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A terminally ill patient is admitted to the hospital. Which of the following actions should the nurse include in the initial plan of care?
- A. Determine the patient's wishes regarding end-of-life care.
- B. Emphasize the importance of addressing any family issues.
- C. Discuss the normal grief process with the patient and family.
- D. Encourage the patient to talk about any fears or unresolved issues.
Correct Answer: A
Rationale: The nurse's initial action should be to assess the patient's wishes at this time. The other actions may be implemented if the patient or the family express a desire to discuss fears, understand the grief process, or address family issues, but they should not be implemented until the assessment indicates that they are appropriate.
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The nurse is planning for an end-of-life care discussion with a newly admitted patient who is terminally ill and has decided to use the NURSE protocol during the difficult conversation to respond to patient and/or family emotions. Which of the following terms describes the 'E' in the NURSE protocol?
- A. Experimentation
- B. Exploration
- C. Empathy
- D. Emotion
Correct Answer: B
Rationale: Nurses may use several approaches to difficult conversations that share common features. Suggested approaches are 'ask-tell-ask,' 'tell me more,' responding to emotions with the NURSE protocol (naming, understanding, respecting, supporting, and exploring).
The family member of a patient who is dying tells the nurse, 'Mother doesn't really respond any more when I visit. I don't think she knows that I am here.' Which of the following responses by the nurse is most appropriate?
- A. You may need to cut back your visits for now to avoid overtiring your mother.
- B. Withdrawal may sometimes be a normal response when preparing to leave life.
- C. It will be important for you to stimulate your mother as she gets closer to dying.
- D. Many patients don't really know what is going on around them at the end of life.
Correct Answer: B
Rationale: Withdrawal is a normal psychosocial response to approaching death. Dying patients may maintain the ability to hear while not being able to respond. Stimulation will tire the patient and is not an appropriate response to withdrawal in this circumstance. Visitors are encouraged to be 'present' with the patient, talking softly and making physical contact in a way that does not demand a response from the patient.
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.
A patient who is in the clinic for an immunization tells the nurse, 'My mother died 4 months ago, and I just can't seem to get over it. I'm not sure it is normal to still think about her every day.' Which of the following nursing diagnoses is most appropriate?
- A. Ineffective role performance related to depression
- B. Complicated grieving related to emotional disturbance (death of loved one)
- C. Anxiety related to unmet needs (lack of knowledge about normal grieving)
- D. Impaired mood regulation related to loneliness
Correct Answer: C
Rationale: The patient should be reassured that grieving activities such as frequent thoughts about the deceased are considered normal for months or years after a death. The other nursing diagnoses imply that the patient's grief is unusual or pathological, which is not the case.
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.