NUR 130 Exam 4

Correct Answer is:

B. Financial concerns

C. Cultural practices

D. Religious beliefs

E. Gender

Explanation:

Several factors influence a client’s perception of death, including financial concerns, cultural practices, religious beliefs, and gender. Each of these factors plays a significant role in how a person understands and copes with death and the dying process.

B. Financial concerns:

Financial concerns can influence how individuals approach death, especially in terms of end-of-life care and funeral arrangements. The financial strain of medical bills, insurance, and funeral costs can impact the overall experience and perception of death, as these practical issues can add stress and affect emotional well-being.

C. Cultural practices:

Cultural practices are crucial in shaping how individuals perceive and experience death. Different cultures have distinct rituals, beliefs, and mourning practices, which affect the individual’s response to death. Cultural norms may dictate how grief is expressed, how death is understood, and what happens after death, influencing one’s emotional response.

D. Religious beliefs:

Religious beliefs often offer a framework for understanding the afterlife, the purpose of life, and the significance of death. These beliefs strongly shape how a person perceives death, influences their coping mechanisms, and can provide comfort and meaning during the grieving process.

E. Gender:

Gender influences how individuals express grief and cope with loss, as societal norms often shape emotional expression. Men and women might experience and demonstrate grief differently due to cultural expectations of their roles and emotional responses, which can affect their perceptions of death.

Why the Other Option is Incorrect:

A. Education level:

While education may affect an individual’s general understanding of death, it does not directly influence their emotional or cultural perception of death. Education might provide more information about death, but it is not as critical a factor as financial concerns, cultural practices, religious beliefs, or gender when it comes to the perception of death.

Summary:

The perception of death is strongly influenced by financial concerns, cultural practices, religious beliefs, and gender. While education provides knowledge, it is not a primary factor in shaping emotional or cultural responses to death.

The correct answers are: A. Give the client privacy when providing care.

B. Demonstrate empathy when caring for the client.

C. Perform nasopharyngeal suctioning to clear the client's secretions.

Explanation:

At the end of life, it is essential to maintain the client's dignity and provide care that respects their needs and wishes. Below is an explanation of the correct answers:

A. Give the client privacy when providing care:

Providing privacy during care ensures that the client feels respected and maintains their personal dignity. This helps them feel more in control and less vulnerable, which is especially important at the end of life.

B. Demonstrate empathy when caring for the client:

Empathy involves understanding the client's emotions and providing compassionate care. Demonstrating empathy at the end of life helps the client feel understood and valued, which is crucial for preserving their dignity during this challenging time.

C. Perform nasopharyngeal suctioning to clear the client's secretions:

If the client is experiencing excessive secretions, performing suctioning may help keep them comfortable and prevent discomfort. This is an appropriate action to manage symptoms at the end of life, improving the client's quality of life while maintaining their dignity.

Why the other options are incorrect:

D. Tell the client that their condition will improve:

This is misleading and dishonest. At the end of life, clients and families should be provided with honest information about the prognosis. Offering false hope can lead to confusion and loss of trust, which diminishes the client’s dignity.

E. Provide care with an optimistic attitude:

While it’s important to be compassionate and supportive, being overly optimistic about the client’s condition when the end is imminent can be misleading. It is better to be realistic and offer emotional support that aligns with the client’s current state and needs.

Summary:

To support the client's dignity at the end of life, the nurse should focus on providing privacy, demonstrating empathy, and addressing symptoms (like secretions) appropriately. It is important to avoid offering false hope and instead, engage in honest, compassionate care.

Correct Answer: A. Arrange for the client to receive home health care services

Explanation:

Case management services are designed to coordinate care, facilitate transitions, and ensure that clients receive the appropriate services and resources across the healthcare continuum. A primary responsibility of the case manager is to arrange referrals and coordinate services, such as home health care, physical therapy, durable medical equipment, or community support. This ensures that the client’s care is well-organized, cost-effective, and individualized, especially after discharge or during complex treatment plans.

Why the Other Options Are Incorrect:

B. Write a prescription for the client’s medications

This is outside the scope of case management. Only licensed prescribers such as physicians, nurse practitioners, or physician assistants can write prescriptions. Case managers may help facilitate the process, but they do not have prescribing authority.

C. Perform nursing skills for the client such as dressing changes

This is a direct care responsibility of licensed nurses, not case managers. Case managers focus on coordination, planning, and communication, not the performance of hands-on clinical procedures.

