Nokea
The spouse of a patient with terminal lung cancer visits daily and cheerfully talks with the patient about vacation plans for the next year. When the nurse asks about any concerns, the spouse says, 'I'm busy at work, but otherwise things are fine.' Which of the following nursing diagnoses is appropriate?
- A. Ineffective denial related to threat of unpleasant reality
- B. Anxiety related to threat to current status
- C. Caregiver role strain related to inexperience with caregiving
- D. Hopelessness related to persistent stress
Correct Answer: A
Rationale: The spouse's behaviour and statements indicate the absence of anticipatory grieving, which may lead to impaired adjustment as the patient progresses toward death. The spouse does not appear to feel overwhelmed, hopeless, or anxious about the partner's impending death.
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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.
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).
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.
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.