Nokea
A nurse is caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patients daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as?
- A. Lack of an American education of the patient and her family
- B. A language barrier to hospice care for this patient
- C. A barrier to hospice care for this patient
- D. Inability to grasp American concepts of health care
Correct Answer: C
Rationale: Historical mistrust of the health care system and unequal access to even basic medical care may underlie the beliefs and attitudes among ethnically diverse populations. In addition, lack of education or knowledge about end-of-life care treatment options and language barriers influence decisions among many socioeconomically disadvantaged groups. The scenario does not indicate whether the patients family has an American education, whether they are unable to grasp American concepts of health care, or whether they can speak or understand English.
You may also like to solve these questions
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 pediatric nurse is emotionally distraught by the death of a 9-year-old girl who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurses own grief?
- A. Take time off from work to mourn the death.
- B. Post mementos of the patient on the unit.
- C. Solicit emotional support from the patients family.
- D. Attend the patients memorial service.
Correct Answer: D
Rationale: In many settings, staff members organize or attend memorial services to support families and other caregivers who find comfort in joining each other to remember and celebrate the lives of patients. Taking time off should not be necessary and posting mementos would be inappropriate. It would be highly inappropriate to solicit emotional support from the patients family during their time of loss.
A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patients care in this setting be based?
- A. Meaningful living during terminal illness requires technologic interventions.
- B. Meaningful living during terminal illness is best supported in designated facilities.
- C. Meaningful living during terminal illness is best supported in the home.
- D. Meaningful living during terminal illness is best achieved by prolonging physiologic dying.
Correct Answer: C
Rationale: The hospice movement in the United States is based on the belief that meaningful living is achievable during terminal illness and that it is best supported in the home, free from technologic interventions to prolong physiologic dying.
The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the patients death is imminent?
- A. Mottling of the lower limbs
- B. Slow, steady pulse
- C. Bowel incontinence
- D. Increased swallowing
Correct Answer: A
Rationale: The time of death is generally preceded by a period of gradual diminishment of bodily functions in which increasing intervals between respirations, weakened and irregular pulse, and skin color changes or mottling may be observed. The patient will not be able to swallow secretions, so suctioning, frequent and gentle mouth care, and, possibly, the administration of a transdermal anticholinergic drug. Bowel incontinence may or may not occur.
A nurse who works in the specialty of palliative care frequently encounters issues and situations that constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the context of palliative care?
- A. The increase in cultural diversity in the United States
- B. Staffing shortages in health care and questions concerning quality of care
- C. Increased costs of health care coupled with inequalities in access
- D. Ability of technology to prolong life beyond meaningful quality of life
Correct Answer: D
Rationale: The application of technology to prolong life has raised several ethical issues. The major question is, Because we can prolong life through increasingly sophisticated technology, does it necessarily follow that we must do so? The increase in cultural diversity has not raised ethical issues in health care. Similarly, costs and staffing issues are relevant, but not central to the most common ethical issues surrounding palliative care.