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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.
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A hospice nurse is caring for a 22-year-old with a terminal diagnosis of leukemia. When updating this patients plan of nursing care, what should the nurse prioritize?
- A. Interventions aimed at maximizing quantity of life
- B. Providing financial advice to pay for care
- C. Providing realistic emotional preparation for death
- D. Making suggestions to maximize family social interactions after the patients death
Correct Answer: C
Rationale: Hospice care focuses on quality of life, but, by necessity, it usually includes realistic emotional, social, spiritual, and financial preparation for death. Financial advice and actions aimed at post-death interaction would not be appropriate priorities.
A patient on the medical unit is dying and the nurse has determined that the familys psychosocial needs during the dying process need to be addressed. What is a cause of many patient care dilemmas at the end of life?
- A. Poor communication between the family and the care team
- B. Denial of imminent death on the part of the family or the patient
- C. Limited visitation opportunities for friends and family
- D. Conflict between family members
Correct Answer: A
Rationale: Many dilemmas in patient care at the end of life are related to poor communication between team members and the patient and family, as well as to failure of team members to communicate with each other effectively. Regardless of the care setting, the nurse can ensure a proactive approach to the psychosocial care of the patient and family. Denial of death may be a response to the situation, but it is not classified as a need. Visitation should accommodate wishes of the family member as long as patient care is not compromised.
A patient has just died following urosepsis that progressed to septic shock. The patients spouse says, I knew this was coming, but I feel so numb and hollow inside. The nurse should know that these statements are characteristic of what?
- A. Complicated grief and mourning
- B. Uncomplicated grief and mourning
- C. Depression stage of dying
- D. Acceptance stage of dying
Correct Answer: B
Rationale: Uncomplicated grief and mourning are characterized by emotional feelings of sadness, anger, guilt, and numbness; physical sensations, such as hollowness in the stomach and tightness in the chest, weakness, and lack of energy; cognitions that include preoccupation with the loss and a sense of the deceased as still present; and behaviors such as crying, visiting places that are reminders of the deceased, social withdrawal, and restless overactivity. Complicated grief and mourning occur at a prolonged time after the death. The spouses statement does not clearly suggest depression or acceptance.
The nurse has observed that an older adult patient with a diagnosis of end-stage renal failure seems to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the patient explains to you that this is a cultural practice and very important to him. How should you respond?
- A. Privately ask the son to allow the patient to make his own health care decisions.
- B. Explain to the patient that he is responsible for his own decisions.
- C. Work with the team to negotiate informed consent.
- D. Avoid divulging information to the eldest son.
Correct Answer: C
Rationale: In this case of a patient who wishes to defer decisions to his son, the nurse can work with the team to negotiate informed consent, respecting the patients right not to participate in decision making and honoring his familys cultural practices.
A patient who is receiving care for osteosarcoma has been experiencing severe pain since being diagnosed. As a result, the patient has been receiving analgesics on both a scheduled and PRN basis. For the past several hours, however, the patients level of consciousness has declined and she is now unresponsive. How should the patients pain control regimen be affected?
- A. The patients pain control regimen should be continued.
- B. The pain control regimen should be placed on hold until the patients level of consciousness improves.
- C. IV analgesics should be withheld and replaced with transdermal analgesics.
- D. The patients analgesic dosages should be reduced by approximately one half.
Correct Answer: A
Rationale: Pain should be aggressively treated, even if dying patients become unable to verbally report their pain. There is no need to forego the IV route. There is no specific need to discontinue the pain control regimen or reduce dosages.