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A patient who is very close to death is very restless and keeps repeating, 'I am not ready to die.' Which of the following actions should the nurse take?
- A. Remind the patient that no one feels ready for death.
- B. Sit at the bedside and ask if there is anything the patient needs.
- C. Insist that family members remain at the bedside with the patient.
- D. Tell the patient that everything possible is being done to delay death.
Correct Answer: B
Rationale: Staying at the bedside and listening allows the patient to discuss any unresolved issues or physical discomforts that should be addressed. Stating that no one feels ready for death fails to address the individual patient's concerns. Telling the patient that everything possible is being done to delay death does not address the patient's fears about dying, especially since the patient is likely to die soon. Family members may not feel comfortable staying at the bedside of a dying patient, the nurse should not insist they remain there.
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The nurse is caring for a patient with lung cancer as part of a home hospice palliative program. Which of the following interventions should the nurse implement?
- A. Discuss cancer risk factors and appropriate lifestyle modifications.
- B. Encourage the patient to discuss past life events and their meaning.
- C. Accomplish a thorough head-to-toe assessment once a week.
- D. Educate the patient about the purpose of chemotherapy and radiation.
Correct Answer: B
Rationale: The role of the hospice palliative nurse includes assisting the patient with the important end-of-life task of finding meaning in the patient's life. Frequent head-to-toe assessments are not needed for hospice patients and may tire the patient unnecessarily. Patients admitted to hospice forego curative treatments such as chemotherapy and radiation for lung cancer; discussion of cancer risk factors and therapies is not appropriate.
The nurse is caring for a young adult who is dying after an automobile accident. The family members want to donate the patient's organs and ask the nurse how the decision when death has occurred is made. Which of the following is the basis for the nurses' response to the family in this situation?
- A. The patient is flaccid and unresponsive.
- B. The patient is experiencing respiratory acidosis and is on a ventilator.
- C. The patient is unconscious with no brain stem activity.
- D. Respiratory efforts cease and no apical pulse is audible.
Correct Answer: C
Rationale: Death is the permanent loss of capacity for consciousness and all brain stem functions. This may result from permanent cessation of circulation or catastrophic brain injury. In the context of death determination, permanent refers to loss of function that cannot resume spontaneously and will not be restored through intervention. The other descriptions describe other clinical manifestations associated with death but are insufficient to declare a patient brain dead.
The nurse has been caring for a terminally ill patient for the past 10 months. The nurse and the family are present when the patient dies and feels saddened and tearful as the family members begin to cry. Which of the following actions should the nurse take at this time?
- A. Contact a grief counsellor as soon as possible.
- B. Cry along with the patient's family members.
- C. Leave the home as quickly as possible to allow the family to grieve privately.
- D. Consider whether working in hospice is desirable since patient losses are common.
Correct Answer: B
Rationale: It is appropriate for the nurse to cry and express sadness in other ways when a patient dies, and the family is likely to feel that this is therapeutic. Contacting a grief counsellor, leaving the family to grieve privately, and considering whether hospice continues to be a satisfying place to work are all appropriate actions as well, but the nurse's initial action at this time should be to share the grieving process with the family.
Which of the following patients is most appropriate for the nurse to refer to hospice palliative care?
- A. A 60-year-old with lymphoma whose children are unable to discuss issues related to dying
- B. A 72-year-old with persistent severe pain as a result of spinal arthritis and vertebral collapse
- C. A 28-year-old with AIDS-related dementia who needs palliative care and pain management
- D. A 56-year-old with advanced liver failure whose family members can no longer care for him or her at home
Correct Answer: C
Rationale: Hospice is designed to provide palliative care such as symptom management and pain control for patients at the end of life. Patients who require more care than the family can provide, whose families are unable to discuss important issues related to dying, or who have severe pain are candidates for other nursing services but are not appropriate hospice patients.
As the nurse admits a patient with severe heart failure to the hospital, the patient tells the nurse, 'If my heart or breathing stop, I do not want to be resuscitated.' Which of the following actions should the nurse take?
- A. Ask if these wishes have been discussed with the health care provider.
- B. Place a 'Do-Not-Resuscitate' (DNR) notation in the patient's care plan.
- C. Inform the patient that a notarized advance directive must be included in the record or resuscitation must be performed.
- D. Advise the patient to designate a person to make health care decisions when the patient is not able to make them independently.
Correct Answer: A
Rationale: A health care provider's order should be written describing the actions that the nurses should take if the patient requires CPR, but the primary right to decide belongs to the patient or family. The nurse should document the patient's request but does not have the authority to place the DNR order in the care plan. A notarized advance directive is not needed to establish the patient's wishes. The patient may need a durable power of attorney for health care (or the equivalent), but this does not address the patient's current concern with possible resuscitation.