D. Provide education to the client about adverse effects of their medications

While case managers may participate in client advocacy and general support, medication education is typically the role of nurses, pharmacists, or providers, who have the appropriate scope and expertise to educate clients about drug therapies.

Summary:

The correct answer is A. Arrange for the client to receive home health care services, as this reflects the core function of case management, which is to coordinate services and ensure that the client receives necessary care and support across settings. The other options fall within the scope of direct clinical care or prescribing, which are not case manager responsibilities.

Correct Answers:

B. Speak slowly

C. Encourage questions

D. Use the teach-back method

Explanation:

When reinforcing teaching with a client who has low health literacy, the nurse should use communication strategies that promote understanding, engagement, and retention of information. Health literacy refers to a client's ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

B. Speak slowly

Speaking slowly gives the client more time to process the information being presented. It reduces cognitive overload and helps ensure that key points are understood, especially for individuals who may feel overwhelmed or embarrassed by complex medical discussions.

C. Encourage questions

Creating a welcoming and nonjudgmental environment where clients feel safe to ask questions promotes clarity and active learning. Encouraging questions empowers the client and helps the nurse identify misunderstandings.

D. Use the teach-back method

This evidence-based technique involves asking the client to repeat the information back in their own words. It allows the nurse to assess understanding and clarify or reteach as needed. Teach-back is especially helpful in improving comprehension in clients with low health literacy.

Why the Other Options Are Incorrect:

A. Provide written materials

While this may seem helpful, written materials alone are not effective for clients with low health literacy—especially if they are written at a high reading level. If written materials are used, they should be supplemented with verbal explanations and be written in plain language with visual aids.

E. Use medical terminology

Using complex medical language or jargon can confuse clients with low health literacy. Nurses should avoid medical terminology and instead use simple, clear, everyday words to explain health information.

Summary:

The correct actions to take when teaching a client with low health literacy are B. Speak slowly, C. Encourage questions, and D. Use the teach-back method. These techniques promote understanding, increase client engagement, and reduce the risk of miscommunication.

Correct Answer is D. Burn injury

Explanation:

A burn injury is a clear example of a physiological stressor, as it directly affects the body’s physical functioning. Physiological stressors are those that result from actual physical damage or disruption to the body, such as illness, injury, pain, or extreme temperatures. These stressors activate the body’s stress response system, including hormonal and immune reactions, as the body attempts to restore balance.

Why the Other Options are Incorrect:

A. Academic pressure:

Academic pressure is a psychological stressor, as it originates from emotional and mental demands related to school performance, exams, and deadlines. It does not involve direct physical harm to the body.

B. Financial difficulties:

Financial difficulties are also psychological stressors. They can lead to anxiety and worry but are not considered physiological because they do not cause immediate physical injury or disruption to body systems.

C. Change in marital status:

A change in marital status (such as divorce or marriage) is a life event stressor that falls under psychological or emotional stress. It may affect mental health but is not inherently a physiological stressor.

Summary:

The correct action is D. Burn injury. Physiological stressors involve direct physical challenges to the body, such as injury or illness, whereas academic, financial, and marital issues are psychological in nature.

Correct Answer: B. Efficiency in client-care services

Explanation:

An interprofessional team involves healthcare professionals from different disciplines working collaboratively to provide comprehensive care. One significant benefit of this team-based approach is efficiency in client-care services. The collective expertise of various professionals leads to improved communication, faster decision-making, and a more coordinated care plan. This reduces delays and redundancy, resulting in a more efficient process for delivering care.

Why the Other Options Are Incorrect:

A. Decrease number of referrals needed for client

An interprofessional team might not necessarily decrease the number of referrals. In fact, it could lead to more referrals to specialists as different professionals collaborate to provide comprehensive care. The goal of the team is to ensure that all aspects of a patient's care are addressed, which may involve referring the patient to various specialists.

C. Increase in length of stay for client

The goal of an interprofessional team is to improve patient care, and this often leads to a reduction in the length of stay. By providing timely and coordinated interventions, the team can address issues more efficiently, potentially shortening the hospital stay.

D. Decrease the number of visits to client by staff

The number of visits made by staff might not decrease with an interprofessional team. The main focus of such teams is to ensure that the right care is provided at the right time, which could either increase or decrease the frequency of visits depending on the patient's needs. The priority is the quality of care, not the reduction in visits.

