RN exams end-of-life practice questions set 5

Correct answer:

The nurse would first try to determine why the client is refusing additional pain medication despite severe pain, as understanding the reasonfear of addiction, side effects, or cultural beliefsguides effective, respectful care. Post-surgical pain needs management, but forcing treatment violates autonomy. Choice A, forcing medication, is unethical and illegal, ignoring consent and escalating distress. Choice C, telling the client it's needed, assumes refusal stems from ignorance, not addressing underlying concerns, and may erode trust. Choice D, reporting to the surgeon, delays action; nurses assess first to inform reports with data. Choice B is correct, reflecting nursing's patient-centered approachasking open-ended questions (e.g., What worries you about the medication?') uncovers barriers, enabling education (e.g., on safety) or alternatives (e.g., non-opioids), ensuring pain relief aligns with the client's values and needs post-surgery.

Correct answer:

Pressure ulcers require optimal nutrition for healing, and inadequate protein intake (Choice B) is the most likely reason for non-healing despite repositioning and skin care. Protein is essential for collagen synthesis, tissue repair, and immune function; deficiency causes negative nitrogen balance, stalling granulation and epithelialization. Prolonged bed rest already reduces muscle mass, exacerbating protein needs. Vitamin D (Choice A) aids calcium absorption for bone health, not directly wound healing, though it supports overall recovery. Massaging the affected area (Choice C) is contraindicated, as it damages fragile tissue, and isn't part of standard care here. Low calcium (Choice D) affects bones more than soft tissue repair. For example, a client needing 1.5-2 g/kg protein daily but receiving less won't heal, even with turning, as protein fuels fibroblast activity and angiogenesis. Thus, Choice B is the correct and primary factor.

Correct answer:

Pressure ulcers require optimal nutrition for healing, and inadequate protein intake (Choice B) is the most likely reason for non-healing despite repositioning and skin care. Protein is essential for collagen synthesis, tissue repair, and immune function; deficiency causes negative nitrogen balance, stalling granulation and epithelialization. Prolonged bed rest already reduces muscle mass, exacerbating protein needs. Vitamin D (Choice A) aids calcium absorption for bone health, not directly wound healing, though it supports overall recovery. Massaging the affected area (Choice C) is contraindicated, as it damages fragile tissue, and isn't part of standard care here. Low calcium (Choice D) affects bones more than soft tissue repair. For example, a client needing 1.5-2 g/kg protein daily but receiving less won't heal, even with turning, as protein fuels fibroblast activity and angiogenesis. Thus, Choice B is the correct and primary factor.

Correct answer:

Team ineffectiveness despite individual competence often stems from poor group dynamics, with unexpected feelings and emotions among staff (Choice B) being the usual culprit. Emotions like mistrust, resentment, or unresolved conflict disrupt communication and collaboratione.g., a nurse feeling undervalued might withhold input. Unhappiness about leadership change (Choice A) could contribute but isn't universal; new leaders can inspire if communication is strong. Fatigue from overwork (Choice C) reduces productivity but typically affects individuals uniformly, not just teamwork. Failure to involve staff in decisions (Choice D) is a factor, but emotions underlie its impacte.g., feeling ignored breeds frustration. Research (e.g., Tuckman's group development) shows emotional undercurrents derail forming cohesive teams. Addressing feelings via open forums or team-building restores function, making Choice B the correct and most common reason.

Correct answer:

Team ineffectiveness despite individual competence often stems from poor group dynamics, with unexpected feelings and emotions among staff (Choice B) being the usual culprit. Emotions like mistrust, resentment, or unresolved conflict disrupt communication and collaboratione.g., a nurse feeling undervalued might withhold input. Unhappiness about leadership change (Choice A) could contribute but isn't universal; new leaders can inspire if communication is strong. Fatigue from overwork (Choice C) reduces productivity but typically affects individuals uniformly, not just teamwork. Failure to involve staff in decisions (Choice D) is a factor, but emotions underlie its impacte.g., feeling ignored breeds frustration. Research (e.g., Tuckman's group development) shows emotional undercurrents derail forming cohesive teams. Addressing feelings via open forums or team-building restores function, making Choice B the correct and most common reason.

