A nurse is speaking with the adult child of a client who is terminally ill and has decided to discontinue further treatment. The adult child states, "I am not going to let this happen." Which of the following responses should the nurse make?

"Maybe you should try obtaining power of attorney to make the decisions."

"You must be devastated that your parent wants to stop treatment."

"We have to respect the wishes of your parent."

"I also feel really bad about this situation."

Answer and Explanation

The Correct Answer is C

C. It promotes patient-centered care and acknowledges the client's right to make decisions about their own care, especially regarding end-of-life choices. This response supports ethical principles of autonomy and beneficence.

A. While obtaining power of attorney can be important for legal decision-making, this response may not address the emotional and supportive needs of the adult child or the family in this moment of distress and decision-making about end-of-life care.

B. It shows empathy and understanding of the adult child's feelings. However, it does not directly address the need to respect the client's wishes or provide guidance on how to navigate the situation practically.

D While it shows empathy, it may not fully address the needs of the adult child in terms of understanding and navigating the client's decision to discontinue treatment. The focus should be on supporting the family's emotional needs and facilitating communication about the client's wishes.

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Correct Answer is ["42"]

Explanation

Calculate the rate as follows: 500 mL divided by 12 hours equals approximately 41.67 mL per hour.

Rounding to the nearest whole number, the nurse should set the IV pump to deliver 42 mL/hr.

A. Eyelid edema B. Nausea C. Insomnia D. Dry cough

Correct Answer is A

Explanation

A. Eyelid edema (swelling) can be a sign of angioedema, which is a rare but serious side effect of ACE inhibitors like lisinopril. Angioedema involves swelling of deeper layers of the skin, often around the eyes, lips, tongue, throat, and sometimes the hands and feet. It can lead to airway obstruction and is potentially life-threatening. Immediate medical evaluation and possibly discontinuation of the medication are necessary if angioedema is suspected.

B. Nausea is a common side effect of many medications, including lisinopril, but it is generally not considered a serious adverse reaction unless severe or persistent.

C Insomnia (difficulty sleeping) can occur as a side effect of medications but is not typically associated with lisinopril to the extent of warranting immediate reporting.

D. A dry, persistent cough is a well-known side effect of ACE inhibitors like lisinopril.

Rationale: While annoying and uncomfortable, a dry cough is usually not dangerous and can be managed with symptomatic treatment or, if severe, by switching to a different class of antihypertensive medication.

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A nurse is speaking with the adult child of a client who is terminally ill and has decided to discontinue further treatment. The adult child states, "I am not going to let this happen." Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer dextrose 5% in water 500 mL over 12 hr to a client. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["42"]

Explanation

A nurse is assessing a client who has hypertension and has started taking lisinopril. Which of the following findings should the nurse report to the provider immediately?

Correct Answer is A

Explanation

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