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The nurse has observed that an older adult patient with a diagnosis of end-stage renal failure seems to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the patient explains to you that this is a cultural practice and very important to him. How should you respond?
- A. Privately ask the son to allow the patient to make his own health care decisions.
- B. Explain to the patient that he is responsible for his own decisions.
- C. Work with the team to negotiate informed consent.
- D. Avoid divulging information to the eldest son.
Correct Answer: C
Rationale: In this case of a patient who wishes to defer decisions to his son, the nurse can work with the team to negotiate informed consent, respecting the patients right not to participate in decision making and honoring his familys cultural practices.
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One aspect of the nurses comprehensive assessment when caring for the terminally ill is the assessment of hope. The nurse is assessing a patient with liver failure for the presence of hope. What would the nurse identify as a hope-fostering category?
- A. Uplifting memories
- B. Ignoring negative outcomes
- C. Envisioning one specific outcome
- D. Avoiding an actual or potential threat
Correct Answer: A
Rationale: Hope is a multidimensional construct that provides comfort as a person endures life threats and personal challenges. Uplifting memories are noted as a hope-fostering category, whereas the other listed options are not identified as such.
In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying?
- A. Increased incidence of infections and acute illnesses
- B. Increased focus of health care providers on disease prevention
- C. Larger numbers of people dying in hospital settings
- D. Demographic changes in the population
Correct Answer: D
Rationale: The focus on care of the dying has been motivated by the aging of the population, the prevalence of, and publicity surrounding, life-threatening illnesses (e.g., cancer and AIDS), and the increasing likelihood of a prolonged period of chronic illness prior to death. The salience of acute infections, prevention measures, and death in hospital settings are not noted to have had a major influence on this phenomenon.
A medical nurse is providing palliative care to a patient with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurses care?
- A. To improve the patients and familys quality of life
- B. To support aggressive and innovative treatments for cure
- C. To provide physical support for the patient
- D. To help the patient develop a separate plan with each discipline of the health care team
Correct Answer: A
Rationale: The goal of palliative care is to improve the patients and the familys quality of life. The support should include the patients physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the patient and family. The goal of palliative care is not aggressive support for curing the patient. Providing physical support for the patient is also not the goal of palliative care. Palliative care does not strive to achieve separate plans of care developed by the patient with each discipline of the health care team.
A 66-year-old patient is in a hospice receiving palliative care for lung cancer which has metastasized to the patients liver and bones. For the past several hours, the patient has been experiencing dyspnea. What nursing action is most appropriate to help to relive the dyspnea the patient is experiencing?
- A. Administer a bolus of normal saline, as ordered.
- B. Initiate high-flow oxygen therapy.
- C. Administer high doses of opioids.
- D. Administer bronchodilators and corticosteroids, as ordered.
Correct Answer: D
Rationale: Bronchodilators and corticosteroids help to improve lung function as well as low doses of opioids. Low-flow oxygen often provides psychological comfort to the patient and family. A fluid bolus is unlikely to be of benefit.
A patients daughter has asked the nurse about helping him end his terrible suffering. The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress?
- A. Educating families about the moral implications of assisted suicide
- B. Identifying patient and family concerns and fears
- C. Identifying resources that meet the patients desire to die
- D. Supporting effective means to honor the patients desire to die
Correct Answer: B
Rationale: The ANA Position Statement further stresses the important role of the nurse in supporting effective symptom management, contributing to the creation of environments for care that honor the patients and familys wishes, as well as identifying their concerns and fears. Discussion of moral implications would normally be beyond the purview of the nurse.