A hospice nurse is caring for a client who is near the end of life and has noisy breathing. Which of the following actions should the nurse take?
Use oropharyngeal suctioning PRN.
Turn the client every 2 hours.
Administer an antiemetic.
Insert an indwelling urinary catheter.
The Correct Answer is B
Choice A reason: Oropharyngeal suctioning may be necessary if secretions are causing distress, but it can also be uncomfortable and should be used cautiously.
Choice B reason: Turning the client can help manage noisy breathing by allowing secretions to drain and is a non- invasive comfort measure.
Choice C reason: Antiemetics are used to manage nausea and vomiting, not noisy breathing.
Choice D reason: An indwelling urinary catheter may be considered for comfort if the client cannot use the bathroom, but it does not address noisy breathing.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Apologizing for untidiness does not indicate adaptation but rather a concern for the nurse's perception.
Choice B reason: Expressing financial concerns suggests stress related to the caregiving role, not adaptation.
Choice C reason: Attempting to rearrange furniture for walker use shows problem-solving but does not directly indicate adaptation to the caregiver role.
Choice D reason: Arranging for personal time away from caregiving responsibilities indicates that the caregiver is adapting to their new role by ensuring they also care for their own needs.
Correct Answer is C
Explanation
Choice A reason: Myalgia, or muscle pain, is a common symptom of many infections and is not typically a priority over more severe symptoms.
Choice B reason: While a fever is a concern, it is not as immediately threatening as a decreased level of consciousness, which can indicate a more severe infection affecting the central nervous system.
Choice C reason: A decreased level of consciousness can be a sign of severe illness affecting the central nervous system, such as encephalitis or meningitis, which are serious complications of West Nile virus infection.
Choice D reason: Vomiting can be a symptom of West Nile virus infection but is less concerning than neurological symptoms like decreased consciousness.
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