Nokea
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).
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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 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.
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.
The nurse is caring for a patient with lung cancer as part of a home hospice palliative program. Which of the following interventions should the nurse implement?
- A. Discuss cancer risk factors and appropriate lifestyle modifications.
- B. Encourage the patient to discuss past life events and their meaning.
- C. Accomplish a thorough head-to-toe assessment once a week.
- D. Educate the patient about the purpose of chemotherapy and radiation.
Correct Answer: B
Rationale: The role of the hospice palliative nurse includes assisting the patient with the important end-of-life task of finding meaning in the patient's life. Frequent head-to-toe assessments are not needed for hospice patients and may tire the patient unnecessarily. Patients admitted to hospice forego curative treatments such as chemotherapy and radiation for lung cancer; discussion of cancer risk factors and therapies is not appropriate.
A patient who is in the clinic for an immunization tells the nurse, 'My mother died 4 months ago, and I just can't seem to get over it. I'm not sure it is normal to still think about her every day.' Which of the following nursing diagnoses is most appropriate?
- A. Ineffective role performance related to depression
- B. Complicated grieving related to emotional disturbance (death of loved one)
- C. Anxiety related to unmet needs (lack of knowledge about normal grieving)
- D. Impaired mood regulation related to loneliness
Correct Answer: C
Rationale: The patient should be reassured that grieving activities such as frequent thoughts about the deceased are considered normal for months or years after a death. The other nursing diagnoses imply that the patient's grief is unusual or pathological, which is not the case.