A nurse is reinforcing teaching about end-of-life care with the partner of a client. Which of the following statements should the nurse make?

"Encourage your partner to eat three large meals each day."

"We will use an electric blanket to keep your partner warm."

"Opioids will be restricted if your partner develops respiratory distress."

"Assume your partner can hear you, even if they do not respond."

Answer and Explanation

The Correct Answer is D

Choice A Reason:

"Encourage your partner to eat three large meals each day." In end-of-life care, the focus shifts from large meals to providing comfort and meeting the patient's nutritional needs, which might not involve large meals due to potential decreased appetite or difficulty swallowing.

Choice B Reason:

"We will use an electric blanket to keep your partner warm. “While keeping the patient warm is essential, the use of an electric blanket might not always be appropriate due to the risk of burns or changes in sensation that can occur in some conditions.

Choice C Reason:

"Opioids will be restricted if your partner develops respiratory distress. “This statement might not convey the full context of pain and symptom management in end-of-life care. Opioids are often used judiciously to manage distressing symptoms, including pain and respiratory distress, under careful monitoring rather than being strictly restricted.

Choice D Reason:

"Assume your partner can hear you, even if they do not respond." This statement emphasizes the importance of communication and connection with the partner who may be unresponsive. Research suggests that hearing may persist even when a person is unable to respond, so speaking to the person respectfully and with care can provide comfort and support during this time.

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Correct Answer is B

Explanation

Choice A Reason:

Providing video games prior to bedtime might actually stimulate the child and make it harder for them to relax and fall asleep.

Choice B Reason:

Follow the child's home sleep routine to reduce anxiety. Maintaining consistency with the child's home sleep routine can provide familiarity and comfort, potentially reducing anxiety and promoting better sleep. This familiarity can help the child feel more secure and relaxed, aiding in the transition to sleep in an unfamiliar environment.

Choice C Reason:

Leaving the lights on in the child's room can disrupt the child's ability to achieve restful sleep as the environment may not be conducive to falling and staying asleep.

Choice D Reason:

Allowing the child to adjust their bedtime might not be the best approach in a hospital setting, as maintaining some routine and structure could be more beneficial for their recovery and overall well-being during the hospital stay.

A. Assess respiratory status. B. Examine the scalp for lacerations. C. Check pupil reactions. D. Inspect for fluid leaking from the ears.

Correct Answer is A

Explanation

Choice A Reason:

Assess respiratory status is correct. Ensuring the child's respiratory status is the first priority in any emergency situation. A head injury might result in an altered level of consciousness, which can compromise the child's ability to maintain a patent airway or adequate breathing. Assessing respiratory status involves observing breathing patterns, chest movements, and ensuring airway patency to ensure the child is adequately oxygenated.

Choice B Reason:

Examining the scalp for lacerations is incorrect. While assessing for any lacerations or external signs of head trauma is essential, it's not the primary immediate concern. The focus should be on ensuring the child's respiratory status and stabilizing their condition first.

Choice C Reason:

Checking pupil reactions is incorrect. Assessing pupil reactions is crucial in evaluating neurological function after a head injury. However, assessing respiratory status takes precedence as it is the most critical and immediate concern in any emergency situation.

Choice D Reason:

Inspecting for fluid leaking from the ears is incorrect. Fluid leaking from the ears might indicate a serious head injury, potentially involving the skull base. While this is an important assessment, it doesn't take priority over assessing the child's respiratory status, which is crucial for immediate intervention to ensure adequate oxygenation.

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A nurse is reinforcing teaching about end-of-life care with the partner of a client. Which of the following statements should the nurse make?

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