A male client who has just been told he has cancer asks the practical nurse (PN) to leave his room so he can be alone.

Which action should the PN implement?

Consult with the charge nurse about implementing suicide precautions

Sit quietly in the client's room until the client is ready to verbalize his feelings

Notify a member of the client's family of the need to come stay with the client

Leave the room after oﬀering to return to the client's room at a later time

Answer and Explanation

The Correct Answer is D

d) Leave the room after oﬀering to return to the client's room at a later time.

This is the action that the PN should implement for a male client who has just been told he has cancer and asks to be left alone. Leaving the room after oﬀering to return later respects the client's autonomy and privacy, while also showing empathy and availability. The client may need some time and space to process the diagnosis and cope with his emotions. The PN should not force the client to talk or stay with him if he does not want to, but should also not abandon him or ignore his needs.

a) Consult with the charge nurse about implementing suicide precautions.

This is not the action that the PN should implement for a male client who has just been told he has cancer and asks to be left alone. Consulting with the charge nurse about implementing suicide precautions is premature and unnecessary, as there is no evidence that the client is suicidal or at risk of harming himself. The client's request to be alone is a normal and understandable reaction to a stressful and life-changing situation, not a sign of suicidal ideation or intent.

b) Sit quietly in the client's room until the client is ready to verbalize his feelings.

This is not the action that the PN should implement for a male client who has just been told he has cancer and asks to be left alone. Sitting quietly in the client's room until he is ready to verbalize his feelings is intrusive and disrespectful, as it goes against the client's wishes and may make him feel uncomfortable or pressured. The PN should not impose their presence or expectations on the client, but should honor his request and give him some privacy.

c) Notify a member of the client's family of the need to come stay with the client.

This is not the action that the PN should implement for a male client who has just been told he has cancer and asks to be left alone. Notifying a member of the client's family of the need to come stay with him is inappropriate and unethical, as it violates the client's confidentiality and autonomy. The PN should not share the client's diagnosis or condition with anyone without his consent, nor should they assume that he wants or needs his family's support at this time. The PN should respect the client's right to decide who he wants to involve in his care and when.

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Correct Answer is ["A","D","E"]

Explanation

Choice A rationale:
Correcting electrolytes that are out of normal range is a crucial goal of therapy for this client. In diabetic ketoacidosis (DKA), the body’s cells are unable to use glucose for energy due to a lack of insulin. This leads to the breakdown of fat for energy, producing ketones as a by-product. Ketones are acidic and can cause the blood’s pH to decrease, leading to metabolic acidosis. This process also leads to an increased production and excretion of electrolytes such as potassium and sodium. Therefore, correcting these electrolyte imbalances is a key goal of therapy.
Choice B rationale:
While promoting oxygenation to tissues is generally important in critical care, it is not a specific goal in the management of DKA. The primary issues in DKA are metabolic in nature, including hyperglycemia, ketosis, and acidosis.
Choice C rationale:
Preventing hyperventilation is not a specific goal in the management of DKA. Hyperventilation in DKA is a compensatory mechanism for metabolic acidosis (Kussmaul breathing). The body tries to expel more carbon dioxide to reduce the acidity of the blood.
Choice D rationale:
Reversing dehydration is another important goal of therapy for this client. In DKA, high blood glucose levels lead to osmotic diuresis, where water is drawn into the urine from the blood, leading to dehydration. This can cause hypotension and reduced tissue perfusion. Therefore, reversing dehydration through fluid replacement is a key part of treatment.
Choice E rationale:
Replacing insulin is a fundamental goal of therapy for this client. Insulin deficiency is the primary cause of DKA. Insulin allows glucose to enter cells where it can be used for energy, preventing the breakdown of fat for energy and the subsequent production of ketones.
Choice F rationale:
Providing respiratory support may be necessary in severe cases of DKA where the patient’s compensatory respiratory efforts are insufficient to maintain adequate gas exchange. However, it is not one of the primary goals of therapy in DKA management.

A. Decreasing gastrointestinal (GI) cramping and nausea. B. Chest pain and dysrhythmia. C. Vasodilation of the extremities. D. Hypotension and tachycardia.

Correct Answer is B

Explanation

The correct answer is choiceb. Chest pain and dysrhythmia.

Choice A rationale:

Decreasing gastrointestinal (GI) cramping and nausea are not typical adverse effects of vasopressin.In fact, vasopressin can cause abdominal cramps and nausea as side effects.

Choice B rationale:

Chest pain and dysrhythmia are significant adverse effects of vasopressin.Vasopressin can cause vasoconstriction, leading to myocardial ischemia and arrhythmias.

Choice C rationale:

Vasodilation of the extremities is not an adverse effect of vasopressin.Instead, vasopressin typically causes vasoconstriction, which can lead to peripheral ischemia.

Choice D rationale:

Hypotension and tachycardia are not common adverse effects of vasopressin.Vasopressin is more likely to cause hypertension due to its vasoconstrictive properties.

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A male client who has just been told he has cancer asks the practical nurse (PN) to leave his room so he can be alone. Which action should the PN implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Patient Data. Exhibits What are the three goals of therapy for this client? Select three that apply.

Correct Answer is ["A","D","E"]

Explanation

A client with bleeding esophageal varices receives vasopressin intravenously (IV). Which adverse effect should the nurse monitor for during the IV infusion of this medication?

Correct Answer is B

Explanation

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A male client who has just been told he has cancer asks the practical nurse (PN) to leave his room so he can be alone.

Which action should the PN implement?