Which tissue or organ can be repeatedly donated to clients needing a transplant?
- A. Skin.
- B. Bones.
- C. Kidneys.
- D. Bone marrow.
Correct Answer: D
Rationale: Bone marrow regenerates, allowing repeated donation. Skin, bones, and kidneys are limited or single-donation tissues/organs.
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The hospice nurse is making the final visit to the wife whose husband died a little more than a year ago. The nurse realizes the husband's clothes are still in the closet and chest of drawers. Which action should the nurse implement first?
- A. Discuss what the wife is going to do with the clothes.
- B. Refer the wife to a grief recovery support group.
- C. Do not take any action because this is normal grieving.
- D. Remove the clothes from the house and dispose of them.
Correct Answer: C
Rationale: Keeping clothes is a normal part of grieving, requiring no immediate action. Discussing plans, referring to support, or removing clothes may rush or distress the widow.
The nurse is caring for a client who is confused and fell trying to get out of bed. There is no family at the client's bedside. Which action should the nurse implement first?
- A. Contact a family member to come and stay with the client.
- B. Administer a sedative medication to the client.
- C. Place the client in a chair with a sheet tied around him or her.
- D. Notify the health-care provider to obtain a restraint order.
Correct Answer: D
Rationale: Notifying the HCP for a restraint order ensures safety and legal compliance for a confused client at risk of falls. Family contact, sedation, or makeshift restraints are unsafe or secondary.
The client diagnosed with end-stage congestive heart failure and type 2 diabetes is receiving hospice care. Which action by the nurse demonstrates an understanding of the client's condition?
- A. The nurse monitors the blood glucose four (4) times a day.
- B. The nurse keeps the client on a strict fluid restriction.
- C. The nurse limits the visitors the client can receive.
- D. The nurse brings the client a small piece of cake.
Correct Answer: D
Rationale: In hospice, comfort is prioritized; a small piece of cake aligns with the client’s enjoyment, given end-stage status. Glucose monitoring, fluid restriction, and visitor limits are less relevant.
The client asks the nurse, 'When will the durable power of attorney for health care take effect?' On which scientific rationale would the nurse base the response?
- A. It goes into effect when the client needs someone to make financial decisions.
- B. It will be effective when the client is under general anesthesia during surgery.
- C. The client must say it is all right for it to become effective and enforced.
- D. It becomes valid only when the clients cannot make their own decisions.
Correct Answer: D
Rationale: A durable power of attorney for health care activates when the client is incapacitated, per legal standards. Financial decisions, anesthesia, or client permission are incorrect triggers.
The client with chronic low back pain is having trouble sleeping at night. Which nonpharmacological therapy should the nurse teach the client?
- A. Acupuncture.
- B. Massage therapy.
- C. Herbal remedies.
- D. Progressive relaxation techniques.
Correct Answer: D
Rationale: Progressive relaxation reduces muscle tension and promotes sleep, a safe nonpharmacological option. Acupuncture, massage, or herbs are less directly linked to sleep.