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Which patient should the nurse refer for hospice care?
- A. A 60-year-old with lymphoma whose children are unable to discuss issues related to dying.
- B. A 72-year-old with chronic severe pain due to 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 provide care in the home.
Correct Answer: C
Rationale: The correct answer is C because the patient with AIDS-related dementia requires palliative care and pain management, which are key components of hospice care. This patient is likely in the terminal stage of their illness and would benefit from the comprehensive support provided by hospice services.
Choice A is incorrect because the patient's children's inability to discuss dying issues does not necessarily indicate a need for hospice care. Choice B is incorrect as chronic severe pain due to spinal arthritis is not a sole criterion for hospice referral. Choice D is incorrect as advanced liver failure alone does not automatically qualify a patient for hospice care.
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An 81-year-old patient who has been in the intensive care unit (ICU) for a week is now stable, and transfer to the progressive care unit is planned. On rounds, the nurse notices that the patient has new onset confusion. The nurse will plan to:
- A. Give PRN lorazepam (Ativan) and cancel the transfer.
- B. Inform the receiving nurse and then transfer the patient.
- C. Notify the health care provider and postpone the transfer.
- D. Obtain an order for restraints as needed and transfer the patient.
Correct Answer: C
Rationale: The correct answer is C: Notify the health care provider and postpone the transfer. The new onset confusion in an elderly patient in the ICU can be a sign of delirium, which is a serious condition that requires prompt evaluation and management. By notifying the healthcare provider, they can assess the patient's condition, order appropriate tests, and adjust the treatment plan as needed. Postponing the transfer allows for further observation and intervention to address the underlying cause of the confusion.
Choice A (Give PRN lorazepam and cancel the transfer) is incorrect because administering lorazepam may worsen the confusion in an elderly patient and should not be done without proper evaluation.
Choice B (Inform the receiving nurse and then transfer the patient) is incorrect because transferring the patient without addressing the new onset confusion can lead to potential complications and delay in appropriate management.
Choice D (Obtain an order for restraints as needed and transfer the patient) is incorrect because using restraints should only be considered as a
The patient has a Glasgow Coma Scale (GCS) score of 3 and discussions have been held with the family about withdrawing life support. Which statemen t by the nurse best describes requirements that must be met to sustain Centers for Medicare and Medicaid Services (CMS) Conditions of Participation?
- A. “I need to notify the organ procurement organization O PO of my patient’s impending death.”
- B. “I will contact the physician to obtain informed consen t for organ donation.”
- C. “The charge nurse will notify organ procurement organization OPO once the patient has been pronounced brain dead.”
- D. “I need the physician to evaluate my patient’s suitability for organ donation.”
Correct Answer: C
Rationale: The correct answer is C because notifying the organ procurement organization (OPO) once the patient has been pronounced brain dead is a requirement to sustain CMS Conditions of Participation. This step ensures that the proper protocols are followed for organ donation.
Choice A is incorrect because notifying the OPO of impending death is not a requirement for sustaining CMS Conditions of Participation.
Choice B is incorrect because obtaining informed consent for organ donation is not directly related to meeting the requirements of CMS Conditions of Participation.
Choice D is incorrect because while evaluating the patient's suitability for organ donation is important, it is not a specific requirement under CMS Conditions of Participation.
A young adult patient with metastatic cancer, who is very close to death, appears restless. The patient keeps repeating, 'I am not ready to die.' Which action is best for the nurse to 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: The correct answer is B because sitting at the bedside and asking if there is anything the patient needs demonstrates empathy and support. It allows the patient to express their concerns and fears, providing emotional comfort. It shows the nurse is actively listening and willing to help address any immediate needs or concerns.
Choice A is incorrect because it dismisses the patient's feelings and may come across as invalidating. Choice C is incorrect because insisting that family members remain may not be what the patient needs at that moment and could cause additional stress. Choice D is incorrect because it does not address the patient's emotional distress and may not be true in the context of terminal illness.
The patient is undergoing a necessary but painful procedure that is greatly increasing her anxiety. The nurse decides to use guided imagery to help alleviate the patients anxiety. What is a key part of this technique?
- A. Provide the patient with an external focus point such as a picture.
- B. Have the patient take slow, shallow breaths while staring at a focus point.
- C. Have the patient remember tactile sensations of a pleasant experience.
- D. Encourage the patient to consciously relax all of her muscles.
Correct Answer: C
Rationale: The correct answer is C because guided imagery involves using the patient's imagination to focus on pleasant sensory experiences. This helps distract the patient from the current situation and reduces anxiety. By remembering tactile sensations of a pleasant experience, the patient can create a calming mental image.
Choice A is incorrect because guided imagery does not require an external focus point like a picture. Choice B is incorrect because the technique does not involve staring at a focus point but rather focusing on mental images. Choice D is incorrect because while relaxation is beneficial, guided imagery specifically focuses on visualization of positive experiences to reduce anxiety.
Which of the following is a National Patient Safety Goal? a(bSirebl.ceocmt /taelslt that apply.)
- A. Accurately identify patients.
- B. Eliminate use of patient restraints.
- C. Reconcile medications across the continuum of care.
- D. Reduce risks of healthcare-acquired infection.
Correct Answer: A
Rationale: Rationale: Accurately identifying patients is a National Patient Safety Goal to prevent errors in patient care. Proper patient identification ensures correct treatments and medications are given, reducing harm. Restraint elimination, medication reconciliation, and infection reduction are important goals but not specific National Patient Safety Goals. Accurate patient identification directly addresses patient safety concerns.