Hurst Psychosocial Integrity Final Exam.

Hurst Psychosocial Integrity Final Exam. The nurse is teaching a family member of a client with a terminal illness the signs of impending death. Which statement by a family member indicates the need for further teaching? 1. "I will continue to talk in normal tones." 2. "Decrease in respirations may happen." 3. "Death is soon, if their shoulders are cool." 4. "They may prefer to sleep rather than talk." - CORRECT ANSWER 3. "Death is soon, if their shoulders are cool." 3. Correct: The systems of the body will begin to function erratic and slower as death approaches. As the feedback of the circulatory system fails, the client will have fluctuating temperature control. As death process continues, the circulatory system in the extremities will fail. The arms and legs will become cooler. The family member will require further teaching regarding indicators of approaching death. A client who was diagnosed with paranoid delusions has been prescribed a chest x-ray. The client refuses the chest x-ray and states "No, they want to kill me with the rays from the x-ray machine." Which nursing response is appropriate? "1. "Do you think people want to kill you with rays?" 2. "You don't have to worry that someone is going to kill you." 3. "I don't want you to talk about the x-ray technicians." 4. "Where did you get the idea that someone was trying to kill you?" - CORRECT ANSWER "Do you think people want to kill you with rays?" 1. Correct: By restating the client's primary idea this reinforces to the client that statement has been heard. This allows the client to clarify the statement or realize that the nurse has understood the comment. This is the therapeutic communication technique of restating. A distraught client arrives at a mental health crisis center following a house fire that also took the life of a young family member. The nurse knows what action is most important when initiating crisis intervention for this client? 1. Assist the client to verbalize feelings of grief. 2. Assess client for any suicidal behaviors. 3. Admit client to general mental health unit.