PN Fundamentals of Nursing 2020 with NGN Exam 2
ATI PN Fundamentals of Nursing 2020 with NGN Exam 2
Total Questions : 49
Showing 10 questions Sign up for moreA nurse is reinforcing teaching with a newly hired nurse about cultural sensitivity during death and dying. Which of the following information should the nurse include?
Explanation
A. Devout practitioners of Buddhism prefer a ritual bath prior to burial.
Explanation: In Buddhism, the funeral customs can vary widely depending on the cultural and regional practices. Some Buddhists may prefer cremation, while others may choose burial. There isn't a strict requirement for a ritual bath, and practices can differ.
B. Devout practitioners of Judaism prefer to be buried 5 days after death.
Explanation: In Judaism, there is a tradition of burying the deceased as soon as possible, ideally within 24 hours. Waiting for 5 days is not consistent with Jewish burial practices.
C. Devout practitioners of Hinduism prefer to be buried after death and not cremated.
Explanation: In Hinduism, cremation is a common practice. Hindus believe in the cycle of reincarnation, and cremation is seen as a way to release the soul from the body. Burial is not a typical practice in Hinduism.
D. Devout practitioners of Islam prefer to have their heads turned toward Mecca at death.
Explanation: In Islam, it is a common practice to bury the deceased with their right side facing the Qiblah, which is the direction of the Kaaba in Mecca. This is part of the Islamic funeral rites.
A nurse is caring for a client who has experienced a cerebrovascular accident with resulting dysphagia. Which of the following therapists assists clients to learn to eat with less risk of aspiration?
Explanation
Choice Reason:
Occupational Therapist is incorrect. Occupational therapists focus on helping individuals regain or enhance their ability to perform daily activities and tasks. While they might not directly address dysphagia or swallowing concerns, they could assist in modifying the environment or providing adaptive equipment to facilitate eating, such as recommending specialized utensils or adapting seating positions to support safe eating practices.
Choice B Reason:
Physical Therapist is incorrect. Physical therapists primarily concentrate on restoring mobility, strength, and function in individuals who have experienced injuries or illnesses affecting movement. While they might not directly address dysphagia, they could be involved in helping patients with postural adjustments or exercises that indirectly support safe eating and swallowing.
Choice C Reason:
Respiratory Therapist is incorrect. Respiratory therapists specialize in assessing and treating breathing problems and disorders related to the lungs and respiratory system. While they may not focus directly on dysphagia, they can be involved in managing respiratory complications that can arise from aspiration, such as pneumonia. They might assist in suctioning, breathing exercises, or respiratory treatments in cases where aspiration has led to lung issues.
Choice D Reason:
Speech therapists, also known as speech-language pathologists, is correct because it specializes in evaluating and treating communication and swallowing disorders. They work with individuals who have experienced strokes or other conditions affecting swallowing abilities to improve their swallowing function and reduce the risk of aspiration (when food or liquid enters the airway instead of the digestive tract).
A nurse is reinforcing teaching with a client who has an ostomy. Which of the following statements by the client indicates an understanding of the teaching?
Explanation
Choice A Reason:
Pressing on the skin barrier for about 30 seconds ensures that it adheres properly to the skin, which helps secure the ostomy appliance and prevents leakage.
Choice B Reason:
Moisturizing soap is not recommended for cleaning around the stoma, as it can leave a residue that interferes with the appliance's adhesion. Mild soap without moisturizers or just water should be used.
Choice C Reason:
Applying talc powder around the stoma can prevent the appliance from adhering properly, leading to leakage. It is not recommended for ostomy care.
Choice D Reason:
The skin barrier should be cut to fit closely around the stoma, leaving no more than a 1/8 inch gap, not 1/2 inch. A larger opening may cause skin irritation or leakage.
A nurse is performing postmortem care for a client who was a devout Muslim. Which of the following actions should the nurse take?
Explanation
Choice A Reason:
Allowing the family to participate in washing the client's body is appropriate. In Islamic tradition, it's customary for family members or individuals of the same gender to participate in washing the deceased's body. This practice is a part of the Islamic ritual of ghusl (ritual washing). It's respectful and important to honor the religious and cultural customs of the deceased and their family.
Choice B Reason:
Providing the family with an eagle feather for the client's hair is inappropriate. In Islamic traditions, the use of eagle feathers or any specific animal-related items isn't a part of postmortem care rituals. Additionally, incorporating items from other traditions or cultures might not align with the religious practices or beliefs of the deceased and their family.
Choice C Reason:
Encouraging the family to chant a mantra before moving the body is inappropriate. Chanting mantras isn't a practice in Islamic postmortem care. Islamic rituals involve specific prayers and actions according to the teachings of Islam, and chanting mantras isn't a part of this tradition.
Choice D Reason:
Dressing the client in a special amulet provided by the family is inappropriate. The use of amulets or charms isn't typically part of Islamic postmortem rituals. Islamic customs emphasize modesty in dress and following specific rites for the deceased, but incorporating special amulets or charms isn't a common practice.
A nurse is reinforcing teaching with a client who has recurrent back injuries related to lifting. Which of the following lifting instructions should the nurse include?
Explanation
Choice A Reason:
Keeping the knees straight is not appropriate. It's advisable to bend the knees while lifting to engage the leg muscles and reduce strain on the back.
Choice B Reason:
Standing with the feet close together is not appropriate. Having a wider stance provides better stability and balance while lifting heavy objects, which is preferable to standing with the feet close together.
Choice C Reason:
Holding objects away from the torso is not appropriate. Keeping objects close to the body while lifting helps maintain control and reduces strain on the back. Holding objects away from the torso can increase the load on the back muscles and lead to injury.
