NR-226 Patient Care Fundamentals - Set 5 - Part 2

Correct Answer: Hospice neither hastens nor postpones his death.

Hospice supports the natural dying process without speeding or delaying it, and families need that stated plainly. Saying it directly addresses the daughter's fear that choosing hospice causes her father's death. Option a is incorrect because any sentence beginning with the words at least minimizes the loss and tells the listener her pain is smaller than she believes. It also sidesteps the guilt she voiced. Option b is incorrect because telling a family member not to worry is false reassurance. Her concern is factual as well as emotional, and dismissing it leaves the misconception about hospice completely uncorrected. Option d is incorrect because handing the daughter off names her feeling as guilt she did not claim and ends the conversation. Chaplain support may help later, once the nurse has answered what she actually asked.

Correct Answer: Stay with the client and report concerns

Remaining with a distressed client and reporting what is observed is within the assistive personnel's scope and keeps the client from being left alone while the nurse arranges provider and social work involvement. Option a is incorrect because judging self-harm risk requires nursing assessment and clinical judgment, which cannot be transferred. Assistive personnel may report what they see and hear, but they do not evaluate it. Option c is incorrect because teaching belongs to the registered nurse and is poorly timed here. A woman in acute shock cannot absorb information about grief; presence and safety come before any explanation. Option d is incorrect because identifying a client's coping strategies is an assessment activity requiring interpretation of the answers given. Delegating it would hand a nursing judgment to someone not licensed to make it.

Correct Answer: Explain that anniversary surges of grief are normal

A sudden temporary upsurge of grief around anniversaries, holidays and birthdays is expected for years and is not a relapse. Because his appetite and work are intact, normalizing the surge is the right response. Option b is incorrect because prolonged grief disorder describes grief that never attenuates and disables daily function. This man is working and eating, and a brief anniversary surge does not meet that threshold. Option c is incorrect because medicating ordinary grief treats the observer's discomfort rather than the mourner's need. Sedation blunts the emotional work that has to happen and offers this man nothing he cannot get from being heard. Option d is incorrect because steering someone away from reminders promotes avoidance, which is the pattern that stalls mourning. Anniversaries are an opportunity to remember deliberately, with support, rather than a hazard to be dodged.

Correct Answer: Answer his questions honestly at the level asked

School-age children understand death as final and want concrete, biological facts, sometimes graphically. Honest answers pitched to the question asked prevent them from filling the gaps with something worse than the truth. Option a is incorrect because steering a child toward pleasant memories closes a topic he has deliberately opened. Curiosity about the body is developmentally ordinary at this age and is not a sign of distress. Option b is incorrect because shaming the question teaches the child that grief is forbidden conversation. He will stop asking his parents and start assembling answers from classmates and the internet instead. Option c is incorrect because a nine-year-old already grasps that death is permanent and universal. Deferring the truth to some later age leaves him alone with a gap that his imagination will fill badly.

Correct Answer: Refer her to a grief counseling professional

Grief that has not eased after more than a year, with avoidance of the name, social withdrawal and escalating alcohol use, meets the criteria for referral. Evidence-based psychotherapy, not reassurance, is the first-line treatment. Option a is incorrect because reassurance alone leaves three referral triggers unaddressed. Grief truly has no deadline, but this woman shows avoidance, withdrawal and new substance use, and none of those resolves by being normalized. Option b is incorrect because waiting converts a recognized problem into a delayed one. Nightly drinking to fall asleep escalates while the nurse watches, and the criteria for referral are already satisfied at this point. Option d is incorrect because clearing out possessions is the survivor's decision and her timing, not an intervention a nurse assigns. Forcing that step can deepen distress and does nothing about the drinking or the isolation.

Correct Answer: Choose low-residue foods with protein and calories

During a flare the ulcerated bowel is irritated mechanically by roughage, so low-residue eating reduces stool bulk while high-protein, high-calorie choices in small frequent meals counter the catabolism the inflammation is driving. Option a is incorrect because the high-fibre advice belongs to constipation prevention and cancer risk reduction, not to an actively inflamed bowel. Bran and raw vegetables scrape ulcerated mucosa and worsen cramping and diarrhoea. Option c is incorrect because permanent blanket restriction deepens the malnutrition these clients already carry. Once remission returns, fibre is reintroduced gradually, with the lasting exception of someone who has a known stricture. Option d is incorrect because prolonged bowel rest is reserved for fulminant disease, obstruction or a high-output fistula, and it is prescribed rather than self-imposed. Two weeks of clear liquids would starve a client who is already catabolic.

