When caring for a terminally ill client, the nurse determines ...

[MirandaLo]

When caring for a terminally ill client, the nurse determines that the client is nearing death because of what assessment findings?
 
  1. Diarrhea.
  2. Muscle spasms.
  3. Slow, weak pulse.
  4. Decreased blood pressure.
  5. Cyanosis of the extremities.

Question 2

When observing an older client's response upon learning of the death of a close family friend, the nurse realizes that the significance of the loss to the client is dependent upon:
 
  1. Importance of the person to the client.
  2. Amount of changes that will occur because of the loss.
  3. The client's beliefs.
  4. The client's values.
  5. The client's socioeconomic status.

[EAN94]

Answer to Question 1

Correct Answer: 3,4,5
Rationale 1: Diarrhea is not a clinical manifestation of impending death.
Rationale 2: Muscle spasms are not a clinical manifestation of impending death.
Rationale 3: A slow, weak pulse is a clinical manifestation of impending death.
Rationale 4: Decreased blood pressure is a clinical manifestation of impending death.
Rationale 5: Cyanosis of the extremities is a clinical manifestation of impending death.

Answer to Question 2

Correct Answer: 1,2,3,4
Rationale 1: The importance of the lost person to the client affects the significance of the loss.
Rationale 2: The degree of change required because of the loss affects the significance of the loss.
Rationale 3: The client's beliefs affect the significance of the loss.
Rationale 4: The client's values affect the significance of the loss.
Rationale 5: The client's socioeconomic status does not affect the significance of the loss.