A veteran is hospitalized after surgical amputation of both lower extremities owing to injuries sustained during military service. Which type of loss will the nurse focus the plan of care on for this patient?

Maturational loss

Situational loss

Perceived loss

Uncomplicated loss

Answer and Explanation

The Correct Answer is B

Choice A reason: Maturational loss occurs with normal developmental transitions, like aging or menopause. Amputation from military injuries is an unexpected event, not a developmental milestone. This type does not apply to the veteran’s sudden, trauma-related loss, making it incorrect for the care plan focus.

Choice B reason: Situational loss results from unpredictable events, like amputation due to military injuries. This loss impacts the veteran’s mobility, identity, and lifestyle, requiring targeted interventions for grief, adaptation, and rehabilitation. The nurse’s care plan should focus on addressing this situational loss to support emotional and physical recovery.

Choice C reason: Perceived loss is subjective, like loss of self-esteem, but amputation is a tangible, objective loss of limbs. While emotional impacts exist, the primary loss is physical and situational. This type is less specific to the veteran’s experience, making it an incorrect focus for the care plan.

Choice D reason: Uncomplicated loss refers to normal grief without complications, not a specific type of loss. Amputation is a complex situational loss with physical and psychological impacts. This term does not capture the nature of the veteran’s experience, making it inappropriate for the care plan focus.

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Correct Answer is C

Explanation

Choice A reason: Health promotion involves teaching lifestyle changes, not physical touch or emotional support, as seen here. Presence focuses on being with the patient empathetically. Assuming health promotion misaligns with the action, risking neglect of the patient’s emotional and spiritual needs, critical for comfort in terminal illness care settings.

Choice B reason: Offering transcendence involves fostering spiritual meaning, not physical touch or presence. The nurse’s hand-touching establishes emotional connection, not existential exploration. Assuming transcendence overlooks the relational aspect of presence, potentially missing the patient’s immediate need for comfort and connection in the context of terminal illness care.

Choice C reason: Establishing presence involves being physically and emotionally available, as shown by sitting and touching the patient’s hand. This empathetic connection, rooted in Watson’s caring theory, fosters comfort and trust, critical for terminally ill patients. Presence supports emotional well-being, ensuring holistic care and dignity in end-of-life situations.

Choice D reason: Doing for involves performing tasks like bathing, not emotional support through touch. The nurse’s action establishes presence, not task-oriented care. Assuming doing for risks misinterpreting the action, potentially neglecting the patient’s need for empathetic connection, essential for psychological comfort in terminal illness care.

A. Places colored stickers on faucet handles to indicate temperature. B. Uses a heating pad on a low setting to keep warm. C. Asks the nurse to test the temperature of the water before entering the bath. D. Replaces all lace-up shoes with Velcro straps for ease.

Correct Answer is A

Explanation

Choice A reason: Placing colored stickers on faucet handles helps the patient with visual and tactile deficits identify hot and cold water, reducing burn risk. This action demonstrates successful learning of a safety strategy, promoting independence by compensating for sensory impairments and preventing injury from harmful stimuli.

Choice B reason: Using a heating pad, even on low, is risky for a patient with tactile deficits, as they may not feel burns. This does not reflect safe learning, as it increases injury risk rather than mitigating it, making it an incorrect indicator of successful safety strategy adoption.

Choice C reason: Asking the nurse to test water temperature relies on external assistance, not independence. While safe, it does not demonstrate the patient’s ability to manage risks autonomously, which is the goal of the teaching. This action indicates partial understanding, making it less correct.

Choice D reason: Replacing lace-up shoes with Velcro straps improves ease but does not address injury risk from harmful stimuli like heat. This action is unrelated to tactile or visual deficits’ safety concerns, making it an incorrect indicator of successful learning for the taught safety strategies.

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A veteran is hospitalized after surgical amputation of both lower extremities owing to injuries sustained during military service. Which type of loss will the nurse focus the plan of care on for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse caring for a terminally ill patient sits down and lightly touches the patient’s hand. Which technique is the nurse using?

Correct Answer is C

Explanation

The home health nurse is caring for a patient with tactile and visual deficits. The nurse is concerned about injury related to inability to feel harmful stimuli and teaches the patient safety strategies to maintain independence. Which action by the patient indicates successful learning?

Correct Answer is A

Explanation

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The patient has a colostomy but has not yet been able to look at it. The nurse teaches the patient how to care for the colostomy. The nurse sits with the patient and together they form a plan on how to approach dealing with colostomy care. Which caring process is the nurse performing?

Which action indicates the nurse is meeting a primary goal of culturally competent care for marginalized patients?

A nurse makes a connection with the patient when providing spiritual care. Which type of connectedness did the nurse experience?

The nurse is caring for a patient who is having difficulty understanding the written and spoken word. Which type of aphasia will the nurse report to the oncoming shift?

The nurse is caring for a patient in the intensive care unit who is having trouble sleeping. The nurse explains the purpose of sleep and its benefits. Which information will the nurse include in the teaching session? (Select all that apply)