Choice D Reason:
Aligning the back with the neck and feet is appropriate. This instruction emphasizes maintaining proper alignment of the body during lifting to reduce strain on the back muscles and minimize the risk of injury.
A nurse is reinforcing teaching about advance directives with a client who has terminal colorectal cancer. Which of the following statements by the client indicates an understanding of the teaching?
Explanation
Choice A Reason:
"I'll need to sign a separate consent form first." This statement might indicate a misunderstanding of the process or a belief that signing an advance directive requires a separate consent form, which might not be accurate.
Choice B Reason:
“the opportunity to choose what kind of care I receive while I still can. "This statement reflects the understanding that advance directives allow individuals to make decisions about the type of care they wish to receive while they are still capable of expressing their preferences. Advance directives, such as a living will, enable individuals to outline their healthcare preferences in advance, especially in situations where they might not be able to communicate their wishes later due to illness or incapacity.
Choice C Reason:
“living will, there will be a 1-month delay before it is legally binding. “There typically isn't a standard delay before a living will becomes legally binding. Once the living will be properly completed and witnessed according to legal requirements, it becomes effective.
Choice D Reason:
“have my mind about the care I will receive once I sign my living will." The purpose of a living will be to express one's healthcare preferences in advance. While it's possible to update or change a living will if one's preferences change, signing a living will doesn't inherently mean one can easily alter care preferences once it's in place. Amendments or revocations might require specific legal steps.
A nurse is assisting with discharge planning for an older adult client who has vision loss. Which of the following instructions about home safety should the nurse include in the plan?
Explanation
Choice A Reason:
Setting the maximum water heater temperature to 54.4° C (130° F) is appropriate. This temperature is too high and could pose a burn risk, especially for someone with impaired vision who might not easily detect very hot water.
Choice B Reason:
Painting the edges of steps for contrast is appropriate. This measure helps increase visibility by creating a visual contrast between the edges of steps and the surrounding area, aiding the individual in identifying the steps more easily, even with reduced vision.
Choice C Reason:
Securing extension cords across walkways is inappropriate. Placing extension cords across walkways can create tripping hazards, particularly for someone with vision loss who may have difficulty seeing these obstacles.
Choice D Reason:
Using 40-watt bulbs to light hallways is inappropriate. While adequate lighting is crucial for individuals with vision impairment, using only 40-watt bulbs might not provide sufficient illumination. It's recommended to use higher-wattage bulbs or brighter lighting sources to ensure better visibility in the home.
A home health nurse is reinforcing teaching about dietary needs with the son of a client. The son states, "I don't know what to do because he's not eating." Which of the following responses should the nurse make?
Explanation
Choice A Reason:
"He may need a feeding tube" is inappropriate response. Suggesting a feeding tube without further assessment or information might be premature and could cause unnecessary concern or anxiety for the son. It's essential to explore the situation more before proposing such an intervention.
Choice B Reason:
"Tell me more about what happens at mealtime” is appropriate response. This response encourages the son to provide further details about the situation, allowing the nurse to gather more information about the specific issues or challenges related to the client's eating habits. Understanding the circumstances around mealtime can help the nurse identify potential reasons for the lack of appetite or eating difficulties and offer more targeted guidance or solutions.
Choice C Reason:
"Why do you think he's not eating?" This response is inappropriate. While asking about the son's thoughts is valuable, this question might not directly address the situation at hand or provide immediate assistance or guidance to address the client's eating difficulties.
Choice D Reason:
"I'm sure it's nothing serious and his appetite will return soon” is inappropriate response. Offering reassurance without understanding the underlying cause may downplay a potentially concerning issue. It's crucial to investigate the reasons behind the lack of appetite before assuming it will resolve without further action.
A nurse is caring for a client who is angry and states, "The doctor gave me the wrong information. I was lied to!" Which of the following responses by the nurse is appropriate?
Explanation
Choice A Reason:
"Your doctor has an excellent reputation for being honest with clients." This response is incorrect. While intending to provide reassurance, this statement may come across as dismissive of the client's feelings and might not address their immediate concern.
Choice B Reason:
"Why do you think the doctor is lying?" This response is incorrect. This response might come off as confrontational or defensive. It could potentially escalate the client's emotions and not effectively address their feelings of being misled.
Choice C Reason:
"You feel as if the doctor hasn't been honest with you?" This response acknowledges the client's emotions and concerns without making assumptions about the doctor's actions. It demonstrates empathy and allows the client to express their feelings and concerns further.
Choice D Reason:
"I am certain the doctor would not lie to you." This response might be perceived as dismissive or invalidating of the client's feelings and beliefs, as it asserts the nurse's certainty without fully understanding the client's perspective.
A nurse is caring for a client who is pulling on his NG tube. Which of the following actions should the nurse take first?
Explanation
Choice A Reason:
Administering sedative medication should not be the first action. It is important to assess the client's level of comfort and understand the reason for pulling on the NG tube before considering sedation. Sedation may mask underlying issues, and the goal is to address the cause of the behavior.
Choice B Reason:
Assessing the client's level of comfort is the priority. Understanding the reason for pulling on the NG tube is crucial before implementing interventions. The client may be experiencing pain, discomfort, anxiety, or another issue that needs to be addressed.
Choice C Reason:
Applying a restraint should be a last resort and is not the initial action. Restraints are used to ensure safety when other measures have failed. The priority is to address the underlying cause and promote comfort without resorting to restraint.
Choice D Reason:
Documenting the client's behavior is important for the medical record, but it comes after assessing and addressing the immediate needs of the client. Understanding the context and reasons for the behavior is crucial for accurate documentation.
You just viewed 10 questions out of the 49 questions on the ATI PN Fundamentals of Nursing 2020 with NGN Exam 2 Exam. Subscribe to our Premium Package to obtain access on all the questions and have unlimited access on all Exams. Subscribe Now
