Nokea
The nurse is caring for a patient who has been diagnosed with metastatic cancer and plans a trip across the country 'to settle some issues with my sisters and brothers.' Which of the following responses should the nurse recognize that the patient is manifesting?
- A. Restlessness
- B. Yearning and protest
- C. Anxiety about unfinished business
- D. Fear of the meaninglessness of one's life
Correct Answer: C
Rationale: The patient's statement indicates that there is some unfinished family business that the patient would like to address before dying. Restlessness is frequently a behaviour associated with an inability to express emotional or physical distress, but this patient does not express distress and is able to communicate clearly. There is no indication that the patient is protesting the prognosis, or that there is any fear that the patient's life has been meaningless.
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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.
The nurse has been caring for a terminally ill patient for the past 10 months. The nurse and the family are present when the patient dies and feels saddened and tearful as the family members begin to cry. Which of the following actions should the nurse take at this time?
- A. Contact a grief counsellor as soon as possible.
- B. Cry along with the patient's family members.
- C. Leave the home as quickly as possible to allow the family to grieve privately.
- D. Consider whether working in hospice is desirable since patient losses are common.
Correct Answer: B
Rationale: It is appropriate for the nurse to cry and express sadness in other ways when a patient dies, and the family is likely to feel that this is therapeutic. Contacting a grief counsellor, leaving the family to grieve privately, and considering whether hospice continues to be a satisfying place to work are all appropriate actions as well, but the nurse's initial action at this time should be to share the grieving process with the family.
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 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.
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.