Correct Answer: Report the whole tablets to the prescriber

Fast transit and a bypassed colon can carry an extended-release or enteric-coated tablet through undissolved, so a pill in the pouch is a dose the client never received. The prescriber can switch to an absorbable form. Option b is incorrect because crushing an extended-release tablet releases the whole load at once and can cause toxicity. Any change of formulation goes through the pharmacist and prescriber, never the client alone. Option c is incorrect because self-adjusting a dose invites overdose on the days when absorption happens to be adequate. The safe response is to report the finding, not to guess at how much drug got through. Option d is incorrect because bulk-forming fibre binds and delays other oral drugs rather than helping them dissolve. In an ileostomy it also adds an unwanted volume of undigested material to a narrow lumen.

Correct Answer: Explain the options and document the discussion

The nurse provides information, assesses understanding, and documents the response, which is exactly what the federal admission requirement asks of the facility. Teaching what a directive does is nursing practice, not legal advice. Option a is incorrect because the document belongs to the client and must reflect his values, not the nurse's. Filling it out for him crosses the boundary of the nursing role and may invalidate it. Option c is incorrect because steering the client toward a particular agent is pressure disguised as help. He might prefer a sibling or a friend, and the choice of proxy is his alone to make. Option d is incorrect because the question must be asked and answered at admission, when the client can still participate. Waiting risks a sudden decline that leaves the team with no guidance at all.

Correct Answer: Remeasure the stoma before cutting each new opening

The stoma keeps shrinking for about six to eight weeks, so an opening traced from an older wafer no longer fits. Remeasuring at each change keeps the opening no more than an eighth of an inch larger. Option a is incorrect because a generously oversized opening leaves bare skin sitting under the effluent. Ileostomy output carries active digestive enzymes and can excoriate exposed peristomal skin within hours of a change. Option b is incorrect because an opening cut flush presses its edge against fragile mucosa. The result is trauma, bleeding and oedema, and a tight rim can even constrict the stoma's circulation. Option c is incorrect because lotions and oily products leave a residue that stops the adhesive from sticking. Peristomal skin is cleaned with plain warm water and patted completely dry before anything is applied.

Correct Answer: Perceived loss experienced only by him

A perceived loss is felt and defined by the client but cannot be verified by anyone else. Feeling less than a whole man after surgery is intangible to observers yet fully real to him. Option a is incorrect because an actual loss is one bystanders can confirm, such as the surgical removal of the gland itself. What this client reports lives entirely in his own appraisal of himself. Option b is incorrect because necessary losses are the unavoidable ones built into ordinary living and usually replaced by something different, like a grown child moving away. Surgical change to body image does not fit that category. Option d is incorrect because maturational losses arrive with predictable developmental transitions such as retirement or the empty nest. Surgery is not a developmental milestone, so the label misplaces where this man's distress comes from.

Correct Answer: John Bowlby and the grief phases

Bowlby built his grief phases on attachment theory, arguing that mourning behavior is the attachment system responding to the loss of the attachment figure. Searching and protest mirror infant separation behavior. Option a is incorrect because Rando described mourning as six processes, recognize through reinvest, and is remembered for drawing attention to secondary losses. Her model does not rest on infant attachment behavior. Option b is incorrect because Worden framed mourning as active work, four tasks the mourner performs in any order. Tasks generate interventions; they do not explain why separation behavior looks the way it does. Option c is incorrect because Kubler-Ross drew five responses from interviews with dying patients rather than from bereaved survivors. Her work names emotional states and never proposes an attachment mechanism behind them.

Correct Answer: Reposition him side-lying with head elevated

Gravity drains pooled secretions when the client is turned to the side with the head of the bed raised. It is the first and least invasive action, and it is paired with teaching the family. Option a is incorrect because deep suctioning is invasive, causes gagging, coughing and mucosal trauma, and stimulates the production of still more secretions. Only gentle removal of visible secretions in the mouth is appropriate. Option c is incorrect because added fluid feeds the very secretions causing the sound. Artificial hydration is reduced or stopped at this stage, since a higher weekly fluid volume raises the risk of this rattle. Option d is incorrect because a diuretic treats volume overload in the lungs, a different problem from saliva pooling in the throat. Diuresis would not touch this sound and would add a catheter and discomfort.

Correct Answer: A portable medical order set

A portable medical order set is signed by a clinician, takes effect immediately, and travels with the client across settings. It is the only one of these documents that paramedics are authorized to act on. Option b is incorrect because a living will is a legal statement of future wishes rather than a medical order, and it takes effect only after capacity is lost. Emergency crews cannot act on it. Option c is incorrect because naming a decision maker helps once someone reaches the hospital and consent is needed. During the first minutes of a collapse at home, there is no time to locate that agent. Option d is incorrect because an admission consent authorizes care during a hospital stay and expires with the discharge. It carries no information about resuscitation preferences and never leaves the medical record.

Correct Answer: Close the door and allow unhurried time

Providing genuine privacy and unhurried time is within the assistive role and is one of the highest-yield interventions here. A client who cannot relax the external sphincter will not defecate, whatever else is ordered. Option a is incorrect because giving medication is not an assistive personnel task, and no softener has been mentioned in this client's orders. The barrier described is environmental rather than pharmacologic. Option b is incorrect because abdominal assessment requires interpretation of contour, tenderness and bowel sounds, which the licensed nurse performs. Assistive staff may report what they observe but cannot carry out the examination itself. Option d is incorrect because dietary teaching belongs to the nurse and dietitian, who tailor advice to the client's other conditions. Reinforcing a plan already taught is different from delivering the instruction outright.

