Nokea
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.
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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.
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 providing hospice care to a patient who is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28. Which of the following is the basis for the nurses' response about these symptoms?
- A. They will continue to increase until death finally occurs.
- B. They are a normal response before these functions decrease.
- C. They indicate a reflex response to the slowing of other body systems.
- D. They may be associated with an improvement in the patient's condition.
Correct Answer: B
Rationale: An increase in heart and respiratory rate may occur before the slowing of these functions in the dying patient. Heart and respiratory rate typically slow as the patient progresses further toward death. In a dying patient, high respiratory and pulse rates do not indicate improvement, and it would be inappropriate for the nurse to indicate this to the family. The changes in pulse and respirations are not reflex responses.
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.
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.