QUESTIONS AND CORRECT ANSWERS
A 63-year-old female client whose husband died one month ago is seen in the psychiatric clinic. Her
daughter tells the nurse that her mother is eating poorly, sleeps very little at night, and continues to set
the table for her deceased husband. What nursing problem best describes this problem? - CORRECT
ANSWER Denial related to the loss of a loved one.
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Based on the data provided, denial of the loss is the best nursing diagnosis. This client is exhibiting
symptoms of anxiety and the pain is too great for her to acknowledge, so she is denying the situation.
Although she may seem confused, she is actually trying to deal with the pain through the defense
mechanism of denial. Delayed grief occurs after one year or longer following the loss. The client's
husband died one month ago. Unsresolved anger and depression are often related, and depression is
sometimes described as unexpressed anger. However, this client has not acknowledged her loss
(denial) and the anger is not yet realized.
The nurse dons gown, mask with eyeshield, and gloves before entering a client's room that has
airborne precautions. Upon leaving the client's room, in which sequence should the nurse remove the
personal protective equipment (PPE)? (Place the first action on top and last action on the bottom.) -
CORRECT ANSWER Remove gloves
remove gown
remove mask
wash hands
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Correct order is Gloves, Gown, Mask, Wash. The nurse should first remove the contaminated gloves
by grasping the cuff and pulling the glove inside out over the hands. Then, untie the gown waist and
neck strings, remove the gown without the hands touching the outside of the gown, and fold inside out
to discard. Because the client is on airborne precautions, the nurse should then remove the mask .
Handwashing should be done after all the PPE is removed. Handwashing may be recommended at
other times as well, however in this sequence, it should always be done at the end--before leaving the
room and after leaving the room.
The nurse is assessing a client and identifies a bruit over the thyroid. This finding is consistent with
which interpretation? - CORRECT ANSWER Hyperthyroidism.
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