Nokea
An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?
- A. The patient and family should be viewed as a single unit of care.
- B. Persistent symptoms of terminal illness should not be treated.
- C. Each member of the interdisciplinary team should develop an individual plan of care.
- D. Terminally ill patients should die in the hospital whenever possible.
Correct Answer: A
Rationale: Hospice care requires that the patient and family be viewed as a single unit of care. The other listed principles are wholly inconsistent with the principles of hospice care.
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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.
A clinic nurse is providing patient education prior to a patients scheduled palliative radiotherapy to her spine. At the completion of the patient teaching, the patient continues to ask the same questions that the nurse has already addressed. What is the plausible conclusion that the nurse should draw from this?
- A. The patient is not listening effectively.
- B. The patient is noncompliant with the plan of care.
- C. The patient may have a low intelligence quotient or a cognitive deficit.
- D. The patient has not achieved the desired learning outcomes.
Correct Answer: D
Rationale: The nurse should be sensitive to patients ongoing needs and may need to repeat previously provided information or simply be present while the patient and family react emotionally. Telling a patient something is not teaching. If a patient continues to ask the same questions, teaching needs to be reinforced. The patients response is not necessarily suggestive of noncompliance, cognitive deficits, or not listening.
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.
After contributing to the care of several patients who died in the hospital, the nurse has identified some lapses in the care that many of these patients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings?
- A. Families needs for information and support often go unmet.
- B. Patients are too sedated to achieve adequate pain control.
- C. Patients are not given opportunities to communicate with caregivers.
- D. Patients are ignored by the care team toward the end of life.
Correct Answer: A
Rationale: Studies have demonstrated that the health care system continues to be challenged when meeting seriously ill patients needs for pain and symptom management and their families needs for information and support. Oversedation, lack of communication, and lack of care are not noted to be deficiencies to the same degree.
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.