An appropriate nursing diagnosis for the family of a client dying of cancer whose members have expressed sorrow over the forthcoming loss would be
Anticipatory Grieving related to the loss of a family member as evidenced by voicing sorrow and crying.
Dysfunctional Grieving related to future loss of family member as evidenced by family's age regression.
Potential for Grieving related to future loss of family member and sorrow as evidenced by crying and insomnia.
Dysfunctional Grieving related to loss of a family member as evidenced by behaviors indicating anxiety.
The Correct Answer is A
Choice A rationale
Anticipatory grieving is a normal psychological process of acknowledging and preparing for an expected loss. The family's expression of sorrow and crying directly indicates their emotional response to the impending death of their loved one, aligning with the defining characteristics of anticipatory grieving. This diagnosis acknowledges the family's current emotional state in relation to the anticipated loss.
Choice B rationale
Dysfunctional grieving implies an abnormal or maladaptive grief response. Age regression, while a potential manifestation of extreme stress, is not a typical or expected behavior in anticipatory grief. Without further evidence of significantly impaired functioning or prolonged, intense reactions disproportionate to the situation, labeling the grieving as dysfunctional is not supported.
Choice C rationale
Potential for grieving suggests a risk for developing grief, but the family members are already actively expressing sorrow, indicating that grieving has commenced, not just a potential for it. While crying is an expression of sorrow associated with grieving, insomnia, without further context, is a non-specific symptom and does not solely indicate anticipatory grieving related to loss.
Choice D rationale
Dysfunctional grieving, as mentioned before, implies a maladaptive response. While anxiety can be a component of grief, behaviors solely indicating anxiety do not necessarily define dysfunctional grieving related to the loss of a family member. The family's primary expression is sorrow, which is a typical component of anticipatory grief, not necessarily dysfunctional.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Negligence is the failure to exercise the care that a reasonably prudent person would exercise in similar circumstances. While administering the wrong medication is a breach of duty, legal charges of negligence might not fully capture the severity of a serious untoward reaction resulting from a medication error by a professional.
Choice B rationale
Malpractice is a specific type of negligence committed by a professional, such as a nurse, in the performance of their professional duties. Administering the wrong medication, leading to a serious adverse reaction, falls under the scope of professional nursing practice and can be considered a breach of the professional standard of care, thus potentially leading to charges of malpractice.
Choice C rationale
Assault is an intentional act that creates a reasonable apprehension of immediate harmful or offensive contact. Administering medication, even the wrong one, is usually not intended to cause apprehension of harm in the way assault is legally defined.
Choice D rationale
Battery is the intentional touching of another person without consent. While administering the wrong medication involves touching without consent, the more appropriate legal charge in a professional healthcare setting where harm results from a breach of duty is typically malpractice. .
Correct Answer is A
Explanation
Choice A rationale
Before delegating any nursing task, the nurse must first determine if the action is permissible under the state's nurse practice act and the employing agency's policies. These regulations define the scope of practice for nurses and the tasks that can be safely and legally delegated to unlicensed personnel. If delegation is not allowed by these governing bodies, the subsequent questions become irrelevant.
Choice B rationale
While it is crucial to ensure that the UAP has been adequately trained and is competent to perform the delegated task safely and correctly, this consideration comes after establishing the legality and permissibility of the delegation according to the nurse practice act and agency policy. Training is important for safe implementation but not the initial determining factor.
Choice C rationale
Appropriate supervision is necessary when delegating tasks to UAPs to ensure client safety and provide guidance. However, the ability to delegate the task itself must first be established by legal and policy guidelines. Supervision is a component of safe delegation but not the primary question determining if delegation is even an option.
Choice D rationale
Evaluating the client's past response to a treatment might inform how the task is performed or any specific observations needed, but it does not determine the fundamental question of whether the task can be delegated to a UAP in the first place. Legal and policy frameworks dictate the scope of delegation, regardless of the client's history. .
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