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The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patients strategy?
- A. The patient may be trying to protect loved ones from the emotional effects of the illness.
- B. The patient is being noncompliant in order to assert power over caregivers.
- C. The patient may be skeptical of the benefits of the Western biomedical model of health.
- D. The patient thinks that treatment does not provide him comfort.
Correct Answer: A
Rationale: Patients who are characterized as being in denial may be using this strategy to preserve important interpersonal relationships, to protect others from the emotional effects of their illness, and to protect themselves because of fears of abandonment. Each of the other listed options is plausible, but less likely.
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A nurse who works in the specialty of palliative care frequently encounters issues and situations that constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the context of palliative care?
- A. The increase in cultural diversity in the United States
- B. Staffing shortages in health care and questions concerning quality of care
- C. Increased costs of health care coupled with inequalities in access
- D. Ability of technology to prolong life beyond meaningful quality of life
Correct Answer: D
Rationale: The application of technology to prolong life has raised several ethical issues. The major question is, Because we can prolong life through increasingly sophisticated technology, does it necessarily follow that we must do so? The increase in cultural diversity has not raised ethical issues in health care. Similarly, costs and staffing issues are relevant, but not central to the most common ethical issues surrounding palliative care.
One of the functions of nursing care of the terminally ill is to support the patient and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support patients and their families during this process? Select all that apply.
- A. Describe their personal experiences in dealing with end-of-life issues.
- B. Encourage the patient and family to keep fighting as a cure may come.
- C. Try to appreciate and understand the illness from the patients perspective.
- D. Assist patients with performing a life review.
- E. Provide interventions that facilitate end-of-life closure.
Correct Answer: C,D,E
Rationale: Nurses are responsible for educating patients about their illness and for supporting them as they adapt to life with the illness. Nurses can assist patients and families with life review, values clarification, treatment decision making, and end-of-life closure. The only way to do this effectively is to try to appreciate and understand the illness from the patients perspective. The nurses personal experiences should not normally be included and a cure is often not a realistic hope.
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 nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group?
- A. Providing a framework for incorporating the old life into the new life
- B. Normalizing adaptation to a continuation of the old life
- C. Aiding in adjusting to using old, familiar social skills
- D. Normalization of feelings and experiences
Correct Answer: D
Rationale: Although many people complete the work of mourning with the informal support of families and friends, many find that talking with others who have had a similar experience, such as in formal support groups, normalizes the feelings and experiences and provides a framework for learning new skills to cope with the loss and create a new life. The other listed options are incorrect because they indicate the need to hold onto the old life and not move on.
A patient has just been told that her illness is terminal. The patient tearfully states, I cant believe I am going to die. Why me? What is your best response?
- A. I know how you are feeling.
- B. You have lived a long life.
- C. This must be very difficult for you.
- D. Life can be so unfair.
Correct Answer: C
Rationale: The most important intervention the nurse can provide is listening empathetically. To communicate effectively, the nurse should ask open-ended questions and acknowledge the patients fears. Deflecting the statement or providing false sympathy must be avoided.