Correct Answer: Fat is not being absorbed properly

Bulky, greasy, floating, foul stool is steatorrhea, the hallmark of fat malabsorption. Pancreatic insufficiency from chronic pancreatitis removes the enzymes needed to digest fat, so calories pass through and weight falls. Option a is incorrect because absent bile produces pale, putty-like stool accompanied by jaundice and dark urine. Those features belong to biliary obstruction, and the greasy floating quality described here points to fat instead. Option c is incorrect because upper gastrointestinal bleeding turns stool black, tarry and sticky. Nothing in this description mentions color change or the characteristic odor of degraded blood, and pancreatitis does not cause melena. Option d is incorrect because a narrowing lesion in the distal colon shows up as pencil-thin, ribbon-like stool. Caliber is the finding that raises that concern, and this client described bulk rather than narrowing.

Correct Answer: The nonhealing ulcer on the leg

A wound that has not progressed signals impaired tissue integrity with real infection risk, an actual physiological problem outranking the contributing factors. Sustained cortisol suppresses collagen synthesis, which explains the stalled healing. Option a is incorrect because a single reading above baseline needs rechecking and follow-up rather than immediate action. Sustained sympathetic tone and cortisol explain the rise, but no tissue is breaking down from it today. Option b is incorrect because sleep loss keeps the stress axis switched on and belongs in the plan, yet it is a contributing cause rather than the damaged tissue in front of the nurse. Option c is incorrect because irregular eating destabilizes energy and mood over time and deserves dietary counseling. Meal advice cannot substitute for evaluating an open wound that has failed to close.

Correct Answer: Maciejewski and Prigerson in the Yale study

The six-month peak comes from the Yale Bereavement Study, reported by Maciejewski, Zhang, Block and Prigerson as an empirical test of stage theory. Nursing texts frequently misattribute this finding to Parkes. Option b is incorrect because Parkes studied bereaved widows and gave the phase model its empirical grounding, but the timing of the grief peak is not his result. Keeping the two attributions apart is the point of the item. Option c is incorrect because Bowlby worked from attachment theory and clinical observation rather than longitudinal survey data. His contribution explains why grief behavior resembles infant separation protest, not when grief intensity crests. Option d is incorrect because the dual process model addresses how mourners alternate between confronting loss and rebuilding life. Stroebe and Schut proposed a mechanism of coping and never published a timetable for grief intensity.

Correct Answer: Eustress from a positive life demand

Eustress is the stress response to a demand appraised as challenging and motivating rather than overwhelming. A wedding is a positive life event that still requires readjustment, and the member describes drive and improved functioning. Option a is incorrect because distress describes a response that overwhelms the person and impairs performance. This member reports energy and focus, not depletion, so the label does not fit what she experienced. Option b is incorrect because allostatic load names the cumulative biological wear that builds when the body repeatedly resets its set points over months or years. A single happy summer event has not produced that. Option d is incorrect because exhaustion is the third stage of the general adaptation syndrome, reached only after reserves are spent. Nothing here suggests depleted reserves; the wedding planning ended and she recovered fully.

Correct Answer: A right-sided colon lesion bleeding occultly

The right colon has a wide lumen and liquid contents, so a tumour there bleeds slowly into stool that hides and degrades the blood. Iron-deficiency anaemia with fatigue is often the first sign. Option a is incorrect because a rectal lesion irritates a sensitive, low-capacity reservoir and produces urgency, incomplete evacuation and visible red blood. This woman reports none of those local symptoms. Option b is incorrect because haemorrhoidal bleeding is bright, visible on the paper or in the bowl, and rarely heavy enough to drain iron stores this quietly. Nothing here suggests anorectal bleeding at all. Option c is incorrect because the sigmoid holds formed stool in a narrow tube, so a lesion there announces itself by changing stool calibre and causing obstructive cramping. The absence of that change points elsewhere.

Correct Answer: Situational loss from an unpredictable event

Situational loss is sudden, externally caused and outside normal development. A stroke in a previously well man strips mobility and work role without warning, which is exactly the pattern this category names. Option b is incorrect because maturational loss belongs to predictable life-stage transitions such as menopause, retirement or an empty nest. Nothing about a sudden stroke in midlife follows a developmental timetable. Option c is incorrect because a necessary loss is unavoidable, part of living, and generally replaced by something different, as when a toddler gives up the bottle. Nothing replaces what this stroke took. Option d is incorrect because anticipatory loss is grieved ahead of an expected event, giving the family time to prepare. This stroke had already happened when he arrived, so the grieving follows rather than precedes it.