A patient with terminal illness expresses fear and anxiety about dying alone. What intervention should the palliative nurse prioritize to address the patient's concerns?

Correct Answer: A

Rationale: The most appropriate intervention for the palliative nurse to prioritize in this situation is to arrange for family members or loved ones to be present at the patient's bedside. Having loved ones nearby can provide emotional support, comfort, and reassurance to the patient during their final moments. This can help alleviate the fear and anxiety the patient is experiencing about dying alone. Additionally, it can contribute to a sense of connectedness and peace for both the patient and their loved ones during this challenging time. Offering practical solutions to address the patient's emotional needs is key in providing holistic palliative care.

Correct Answer: D

Rationale: The nurse who uses appropriate therapeutic listening skills will display the best behavior by absorbing both the content and the feeling which the patient is conveying. In the given scenario, Belle is experiencing a range of symptoms due to her mental health issues, trauma, and past experiences. By actively listening and absorbing both the content (symptoms, concerns) and the feelings (depressed mood, worry, irritability) which Belle is conveying, the nurse can demonstrate empathy, understanding, and validation of Belle's experiences. This type of therapeutic listening helps to build trust, rapport, and a supportive therapeutic relationship between the nurse and the patient, which is crucial for effective communication, assessment, and treatment in mental health care settings.

Correct Answer: C

Rationale: Dry cough is the most commonly reported adverse effect associated with lisinopril therapy. Lisinopril is an ACE inhibitor, and the mechanism behind the cough is not completely understood but is thought to be related to the accumulation of bradykinin and substance P. This annoying dry cough can be a persistent issue for some patients on lisinopril, and it typically resolves once the medication is discontinued. Patients who experience this side effect should not ignore it and should consult their healthcare provider for further evaluation and possible alternative medication options. Hyperkalemia, hypertension, and bradycardia are not commonly associated adverse effects of lisinopril therapy.

Correct Answer: C

Rationale: Even though Ms. C's self-esteem and weight have improved, her continued negative self-talk and use of derogatory terms like "fatty" indicate a distorted perception of her body image. This distortion needs to be addressed and corrected for her overall long-term psychological well-being. By focusing on addressing the disturbed body image, the nursing team can help Ms. C develop a more positive self-perception and maintain the progress she has made towards recovery from anorexia nervosa. It is important to prioritize interventions that promote a healthier and more realistic body image in order to support her ongoing recovery journey.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: False imprisonment occurs when a client is physically restrained or confined without legal justification. In this scenario, the nurse restraining the confused and combative client without a physician's order constitutes false imprisonment. Restraints should only be used when necessary to ensure the safety of the client or others, and a physician's order is required to authorize their use. In this case, the nurse acted without proper authorization, making it a violation of the client's rights and false imprisonment. It is essential to follow proper protocols and obtain necessary orders before restraining a client.

Correct Answer: C

Rationale: Patients like Emmy who have experienced delayed hypersensitivity to latex typically present with symptoms such as rhinitis (runny or stuffy nose) and conjunctivitis (inflammation of the eyes). In addition, delayed hypersensitivity reactions often involve skin manifestations, such as blisters. These symptoms are reflective of the inflammatory response triggered by exposure to latex in individuals with delayed hypersensitivity. Symptoms like flushing, bronchospasm, urticaria, laryngeal edema, papules, vesicles, and pruritus are more commonly associated with immediate-type hypersensitivity reactions rather than delayed hypersensitivity reactions in latex-sensitive individuals.

Correct Answer: C

Rationale: The sudden onset of shortness of breath, chest pain, and cyanosis in a postpartum client could be indicative of a pulmonary embolism, a potentially life-threatening condition. Therefore, it is crucial to notify the healthcare provider immediately for further assessment and management. Prompt intervention is essential in this situation to prevent any potential complications and ensure the client receives appropriate care as soon as possible. Placing the client in a semi-Fowler's position or administering supplemental oxygen therapy may provide temporary relief, but the priority is to seek immediate medical attention. Consulting with the healthcare provider ensures that the client receives the necessary interventions promptly.

Correct Answer: C

Rationale: Battery is the intentional touching or use of force on another individual without their consent. In this scenario, the nurse's action of slapping the patient constitutes battery as it involves a deliberate physical contact without the patient's permission. This is different from assault, which involves the threat of harm, and abuse, which encompasses various forms of mistreatment. Ultimately, the nurse in this situation would be guilty of committing a battery by unlawfully striking the patient.