Question

A nurse is reinforcing teaching with a newly hired nurse about cultural sensitivity during death and dying. Which of the following information should the nurse include?

Answer 1

Correct Answers:

Devout practitioners of Islam prefer to have their heads turned toward Mecca at death.

Rationale :

🔷 In Islamic tradition, it is customary for the body of the deceased to be positioned with the head turned toward Mecca, which is eastward from many locations.

🔷 Devout Muslims may also require the body to be washed by family or religious leaders of the same gender.

🔷 Burial is preferred as soon as possible, often within 24 hours, not 5 days.

🔷 Practitioners of Hinduism traditionally prefer cremation, not burial.

🔷 Cultural sensitivity during death and dying respects religious customs, dignity, and sacred rituals.

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Answer 2

Correct Answers:

Speech

Rationale :

🟢 Clients who have dysphagia following a stroke (CVA) are referred to a speech-language pathologist (SLP).

🟢 The SLP assesses swallowing safety and techniques, recommends modified diets, and may conduct a swallow study.

🟢 Occupational therapy focuses on fine motor tasks; physical therapy addresses mobility; respiratory therapy manages airway and breathing.

🟢 Swallowing disorders place clients at high risk of aspiration pneumonia, so this therapy is crucial.

🟢 Early involvement supports nutritional intake and safety.

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Answer 3

Correct Answers:

"I will press on the skin barrier for 30 seconds to ensure that it adheres."

Rationale :

🔴 Applying firm pressure to the skin barrier for about 30 seconds ensures it forms a tight seal around the stoma.

🔴 Moisturizing soaps, powders, or oils should not be used, as they can interfere with adherence.

🔴 The opening should be cut to about 1/8 inch larger than the stoma—not ½ inch—to prevent skin irritation or leakage.

🔴 Consistent routine care reduces skin breakdown and infection risk.

🔴 Proper appliance technique promotes confidence and independence in ostomy clients.

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Answer 4

Correct Answers:

Allow the family to participate in washing the client's body.

Rationale :

🟣 Muslim postmortem care often includes ritual washing of the body by same-gender family or religious members.

🟣 This is a sacred act, and healthcare staff should allow and support family participation in this process.

🟣 Eagle feathers and mantras are practices more aligned with Native American or Buddhist traditions, not Islam.

🟣 Modesty, cleanliness, and respect are central to Islamic end-of-life care.

🟣 Nurses should honor these preferences while ensuring facility policies and privacy.

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Answer 5

Correct Answers:

Align the back with the neck and feet.

Rationale :

🟠 Safe lifting technique requires keeping the spine in neutral alignment, which means aligning the head, back, and feet.

🟠 Knees should be slightly bent, not straight, and feet shoulder-width apart to provide a stable base of support.

🟠 Objects should be held close to the torso to reduce strain on the lower back.

🟠 Bending at the hips and knees and using the leg muscles to lift helps prevent injury.

🟠 This practice is key to preventing recurrent back strain and musculoskeletal disorders.

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Answer 6

Correct Answers:

“the opportunity to choose what kind of care I receive while I still can."

Rationale :

🔵 Advance directives allow clients to express their treatment preferences while they are still competent to make decisions.

🔵 This includes choices about life-sustaining treatments, resuscitation, and end-of-life care.

🔵 There is no delay in legal validity once the document is signed appropriately according to state laws.

🔵 Clients can change their advance directives at any time while competent.

🔵 A separate consent form is not required to complete a living will or durable power of attorney for health care.

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Answer 7

Correct Answers:

Paint the edges of steps for contrast.

Rationale :

🟢 For clients with vision loss, adding contrast to physical features, like steps or edges, improves depth perception and safety.

🟢 It helps prevent falls and tripping hazards, especially in unfamiliar or dimly lit environments.

🟢 Extension cords should be tucked away, not secured across walkways, and lighting should be bright (higher than 40 watts) to enhance visibility.

🟢 Water heater temperatures should be kept below 49° C (120° F) to prevent burn injuries.

🟢 Home modifications should support independence and fall prevention.

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Answer 8

Correct Answers:

"Tell me more about what happens at mealtime."

Rationale :

🔴 This response uses therapeutic communication by inviting the son to share more details and explore contributing factors.

🔴 It helps the nurse understand possible emotional, environmental, or physical barriers to eating.

🔴 Rushing to suggest a feeding tube or assuming the issue isn’t serious dismisses the caregiver's concern.

🔴 Avoid asking “why” questions, which may seem accusatory or confrontational.

🔴 Open-ended questions promote a supportive and nonjudgmental conversation.

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Answer 9

Correct Answers:

"You feel as if the doctor hasn't been honest with you?"

Rationale :

🟣 This is a reflective statement, a key therapeutic technique that encourages the client to elaborate on their emotions.

🟣 It demonstrates active listening and empathy, helping de-escalate the situation without defending or dismissing the physician.

🟣 Saying “why” or offering reassurance too soon can come off as defensive or invalidating.

