltreatment. Other factors like substance abuse, history of being abused, and high stress levels are more closely linked to maltreatment risk.

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A nurse is providing postmortem care to a client who just died. Which of the following actions should the nurse take?

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