A nurse is assisting with the care of a client who has cancer that has metastasized. The client has decided to discontinue chemotherapy treatment. Which of the following responses should the nurse make?

"Don't worry. Everything will work out for you."

"We should talk about your decision later."

"How will you discuss this decision with your loved ones?"

"Your quality of life will be compromised if you make this decision."

Answer and Explanation

The Correct Answer is C

A. "Don't worry. Everything will work out for you.": This provides false reassurance and dismisses the client's feelings.

B. "We should talk about your decision later.": This is avoidant and dismisses the client's current need for support.

C. "How will you discuss this decision with your loved ones?": This is an open-ended, therapeutic response that encourages the client to explore their support system and the implications of their decision.

D. "Your quality of life will be compromised if you make this decision.": This is judgmental and uses a "scare tactic" rather than supporting the client's autonomy.

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Correct Answer is B

Explanation

A. Yellow sclera/jaundice: This image shows yellowing of the sclera, known as jaundice or icterus. This is not an expected age-related change; it is a pathological finding that typically indicates liver, gallbladder, or pancreatic dysfunction, or the hemolysis of red blood cells. While some older adults may develop harmless fatty deposits (pinguecula) that appear slightly yellow, generalized yellowing of the eyes always requires medical follow-up.

B. Increased thoracic curvature/kyphosis: This image shows a classic "hunchback" posture, clinically known as kyphosis. While severe kyphosis can be pathological (often due to osteoporosis), a gradual increase in the curvature of the thoracic spine is considered an expected age-related change. It results from the thinning of intervertebral discs, a slight loss of height in the vertebrae, and a decrease in muscle tone as the body ages.

A. Elevate the client's hand above the level of the heart. B. Squeeze the client's finger until a blood drop forms. C. Prick the side of the client's finger. D. Apply clean gloves. E. Cleanse the client's finger with an iodine swab.

Correct Answer is ["C","D"]

Explanation

A. Elevate the client's hand above the level of the heart.: The hand should be kept dependent (below heart level) to increase blood flow to the fingertips.

B. Squeeze the client's finger until a blood drop forms.: Excessive squeezing (milking) can cause hemolysis or dilute the specimen with interstitial fluid.

C. Prick the side of the client's finger.: The sides of the finger have fewer nerve endings and better vascularity than the center of the fingertip.

D. Apply clean gloves.: Standard precautions must be followed when handling blood.

E. Cleanse the client's finger with an iodine swab.: Iodine can interfere with results (especially glucose). Alcohol is typically used and must be allowed to dry completely.

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A nurse is assisting with the care of a client who has cancer that has metastasized. The client has decided to discontinue chemotherapy treatment. Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse at a provider's office is collecting physical data from an older adult client. Which of the following images should the nurse identify as an example of an expected age-related change?

Correct Answer is B

Explanation

A nurse is preparing to obtain a capillary blood specimen from a client. Which of the following actions should the nurse take? (Select all that apply.)

Correct Answer is ["C","D"]

Explanation

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