🟣 Reflecting the client’s statement also helps clarify their perceptions versus facts.

🟣 Nurses should remain neutral while supporting open and honest communication.

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Answer 10

Correct Answers:

Determine the client's level of comfort.

Rationale :

🟡 A client pulling on an NG tube may be experiencing discomfort, anxiety, or confusion, so the nurse must first assess the underlying cause.

🟡 Addressing pain, nausea, or fear may prevent further agitation or injury.

🟡 Restraints and sedatives are last-resort measures after assessing and addressing unmet needs.

🟡 Documentation is important but not the first priority in immediate behavioral concerns.

🟡 This approach supports compassionate, client-centered care.

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ATI PN Fundamentals of Nursing 2020 with NGN Exam 2

No.

1 :
A nurse is reinforcing teaching with a newly hired nurse about cultural sensitivity during death and dying. Which of the following information should the nurse include?

2 :
A nurse is caring for a client who has experienced a cerebrovascular accident with resulting dysphagia. Which of the following therapists assists clients to learn to eat with less risk of aspiration?

3 :
A nurse is reinforcing teaching with a client who has an ostomy. Which of the following statements by the client indicates an understanding of the teaching?

4 :
A nurse is performing postmortem care for a client who was a devout Muslim. Which of the following actions should the nurse take?

5 :
A nurse is reinforcing teaching with a client who has recurrent back injuries related to lifting. Which of the following lifting instructions should the nurse include?

6 :
A nurse is reinforcing teaching about advance directives with a client who has terminal colorectal cancer. Which of the following statements by the client indicates an understanding of the teaching?

7 :
A nurse is assisting with discharge planning for an older adult client who has vision loss. Which of the following instructions about home safety should the nurse include in the plan?

8 :
A home health nurse is reinforcing teaching about dietary needs with the son of a client. The son states, "I don't know what to do because he's not eating." Which of the following responses should the nurse make?

9 :
A nurse is caring for a client who is angry and states, "The doctor gave me the wrong information. I was lied to!" Which of the following responses by the nurse is appropriate?

10 :
A nurse is caring for a client who is pulling on his NG tube. Which of the following actions should the nurse take first?

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ATI PN Fundamentals of Nursing 2020 with NGN Exam 2

No.

1 : A nurse is reinforcing teaching with a newly hired nurse about cultural sensitivity during death and dying. Which of the following information should the nurse include?

2 : A nurse is caring for a client who has experienced a cerebrovascular accident with resulting dysphagia. Which of the following therapists assists clients to learn to eat with less risk of aspiration?

3 : A nurse is reinforcing teaching with a client who has an ostomy. Which of the following statements by the client indicates an understanding of the teaching?

4 : A nurse is performing postmortem care for a client who was a devout Muslim. Which of the following actions should the nurse take?

5 : A nurse is reinforcing teaching with a client who has recurrent back injuries related to lifting. Which of the following lifting instructions should the nurse include?

6 : A nurse is reinforcing teaching about advance directives with a client who has terminal colorectal cancer. Which of the following statements by the client indicates an understanding of the teaching?

7 : A nurse is assisting with discharge planning for an older adult client who has vision loss. Which of the following instructions about home safety should the nurse include in the plan?

8 : A home health nurse is reinforcing teaching about dietary needs with the son of a client. The son states, "I don't know what to do because he's not eating." Which of the following responses should the nurse make?

9 : A nurse is caring for a client who is angry and states, "The doctor gave me the wrong information. I was lied to!" Which of the following responses by the nurse is appropriate?

10 : A nurse is caring for a client who is pulling on his NG tube. Which of the following actions should the nurse take first?

1 :
A nurse is reinforcing teaching with a newly hired nurse about cultural sensitivity during death and dying. Which of the following information should the nurse include?

2 :
A nurse is caring for a client who has experienced a cerebrovascular accident with resulting dysphagia. Which of the following therapists assists clients to learn to eat with less risk of aspiration?

3 :
A nurse is reinforcing teaching with a client who has an ostomy. Which of the following statements by the client indicates an understanding of the teaching?

4 :
A nurse is performing postmortem care for a client who was a devout Muslim. Which of the following actions should the nurse take?

5 :
A nurse is reinforcing teaching with a client who has recurrent back injuries related to lifting. Which of the following lifting instructions should the nurse include?

6 :
A nurse is reinforcing teaching about advance directives with a client who has terminal colorectal cancer. Which of the following statements by the client indicates an understanding of the teaching?

7 :
A nurse is assisting with discharge planning for an older adult client who has vision loss. Which of the following instructions about home safety should the nurse include in the plan?

8 :
A home health nurse is reinforcing teaching about dietary needs with the son of a client. The son states, "I don't know what to do because he's not eating." Which of the following responses should the nurse make?

9 :
A nurse is caring for a client who is angry and states, "The doctor gave me the wrong information. I was lied to!" Which of the following responses by the nurse is appropriate?

10 :
A nurse is caring for a client who is pulling on his NG tube. Which of the following actions should the nurse take first?