A nurse is reinforcing teaching with a guardian about manifestations of the impending death of a child. Which of the following manifestations should the nurse include?
Urinary frequency
Difficulty swallowing
Decreased sleep
Increased senses
The Correct Answer is B
Rationale:
A. Urinary frequency: As death approaches, urinary output typically decreases due to reduced kidney perfusion. Urinary frequency is not a common sign of impending death and may suggest other unrelated conditions.
B. Difficulty swallowing: Difficulty swallowing is a common manifestation of impending death. As muscle tone declines, the child may struggle to manage secretions or food, increasing the risk of aspiration and signaling the body is shutting down.
C. Decreased sleep: Clients nearing death often exhibit increased sleep or lethargy, not decreased sleep. Diminished responsiveness and longer periods of unresponsiveness are expected in the final stages of life.
D. Increased senses: Sensory function generally declines as death nears. Vision, hearing, taste, and touch may all diminish, and the child may become less responsive to external stimuli. Increased senses are not expected at this stage
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. "Rest in supine position for 30 minutes after a meal.": Lying flat after a meal increases the risk of aspiration particularly in stroke clients who may have impaired swallowing. A more upright position should be encouraged during and after meals to reduce this risk.
B. "Dress the affected side first.": Dressing the affected side first promotes independence and makes the task easier by minimizing the need for fine motor coordination on the impaired side. It also reduces frustration and helps establish a safe, consistent dressing routine.
C. "Use the arm on your affected side to brush your hair.": Stroke often leads to muscle weakness or paralysis on one side, making it difficult or unsafe to perform tasks with the affected limb. Initially, clients should use their stronger arm while the affected side is supported and rehabilitated gradually.
D. "Use a straw when you drink liquids.": Using a straw can increase the risk of aspiration in clients with post-stroke dysphagia by promoting rapid fluid intake. It is generally contraindicated until a swallowing assessment confirms that it is safe.
Correct Answer is B
Explanation
Rationale:
A. Social worker: A social worker assists with discharge planning, community resources, and emotional or financial support, but does not assess or manage swallowing difficulties.
B. Speech therapist: A speech therapist specializes in evaluating and treating swallowing disorders (dysphagia), especially after neurological events like a stroke. They play a crucial role in preventing aspiration and developing a safe feeding plan.
C. Physical therapist: A physical therapist focuses on mobility, strength, and ambulation training after injury or stroke. While vital for overall recovery, they are not involved in assessing or treating swallowing function.
D. Dentist: Dentists manage oral health, dental structures, and hygiene but are not involved in evaluating or treating swallowing difficulties related to stroke.
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