Question 1

Family members become dissatisfied and stressed because of a lack of _____ among health care providers.

Accepted Answer

Family members have reported dissatisfaction with communication and decision making.Increasing the frequency of communication and sharing concerns early in the hospitalization will make subsequent discussions easier for the patient,family,and health professional.Based on the level of communication and patient understanding of care,prognosis and outcomes will influence the satisfaction of services being provided to their family member and decrease stress levels.

Question 2

Disagreement and distress among physicians,nurse practitioners,and critical care nurses can lead to

Accepted Answer

Nurses and doctors frequently disagree about the futility of interventions.Sometimes nurses consider withdrawal before physicians and patients do,and they then believe the care they are giving is unnecessary and possibly harmful.This issue is a serious one for critical care nurses because emotional and ethical distress can lead to burnout.

Question 3

_____ is a powerful influence when the decision-making process is dealing with recovery or a peaceful death.

Accepted Answer

Hope is a powerful influence on decision making,and a shift from hope for recovery to hope for a peaceful death should be guided by clinicians with exemplary communication skills.Ethics,religion,and culture can influence the decision process regarding care and end-of-life decisions.

Question 4

Which of the following statements apply to DNR orders?

Accepted Answer

A do-not-resuscitate (DNR)order is intended to prevent the initiation of life-sustaining measures such as endotracheal intubation or CPR.Families should be assured that patients will continue to receive care but that aggressive measures to extend life will not be used.

Question 5

Haloperidol is recommended as useful treatment of _____.

Accepted Answer

Delirium is commonly observed in critically ill patients and in those approaching death.Haloperidol is recommended as useful,and restraints should be avoided.Dyspnea is best managed with close evaluation of the patient and the use of opioids,sedatives,and nonpharmacologic interventions (oxygen,positioning,and increased ambient air flow).Benzodiazepines,especially midazolam with its rapid onset and short half-life,are frequently used to treat anxiety.Morphine is the most common drug used for pain management.

Question 6

Hospice care can help families with

Accepted Answer

Health professionals can assist patients and families by providing information about the hospice benefit,particularly regarding the aggressive symptom management and family support.Organ donations must follow Social Security Act Section 1138 regarding written protocols for identification of potential organ donors and notification of organ recovery agencies.Advance directives can be taken care of at the hospital or legal firm.Euthanasia is also known as assisted suicide and is not legal in the United States.

Question 7

Recommendations for creating a supportive atmosphere during withdrawal discussions include

Accepted Answer

Recommendations for creating a supportive atmosphere during withdrawal discussions include taking a moment at the beginning of the conversation to inquire about the family's emotional state.During the family meeting in which a decision to withdraw life support is made,a time to initiate withdrawal is usually established.

Question 8

The two basic ethical principles underlying the provision of health care are

Accepted Answer

The two basic ethical principles underlying the provision of health care are beneficence and nonmaleficence.

Question 9

Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts?

Accepted Answer

The decision to allow family members at the bedside during resuscitative efforts should be made by the family and caregivers and be based on needs and experiences.The family may become more aware of what is involved in decisions if they are present during procedures or resuscitative attempts.Seeing the steps of resuscitation may make clearer the impact of decisions made or delayed.

Question 10

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The decision is made to remove the patient from the ventilator.Which of the following statements is most accurate?

Accepted Answer

The choice of terminal wean as opposed to extubation is based on considerations of access for suctioning,appearance of the patient for the family,how long the patient will survive off the ventilator,and whether the patient has the ability to communicate with loved ones at the bedside.

Question 11

The patient's condition has deteriorated to the point where she can no longer make decisions about her own care.Which of the following nursing interventions would be most appropriate?

Accepted Answer

If the patient is not able to make end-of-life decisions for herself,her family members should be approached to discuss the next steps because they may have insight into what her wishes would be.

Question 12

According to the Society for Critical Care Medicine,which of the following are among the most important needs of the family of the dying patient?

Accepted Answer

The needs of the patient and the needs of the family may be very different during this stressful time.

Question 13

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.After a family conference,the physician orders a DNR order,and palliative care is begun.This means

Accepted Answer

When palliative care is begun,the primary goal is to keep the patient comfortable by continuing assessments and managing symptoms that might cause pain,anxiety,or distress.

Question 14

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation.The patient continues to grimace and fight the ventilator.What nursing intervention would be appropriate?

Accepted Answer

Even though opiates can cause respiratory depression,the goal in palliative care is to alleviate pain and suffering.A bolus dose of morphine (2-10 mg IV)and a continuous morphine infusion at 50% of the bolus dose per hour is recommended.Because many critical care patients are not conscious,assessment of pain and other symptoms becomes more difficult.Gélinas and colleagues recommended using signs of body movements,neuromuscular signs,facial expressions,or responses to physical examination for pain assessment in patients with altered consciousness.

Question 15

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient does not have an advance directive.Which of the following statements would be the best way to approach the family regarding his ongoing care?

Accepted Answer

Approaching the family and asking what they know about the patient's wishes and preferences is the best way to begin this discussion.Emotional support for the patient and the family is important as they discuss advance care planning in the critical care setting.

Question 16

A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes.The patient is sure he will not be here tomorrow because his grandparent is waiting for him.This is an example of

Accepted Answer

The same behaviors may be seen in conscious critical care patients near death.Having an awareness of the phenomenon enables more careful assessment of behaviors that may be interpreted as delirium,acid-base imbalance,or other metabolic derangements.These behaviors include communicating with someone who is not alive,preparing for travel,describing a place the patient can see,or even knowing when death will occur.

Question 17

Organ donation

Accepted Answer

The Social Security Act Section 1138 requires that hospitals have written protocols for the identification of potential organ donors.The Joint Commission has a standard on organ donation.The nurse must notify the organ procurement official to approach the family with a donation request.

Question 18

Antiemetics should be used to treat

Accepted Answer

Nausea and vomiting are common and should be treated with antiemetics.Dyspnea is best managed with close evaluation of the patient and the use of opioids,sedatives,and nonpharmacologic interventions (oxygen,positioning,and increased ambient air flow).Benzodiazepines,especially midazolam with its rapid onset and short half-life,are frequently used to treat anxiety.

Question 19

Which of the following statements about comfort care is accurate?

Accepted Answer

The goal of comfort care is to provide only treatments that do not cause pain or other discomfort to the patient.

Question 20

A patient was admitted to the critical care unit after having a CVA and MI.The patient has poor activity tolerance,falls in and out of consciousness,and has poor verbal skills.The patient has been resuscitated four times in the past 6 hours.The patient does not have advance directives.Family members are at the bedside.Who should the physician approach to discuss decisions of care and possible DNR status?

Accepted Answer

Patients' capacity for decision making is limited by illness severity; they are too sick or are hampered by the therapies or medications used to treat them.When decision making is required,the patient is the first person to be approached.

Quiz 11: End-Of-Life Issues