Summary:

The correct answer is B. Efficiency in client-care services, as the collaborative nature of an interprofessional team enhances the efficiency of care delivery. The other options do not directly relate to the primary benefits of working in an interprofessional team.

Correct Answer is D. Disenfranchised grief.

Explanation:

Disenfranchised grief occurs when an individual experiences grief but is unable to openly mourn or is not recognized as having a valid reason to grieve. In this case, the client is grieving the loss of a pet and feels alone in their grief, which often happens when the grief is not socially acknowledged or considered significant by others. Pets are often seen as family members, but society may not fully recognize the depth of the emotional bond, leading the person to feel isolated in their mourning process.

Why the Other Options are Incorrect:

A. Uncomplicated grief:

Uncomplicated grief refers to the normal grieving process that most people experience after a loss, without prolonged or excessive symptoms. The client’s experience of feeling alone in their grief may indicate disenfranchised grief, where the grief is not recognized or supported by society, rather than a typical uncomplicated process.

B. Prolonged grief:

Prolonged grief is characterized by grief that lasts longer than expected (typically over six months) and interferes significantly with the individual’s functioning. The client in this scenario is not describing an unusually long duration of grief, only that they feel isolated in the process, which points more to disenfranchised grief.

C. Anticipatory grief:

Anticipatory grief occurs before the actual loss, typically when someone is aware that a loss is imminent, such as in the case of a terminal illness. The client is grieving after the loss has occurred, which makes anticipatory grief an incorrect option in this case.

Summary:

The client is experiencing disenfranchised grief, as they are grieving the loss of a pet and feeling alone in their grief, suggesting that their grief is not fully acknowledged or supported by others. This type of grief is often not openly expressed or socially recognized, making the individual feel isolated.

Correct answers:

A. Elevate the client's head of bed

C. Give the client mouth care every 2 hr

D. Increase the temperature in the client's room

E. Administer an opioid narcotic to the client

Explanation:

The client is in the active phase of dying, as indicated by decreased responsiveness, irregular breathing with rhonchi, mottling, and declining vital signs. The nurse’s role at this stage focuses on comfort care, not prolongation of life.

A. Elevate the client's head of bed:

Elevating the head promotes lung expansion, eases labored breathing, and helps drain secretions, improving the client's comfort.

C. Give the client mouth care every 2 hr:

Frequent oral care keeps the mouth moist and clean, reducing discomfort caused by dry mucous membranes, which is common in dying clients who can no longer eat or drink.

D. Increase the temperature in the client's room:

As peripheral circulation declines, extremities become cold. A warmer environment helps maintain comfort and reduces shivering or chill in the unconscious client.

E. Administer an opioid narcotic to the client:

Opioids are used to relieve pain and ease dyspnea, both of which the client is exhibiting (moaning, grimacing, tachypnea). This is an essential intervention in hospice care.

Why the incorrect option is wrong:

B. Insert a nasogastric tube for enteral feeding:

Not appropriate at end-of-life. Artificial feeding in dying clients often leads to increased secretions, aspiration risk, and discomfort, without improving quality of life.

Summary:

End-of-life care should prioritize non-invasive comfort measures such as positioning, oral hygiene, warmth, and effective pain management. Invasive procedures like tube feeding are contraindicated during the dying process.

Correct Answer: A. Planning

Explanation:

The planning phase of the nursing process involves setting measurable, client-centered goals and desired outcomes to guide nursing care. When the nurse is formulating goals for a positive outcome, they are identifying what they and the client hope to achieve as a result of the interventions. These goals should be SMART (Specific, Measurable, Achievable, Relevant, and Time-bound), and they form the foundation for choosing appropriate nursing actions.

Why the Other Options Are Incorrect:

B. Implementation

Implementation is the step where the nurse carries out the interventions designed in the planning phase. It does not involve setting goals but rather acting on the established care plan.

C. Assessment

Assessment is the first step of the nursing process. It involves gathering subjective and objective data about the client’s health status through observation, interviews, and physical exams. Goals are not set at this stage.

D. Evaluation

Evaluation is the final step of the nursing process. It involves determining whether the goals and outcomes were achieved and whether the interventions were effective. It may lead to revising the plan but does not involve formulating new goals.

Summary:

The correct answer is A. Planning, as this is the step where the nurse develops specific goals and desired outcomes to promote a positive result in the client’s care.