The nurse is assessing a client who is near death. Which of the following findings would indicate to the nurse that the client is in the actively dying phase?

Restlessness

Decreased appetite

Skin pallor

Anuria

Answer and Explanation

The Correct Answer is D

A. Restlessness: This may occur in the pre-active phase of dying but is not specific to the actively dying phase.

B. Decreased appetite: A reduced appetite is common earlier in the dying process, not specific to the actively dying phase.

C. Skin pallor: Skin changes, such as pallor, occur earlier; mottling is more indicative of the actively dying phase.

D. Anuria: Anuria (absence of urine output) is a hallmark sign of multisystem failure and the actively dying phase.

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Correct Answer is A

Explanation

A. Administer oxygen via nasal cannula: The client's symptoms of dyspnea, chest pain, syncope, and hypotension suggest a possible acute cardiovascular event, such as a myocardial infarction (MI) or pulmonary embolism (PE). Administering oxygen should be the priority to improve oxygenation and prevent hypoxia, which could exacerbate the client's symptoms and further compromise cardiac function.

B. Administer prescribed pain medications. Pain relief may be necessary, but stabilizing oxygen levels is the priority.

C. Administer NS IV fluid. Fluid administration may be helpful, but oxygenation is more critical in this situation to address the potential underlying respiratory or cardiac issue.

D. Ask the provider for a dopamine prescription. While dopamine may be used in cases of shock, the immediate action should be to ensure the client is adequately oxygenated.

A. 0.9% normal saline IV at 100 mL/hr continuous B. Bumetanide (Bumex) 1 mg IV bolus every 12 hr C. Laboratory testing of serum potassium upon admission D. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain E. Treats certain arrhythmias through the process of ablation

Correct Answer is A

Explanation

A. 0.9% normal saline IV at 100 mL/hr continuous: This order requires clarification. In acute heart failure, fluid management is crucial. A continuous IV infusion of normal saline could exacerbate fluid overload and worsen heart failure. Typically, IV fluids are given cautiously or restricted in heart failure cases.

B. Bumetanide (Bumex) 1 mg IV bolus every 12 hr: This is a loop diuretic, which is appropriate for managing fluid overload in heart failure.

C. Laboratory testing of serum potassium upon admission: This is appropriate, as diuretics like Bumex can lower potassium levels, so it is important to monitor electrolyte levels.

D. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain: This is appropriate for pain management and to help with anxiety and breathing difficulties in acute heart failure.

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The nurse is assessing a client who is near death. Which of the following findings would indicate to the nurse that the client is in the actively dying phase?

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