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The male client requested a DNR per the AD, and the HCP wrote the order. The client's death is imminent and the client's wife tells the nurse, 'Help him please. Do something. I am not ready to let him go.' Which action should the nurse take?
- A. Ask the wife if she would like to revoke her husband's AD.
- B. Leave the wife at the bedside and notify the hospital chaplain.
- C. Sit with the wife at the bedside and encourage her to say good-bye.
- D. Request the client to tell the wife he is ready to die, and don't do anything.
Correct Answer: C
Rationale: Sitting with the wife and encouraging closure supports her emotionally while respecting the DNR. Revoking AD, notifying chaplain, or requesting client communication is inappropriate.
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The nurse is admitting a client to the medical surgical unit. Which is required to be offered to the client if the hospital accepts Medicare reimbursement?
- A. The opportunity to make an advance directive.
- B. The client must be referred to a case manager.
- C. The client must apply for a Medicare supplement insurance.
- D. The opportunity to discuss end-of-life issues.
Correct Answer: A
Rationale: The Patient Self-Determination Act mandates offering ADs on admission for Medicare-funded hospitals. Case management, insurance, or end-of-life discussions are not required.
Which document is the best professional source to provide direction for a nurse when addressing ethical issues and behavior?
- A. The Hippocratic Oath.
- B. The Nuremberg Code.
- C. Home Health Care Bill of Rights.
- D. ANA Code of Ethics.
Correct Answer: D
Rationale: The ANA Code of Ethics guides nurses on ethical behavior and decision-making, specific to nursing practice. Other documents are less relevant or outdated.
The nurse is moving to another state which is part of the multistate licensure compact. Which information regarding ADs should the nurse be aware of when practicing nursing in other states?
- A. The laws regarding ADs are the same in all the states.
- B. Advance directives can be transferred from state to state.
- C. A significant other can sign a loved one's advance directive.
- D. Advance directives are state regulated, not federally regulated.
Correct Answer: D
Rationale: ADs are governed by state laws, varying in requirements and execution, not federal regulation. Laws differ, transferability depends on state reciprocity, and significant others cannot sign unless designated.
The client diagnosed with cancer is unable to attain pain relief despite receiving large amounts of narcotic medications. Which intervention should be included in the plan of care?
- A. Ask the HCP to increase the medication.
- B. Assess for any spiritual distress.
- C. Change the client's position every two (2) hours.
- D. Turn on the radio to soothing music.
Correct Answer: B
Rationale: Spiritual distress can exacerbate pain perception; assessing it addresses holistic care, per pain management principles. Increasing medication, repositioning, or music is less targeted.
Which intervention should the nurse implement to provide culturally sensitive health care to the European-American Caucasian elderly client who is terminal?
- A. Discuss health-care issues with the oldest male child.
- B. Determine if the client will be cremated or have an earth burial.
- C. Do not talk about death and dying in front of the client.
- D. Encourage the client's autonomy and answer questions truthfully.
Correct Answer: D
Rationale: Encouraging autonomy and honesty respects individual preferences, common in European-American culture, per patient-centered care. Family roles, burial plans, or avoiding death talk are less universal.