Question 1

The nurse, new to hospice care, is uncomfortable talking with patients and families about end-of-life care and issues. Which of the following should she do to become more comfortable with the patients and their families?

Accepted Answer

The most important thing a nurse can do to improve end-of-life communication techniques is to take the first step. Observation of a more experienced staff member may help to increase her knowledge and comfort level. She should not avoid conversations until a comfort level is reached nor provide care in a detached manner. She may or may not want to consider another type of nursing or ask for a transfer.

Question 2

The physician is planning to discuss a new diagnosis of cancer with a patient but is concerned that he may not be prepared to hear the information. Which of the following can the nurse do to facilitate this discussion?

Accepted Answer

Communication must be provided in a sensitive manner. Since the physician is not sure the patient is prepared to hear the information, the nurse should ask the patient if there is anyone he would like to have present when the physician discusses the his diagnosis and plan of care. The nurse should not suggest that the discussion be avoided or that the patient not be informed about the diagnosis but rather receive treatment under another reason. The nurse should not schedule the clergy to visit since this might not be the person that the patient wants present when learning about the diagnosis and treatment.

Question 3

A terminally ill patient tells the nurse that he wishes that someone would talk with him about his prognosis so that he can make plans. Which of the following should the nurse do to help this patient?

Accepted Answer

The patient is unsure as to his prognosis and asks for more information. The best approach would be for the nurse to assess what he does know about his prognosis. Having discussions and conversations about end-of-life issues is difficult and the nurse telling the patient that he must not be that ill since no one has talked with him about it would be incorrect and inappropriate. Asking him about his plans or suggesting that he focus on getting better so he can go home and make plans is avoiding a difficult conversation and is inappropriate.

Question 4

The family of a terminally ill patient is unhappy with the care the patient is receiving because the nurse just comes into the room, does activities, and then leaves without conversation. The nurse's behavior could be explained by which of the following?

Accepted Answer

The nurse is denying her own emotions and this inability to cope may lead to an avoidance of end-of-life communication, resulting in distancing oneself from the patient. The nurse is not distracted by the volume of care the patient needs or is planning activities that need to be accomplished. The nurse also is not avoiding conversation so as to not interrupt the patient's time with the family.

Question 5

A terminally ill patient is in a coma. The spouse tells the nurse that the patient would not want to live on life support, whereas the eldest daughter tells the nurse to do "everything possible" to keep her father alive. Which of the following should the nurse do?

Accepted Answer

There is a conflict between the spouse and eldest daughter regarding the wishes of the patient. The first thing that the nurse should do is locate the patient's advance directive to learn the patient's wishes. The nurse should not follow the spouse's direction or the eldest daughter's direction. Allowing the patient to naturally live out his life course may or may not be what the patient wants.

Question 6

A terminally ill patient has been intubated because the advance directive included intubation and ventilatory support if needed. The family, upset to see the "breathing tube," wants to know why he was not permitted to die and demands that something be done immediately. Which of the following should be done in this situation?

Accepted Answer

Conflicts may arise that involve family members, patients, and healthcare personnel. If the patient is no longer able to communicate end-of-life care wishes, the family may not be able to agree on treatment options. It is the ultimate responsibility of the healthcare provider to facilitate productive communication and to resolve conflict. The nurse should not call the physician to inform him that the breathing tube was used accidentally, call Security to have the family removed from the hospital, or remind the family that even with the breathing tube the patient may not recover.

Question 7

After the physician communicates the prognosis for a terminally ill patient, the nurse stays in the patient's room and sits with the family to answer any questions and address concerns. Which of the following is this nurse doing?

Accepted Answer

Active listening contributes to the communication process with the patient and family. The nurse should take the time to listen to questions and concerns and convey a feeling of being unhurried and sincerely caring. The nurse is not interpreting the physician's information, conducting discharge planning, or taking a break from providing care to other patients.

Question 8

A terminally ill patient tells the nurse that even though the news about his health is not good, he feels less anxious about what to expect. The nurse realizes the conversation held with the patient was:

Accepted Answer

The benefits of openly discussing end-of-life issues include reduction of anxiety, clarity in decision-making, and confronting fears in the light of factual information. The patient tells the nurse that he feels less anxious about what to expect; so clearly the conversation was helpful in reducing his anxiety and fears. The nurse has no way of knowing if the conversation was truthful or if it was intended to instill hope. There is also no way of knowing if the conversation was used as a mechanism to place the patient into denial about his prognosis

Question 9

The family of a terminally ill patient tells the nurse that there is to be no talk about death in front of the patient. The nurse realizes this family's request would be considered:

Accepted Answer

One barrier to communication at the endow life is the family wanting to protect the patient from bad news. This request is not a loving gesture to the patient or a way for the patient and family to deal with the patient's death. This request may or may not be a characteristic of the patient and family's culture.

