Nokea
A medical nurse is providing end-of-life care for a patient with metastatic bone cancer. The nurse notes that the patient has been receiving oral analgesics for her pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?
- A. Request the physician to order analgesics by an alternative route.
- B. Crush the medication in order to aid swallowing and absorption.
- C. Administer the patients medication with the meal tray.
- D. Administer the medication rectally.
Correct Answer: A
Rationale: A change in medication route is indicated and must be made by a physicians order. Many pain medications cannot be crushed and given to a patient. Giving the medication with a meal is not going to make it any easier to swallow. Rectal administration may or may not be an option.
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A nurse who sits on the hospitals ethics committee is reviewing a complex case that has many of the hallmarks of assisted suicide. Which of the following would be an example of assisted suicide?
- A. Administering a lethal dose of medication to a patient whose death is imminent
- B. Administering a morphine infusion without assessing for respiratory depression
- C. Granting a patients request not to initiate enteral feeding when the patient is unable to eat
- D. Neglecting to resuscitate a patient with a do not resuscitate order
Correct Answer: A
Rationale: Assisted suicide refers to providing another person the means to end his or her own life. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. The other listed options do not fit this accepted definition of assisted suicide.
A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group?
- A. Providing a framework for incorporating the old life into the new life
- B. Normalizing adaptation to a continuation of the old life
- C. Aiding in adjusting to using old, familiar social skills
- D. Normalization of feelings and experiences
Correct Answer: D
Rationale: Although many people complete the work of mourning with the informal support of families and friends, many find that talking with others who have had a similar experience, such as in formal support groups, normalizes the feelings and experiences and provides a framework for learning new skills to cope with the loss and create a new life. The other listed options are incorrect because they indicate the need to hold onto the old life and not move on.
One aspect of the nurses comprehensive assessment when caring for the terminally ill is the assessment of hope. The nurse is assessing a patient with liver failure for the presence of hope. What would the nurse identify as a hope-fostering category?
- A. Uplifting memories
- B. Ignoring negative outcomes
- C. Envisioning one specific outcome
- D. Avoiding an actual or potential threat
Correct Answer: A
Rationale: Hope is a multidimensional construct that provides comfort as a person endures life threats and personal challenges. Uplifting memories are noted as a hope-fostering category, whereas the other listed options are not identified as such.
A 67-year-old woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply.
- A. Reiterating her anger at her husbands care team
- B. Reinvesting in new relationships at the appropriate time
- C. Reminiscing about the relationship she had with her husband
- D. Relinquishing old attachments to her husband at the appropriate time
- E. Renewing her lifelong commitment to her husband
Correct Answer: B,C,D
Rationale: Six key processes of mourning allow people to accommodate to the loss in a healthy way: 1.) Recognition of the loss 2.) Reaction to the separation, and experiencing and expressing the pain of the loss 3.) Recollection and re-experiencing the deceased, the relationship, and the associated feelings 4.) Relinquishing old attachments to the deceased 5.) Readjustment to adapt to the new world without forgetting the old 6.) Reinvestment Reiterating her anger and renewing her lifelong commitment may be counterproductive to the mourning process.
A patients daughter has asked the nurse about helping him end his terrible suffering. The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress?
- A. Educating families about the moral implications of assisted suicide
- B. Identifying patient and family concerns and fears
- C. Identifying resources that meet the patients desire to die
- D. Supporting effective means to honor the patients desire to die
Correct Answer: B
Rationale: The ANA Position Statement further stresses the important role of the nurse in supporting effective symptom management, contributing to the creation of environments for care that honor the patients and familys wishes, as well as identifying their concerns and fears. Discussion of moral implications would normally be beyond the purview of the nurse.