Correct answer:

The nurse expects a client with chronic cancer pain to be a candidate for patient-controlled analgesia (PCA), as PCA allows self-administration of opioids within safe limits, ideal for managing persistent, severe pain common in cancer. It empowers alert clients to control pain flare-ups, enhancing comfort. Choice A, a confused client, isn't suitablePCA requires cognitive clarity to operate safely, preventing overdose. Choice C, a client unable to push a button, can't use PCA due to physical limitation, needing alternative delivery like IV drips. Choice D, a client with drug addiction history, may be excluded due to misuse risk, though not absoluteit depends on oversight, but cancer pain trumps this concern typically. Choice B is correct, reflecting PCA's design for coherent, pain-afflicted clients, aligning with nursing goals to optimize pain relief in chronic conditions like cancer, where fluctuating pain needs responsive management.

Correct answer:

The nurse expects a client with chronic cancer pain to be a candidate for patient-controlled analgesia (PCA), as PCA allows self-administration of opioids within safe limits, ideal for managing persistent, severe pain common in cancer. It empowers alert clients to control pain flare-ups, enhancing comfort. Choice A, a confused client, isn't suitablePCA requires cognitive clarity to operate safely, preventing overdose. Choice C, a client unable to push a button, can't use PCA due to physical limitation, needing alternative delivery like IV drips. Choice D, a client with drug addiction history, may be excluded due to misuse risk, though not absoluteit depends on oversight, but cancer pain trumps this concern typically. Choice B is correct, reflecting PCA's design for coherent, pain-afflicted clients, aligning with nursing goals to optimize pain relief in chronic conditions like cancer, where fluctuating pain needs responsive management.

Correct answer:

A primary nursing intervention for sleep-rest disorders is promoting a consistent sleep routine, which helps regulate the body's circadian rhythm and improve sleep quality. This includes maintaining regular bedtimes, creating a calming pre-sleep environment, and minimizing disruptions. Choice A, encouraging late-night activities, would worsen sleep difficulties by stimulating the patient when they should be winding down. Choice C, increasing caffeine intake, is counterproductive as caffeine is a stimulant that interferes with sleep onset and quality. Choice D, limiting fluid intake all day, is impractical and unrelated to sleep improvementwhile reducing fluids before bed might prevent nighttime awakenings, all-day restriction risks dehydration. Choice B is the best approach, as it addresses the root of many sleep-rest issues by fostering habits that support restorative sleep, a critical aspect of patient recovery and well-being.

Correct answer:

A primary nursing intervention for sleep-rest disorders is promoting a consistent sleep routine, which helps regulate the body's circadian rhythm and improve sleep quality. This includes maintaining regular bedtimes, creating a calming pre-sleep environment, and minimizing disruptions. Choice A, encouraging late-night activities, would worsen sleep difficulties by stimulating the patient when they should be winding down. Choice C, increasing caffeine intake, is counterproductive as caffeine is a stimulant that interferes with sleep onset and quality. Choice D, limiting fluid intake all day, is impractical and unrelated to sleep improvementwhile reducing fluids before bed might prevent nighttime awakenings, all-day restriction risks dehydration. Choice B is the best approach, as it addresses the root of many sleep-rest issues by fostering habits that support restorative sleep, a critical aspect of patient recovery and well-being.

Correct answer:

Blunt chest trauma from a motor vehicle accident can compromise airway, breathing, or circulation (ABCs), the nurse's top priorities. Assessing the client's airway (Choice A) is first because obstruction (e.g., from blood, swelling, or foreign objects) or injury (e.g., pneumothorax) threatens life within minutes. Signs like stridor, cyanosis, or absent breath sounds demand immediate actione.g., suctioning or intubation. Pain relief (Choice B) is vital but secondary, as unrelieved pain won't kill instantly, unlike airway loss. Encouraging deep breathing and coughing (Choice C) risks worsening injuries like rib fractures or flail chest if airway isn't secured. Splinting the chest (Choice D) aids breathing but assumes airway patency. For example, a tracheal deviation from tension pneumothorax detected during airway assessment takes precedence over pain. ABC prioritization ensures survival, making Choice A the correct first step.