Nokea
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.
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The nurse is caring for a terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing. Which of the following terms should the nurse use to document this finding?
- A. Agonal breathing
- B. Apneustic breathing
- C. Death rattle respirations
- D. Cheyne-Stokes respirations
Correct Answer: D
Rationale: Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep and rapid breaths. The 'death rattle' is caused by accumulation of mucus in the airways, causing wet-sounding respirations. Agonal breathing has a very slow and irregular rate and rhythm. Apneustic respirations are irregular and gasping.
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.
The nurse is caring for a patient in a hospice palliative care program who is experiencing continuous, increasing amounts of pain. Which of the following time schedules should the nurse implement for the administration of opioid pain medications?
- A. Around-the-clock routine administration of analgesics.
- B. PRN doses of medication whenever the patient requests.
- C. Enough pain medication to keep the patient sedated and unaware of stimuli.
- D. Analgesic doses that provide pain control without decreasing respiratory rate.
Correct Answer: A
Rationale: The principles of beneficence and nonmaleficence indicate that the goal of pain management in a terminally ill patient is adequate pain relief even if the effect of pain medications could hasten death. Administration of analgesics on a PRN basis will not provide the consistent level of analgesia the patient needs. Patients usually do not require so much pain medication that they are oversedated and unaware of stimuli. Adequate pain relief may require a dosage that will result in a decrease in respiratory rate.
The nurse is planning for an end-of-life care discussion with a newly admitted patient who is terminally ill and has decided to use the NURSE protocol during the difficult conversation to respond to patient and/or family emotions. Which of the following terms describes the 'E' in the NURSE protocol?
- A. Experimentation
- B. Exploration
- C. Empathy
- D. Emotion
Correct Answer: B
Rationale: Nurses may use several approaches to difficult conversations that share common features. Suggested approaches are 'ask-tell-ask,' 'tell me more,' responding to emotions with the NURSE protocol (naming, understanding, respecting, supporting, and exploring).
As the nurse admits a patient with severe heart failure to the hospital, the patient tells the nurse, 'If my heart or breathing stop, I do not want to be resuscitated.' Which of the following actions should the nurse take?
- A. Ask if these wishes have been discussed with the health care provider.
- B. Place a 'Do-Not-Resuscitate' (DNR) notation in the patient's care plan.
- C. Inform the patient that a notarized advance directive must be included in the record or resuscitation must be performed.
- D. Advise the patient to designate a person to make health care decisions when the patient is not able to make them independently.
Correct Answer: A
Rationale: A health care provider's order should be written describing the actions that the nurses should take if the patient requires CPR, but the primary right to decide belongs to the patient or family. The nurse should document the patient's request but does not have the authority to place the DNR order in the care plan. A notarized advance directive is not needed to establish the patient's wishes. The patient may need a durable power of attorney for health care (or the equivalent), but this does not address the patient's current concern with possible resuscitation.