A nurse is providing postmortem care for a client. Identify the sequence of actions the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Determine the family's preferences about care of the body.
Apply identifying name tags onto the client.
Verify that the provider has certified the client's death.
Remove all equipment and tubes from the client's body.
The Correct Answer is C,A,D,B
Verify that the provider has certified the client's death: Before any postmortem care is initiated, it's crucial to confirm that the client has indeed passed away. This verification is typically done by a healthcare provider, such as a physician or nurse practitioner, who examines the client, checks for signs of life, and makes an official declaration of death.
Determine the family's preferences about care of the body: After the client's death has been certified, the healthcare team should communicate with the family or next of kin to inquire about their preferences regarding the care of the deceased. Families may have specific cultural, religious, or personal requests regarding postmortem care procedures, and it's essential to respect and accommodate these preferences whenever possible.
Remove all equipment and tubes from the client's body: This step involves the removal of any medical equipment, devices, or tubes that may have been in use during the client's medical care. This can include items such as intravenous (IV) lines, catheters, ventilator tubing, and monitoring equipment. Ensuring that all equipment is removed is not only a matter of dignity but also helps prepare the body for viewing by the family, if desired.
Apply identifying name tags onto the client .To maintain accurate identification and tracking of the deceased client, it's common practice to attach identifying name tags or labels to the body. These tags typically contain essential information, such as the client's name, medical record number, and date of birth. This step helps prevent any confusion or mix-up of identities during postmortem procedures and transport.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
Hypoglycemia (low blood sugar) is not a common adverse effect of atorvastatin.
Choice B Reason:
Daytime drowsiness is not a typical side effect of statin medications and is more commonly associated with other types of medications, such as sedatives or sleep aids.
Choice C Reason:
Muscle pain is correct. The nurse should instruct the client to monitor and report muscle pain (myalgia) to the healthcare provider when taking atorvastatin. Myalgia is a potential adverse effect of statin medications, and in rare cases, it can progress to a more serious condition called rhabdomyolysis, which involves muscle breakdown and can lead to kidney damage. Therefore, any new or unexplained muscle pain, tenderness, or weakness should be reported promptly to the healthcare provider for evaluation.
Choice D Reason:
Palpitations (rapid or irregular heartbeats) are not commonly associated with atorvastatin use. If a client experiences palpitations, it may be related to other factors or conditions and should be evaluated separately.
Correct Answer is D
Explanation
Choice A Reason:
Documenting the infiltration is important for the client's medical record, but it should not be the first action when infiltration is suspected.
Choice B Reason:
Elevating the arm can help reduce swelling, but it should come after stopping the infusion.
Choice C Reason:
Applying a warm compress can help with comfort and may be done after stopping the infusion, but it is not the first action.
Choice D Reason:
Stop the infusion is correct. When a nurse observes signs of infiltration around an IV insertion site, such as edema and coolness of the skin, the first and most important action is to stop the infusion immediately. Infiltration occurs when the IV fluid leaks into the surrounding tissue instead of going into the vein. Stopping the infusion prevents further damage to the surrounding tissue and minimizes the risk of complications.
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