The nurse is providing postmortem care to a client who is on home hospice care and has just died. What action should the nurse take?
Apply clean gauze pads over the client's open eyes to prevent damage.
Place the dentures in a bag that is clearly marked with the client's name.
Remove the client's urinary catheter ensuring that the perineum is clean.
Secure the client's upper extremities by tying them together over the abdomen.
The Correct Answer is A
A. "Apply clean gauze pads over the client's open eyes to prevent damage." This is appropriate. Closing the client's eyes and placing gauze pads over them helps to prevent drying and damage, maintaining a respectful appearance of the deceased.
B. "Place the dentures in a bag that is clearly marked with the client's name." This is incorrect. While it is important to handle personal items with respect, this option is less relevant to postmortem care compared to the other options.
C. "Remove the client's urinary catheter ensuring that the perineum is clean." This is incorrect. If the client is on home hospice care and has just died, it is generally not necessary to remove the urinary catheter unless specifically required by the hospice protocols.
D. "Secure the client's upper extremities by tying them together over the abdomen." This is incorrect and inappropriate. Tying extremities is not a standard practice and does not align with respectful postmortem care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While creating personalized meal plans is an important task for a dietitian, it does not reflect the interprofessional collaboration often seen in community health settings, where multiple disciplines work together.
B. A team involving a nurse, social worker, and community health worker exemplifies effective interprofessional care, as it shows collaboration among different professionals to address a complex issue such as homelessness.
C. Medication counseling by a pharmacist is a key component of healthcare but is generally considered part of the pharmacist's role rather than interprofessional collaboration.
D. Blood pressure screenings by a nurse are valuable but represent an individual effort rather than a collaborative, interprofessional approach to community health.
Correct Answer is C
Explanation
A. Although thyroid cancer and medication use can affect health, they are not the most immediate factors influencing fall risk compared to heart failure symptoms.
B. Diabetes mellitus and metformin use are not directly associated with increased fall risk as much as heart failure and its symptoms.
C. Decompensated heart failure and dyspnea on exertion significantly increase fall risk due to decreased physical stability and balance issues.
D. While hypertension and lisinopril can contribute to fall risk, they are less directly impactful than the symptoms of decompensated heart failure.
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