a parent of a child who is terminally ill tells a nurse that she wants to take her child home which of the following responses should the nurse make

ATI RN

RN ATI Capstone Proctored Comprehensive Assessment Form A

1. A parent of a child who is terminally ill tells a nurse that she wants to take her child home. Which of the following responses should the nurse make?

A. Your provider will be here later today.
B. I can give you information on what that would involve.
C. I understand how you feel. I felt the same way when my sister was terminally ill.
D. I think you should speak with social services about your request.

Correct answer: B

Rationale: The nurse should offer to explain the process of taking the child home and provide resources for the parent's decision. Choice B is the best response as it shows willingness to support the parent by offering information on what taking the child home would involve. Choices A, C, and D do not directly address the parent's request or provide the necessary information and support needed in this situation.

2. Which of the following best describes a somatic symptom disorder?

A. Client experiences sudden onset of symptoms due to stress
B. Physical manifestations occur due to underlying medical conditions
C. Client has excessive preoccupation with physical symptoms without a medical cause
D. Client avoids medical care due to fear of receiving a diagnosis

Correct answer: C

Rationale: The correct answer is C. Somatic symptom disorder is characterized by individuals having excessive preoccupation with physical symptoms that may or may not have an identifiable medical cause. Choice A is incorrect because the sudden onset of symptoms due to stress is more indicative of acute stress reaction. Choice B is incorrect as it describes physical manifestations related to known medical conditions, not somatic symptom disorder. Choice D is incorrect as it relates to health anxiety or illness anxiety disorder, where individuals avoid seeking medical care due to fear of receiving a diagnosis.

3. A nurse is assessing the skin of an immobilized patient. What will the nurse do?

A. Use a standardized tool such as the Braden Scale.
B. Limit the amount of fluid intake.
C. Have special times for inspection so as not to interrupt routine care.
D. Assess the skin every 4 hours.

Correct answer: A

Rationale: The correct answer is A. When assessing the skin of an immobilized patient, it is essential to use a standardized tool such as the Braden Scale to identify patients at high risk for impaired skin integrity. This tool helps in early identification and appropriate intervention. Choice B, limiting fluid intake, is not directly related to skin assessment. Choice C, having special times for inspection, may not ensure timely identification of skin issues. Choice D, assessing the skin every 4 hours, lacks specificity regarding the use of a validated tool for risk assessment.

4. What is the priority action for a patient with a fever?

A. Administer an antipyretic medication as prescribed.
B. Assess the patient's temperature regularly.
C. Provide cooling measures such as a cool compress.
D. Provide the patient with blankets for comfort.

Correct answer: B

Rationale: The priority action when a patient has a fever is to assess the patient's temperature regularly. Monitoring the temperature helps track the effectiveness of interventions and detect any worsening fever. Administering antipyretic medication (Choice A) should be done based on healthcare provider's orders after assessing the patient's condition. While providing cooling measures such as a cool compress (Choice C) can help reduce fever, assessing the temperature takes precedence. Providing blankets for comfort (Choice D) is not the priority when dealing with a fever.

5. A healthcare provider is completing discharge teaching to a client about nutrition therapy for wound healing following major surgery. Which of the following vitamins that promote wound healing should the healthcare provider include in the teaching? (SATA)

A. Vitamin B12
B. Vitamin C
C. Vitamin K
D. Vitamin D

Correct answer: B

Rationale: The correct answer is Vitamin C. Vitamin C is essential for wound healing due to its role in collagen production. Collagen is crucial for wound repair and the formation of new tissue. Vitamin B12 is important for nerve function and DNA synthesis but is not directly related to wound healing. Vitamin K is essential for blood clotting and bone health but does not directly promote wound healing. Vitamin D plays a role in bone health and immune function but is not a primary vitamin involved in wound healing.