Question 10

The nurse is considering working with patients and families who are near the end of life but does not really know the type of nursing care that is provided. Which of the following would be helpful for her at this time?

Accepted Answer

The nurse is unsure about providing care to patients and families who are near the endow life. The most important thing she can do is to take the first step -- visiting with end-of-life caregivers, role playing, reviewing literature, and attending end-of-life conferences. The nurse may or may not delay making the decision. Patients and families nearing the end of life have special care needs. Taking a vacation away from patient care may or may not help the nurse make the decision.

Question 11

Family members of a patient have just learned that the patient is terminally ill and will not recover from the current illness. The nurse sits quietly with them and is seen holding the spouse's hand. Which of the following is this nurse doing?

Accepted Answer

Being present means simply staying with a patient or family, as well as listening and providing warmth and support. The nurse is not grieving or mourning. There is no evidence that the family is experiencing conflict.

Question 12

A patient diagnosed with cancer tells the nurse that he is "sorry" he completed an advance directive because he would have done it differently today. Which of the following responses can the nurse give to this patient?

Accepted Answer

Advance directives should be used as a springboard to discussion about patients' wishes. It is possible that patients' wishes may have changed if several years have passed since advance directives were prepared. Wishes may also change as the patient's condition changes. Some patients believe that preparation of an advance directive means that further discussion is inappropriate or unnecessary, so the existence of such documentation may be perceived by the patient as a barrier to communication. The nurse should inform the patient that the advance directive can be changed. She should not question what the patient would do differently, nor falsely inform him that the advance directive may or may not be followed. The patient may or may not have a long time before having to worry about the advance directive.

Question 13

The nurse explains to the terminally ill patient that the medication being given in the IV will remove excess phagocytes from the blood stream, facilitating a normal inflammatory response in his tissues. The nurse's conversation with the patient would be considered as which of the following?

Accepted Answer

One barrier to effective end-of-life communication is the healthcare provider's use of medical jargon. Terms such as IV, phagocytes, facilitate, and inflammatory response should not be used to facilitate effective end-of-life communication. This conversation is not an effective explanation or an excellent instructional episode. This conversation may or may not distract the patient.

Question 14

While providing morning care to a terminally ill patient, the patient tells the nurse that he would like to return home as soon as possible so that he can die knowing he is in his home, surrounded by his belongings and loved ones. He does not feel comfortable telling the doctor this but knows that the nurse understands. Which of the following does this tell the nurse?

Accepted Answer

One way to facilitate communication regarding the end of life is to be present and actively listen to the patient. The patient realizes that the nurse is actively listening and shares his end-of-life wishes and concerns. This conversation does not mean that the patient is unrealistic or delusional. There is no way of knowing if the patient will die during the ride back to his home.

Question 15

The wife of a terminally ill patient asks him to tell her about the time when he was in the Marines and thought the enemy was approaching when he realized it was just a herd of deer. The nurse realizes that the spouse is engaging in which of the following activities?

Accepted Answer

Engaging the patient or family member in storytelling is a valuable method for taking one's thoughts away from the painful reality at hand. Talking about pleasant memories mentally carries each person away to a more pleasant place and time. The wife is not orienting the patient or asking questions to clarify the story, nor helping the patient relive his youth.

Question 16

A terminally ill patient is resting and the spouse is sitting quietly alone in the room. Which of the following can the nurse do at this time?

Accepted Answer

The nurse should talk with the spouse about the patient's needs and what she can do to help since this will be beneficial to the spouse as well as helping the nurse gain comfort and competence with end-of-life conversations. The nurse should not leave the spouse alone or suggest that the she return to home to get rest. The patient may need rest at this time and encouraging the spouse to stimulate the patient may or may not be appropriate.

Question 17

The nurse tells the manager that she does not want to care for patients who are near death since she "doesn't handle" those situations very well. Which of the following explains this nurse's request?

Accepted Answer

Many nurses may feel uncomfortable in dealing with end-of-life issues, and therefore not communicate optimally with patients and their families. An important first step in gaining comfort with addressing end-of-life issues is to first address one's own mortality. The nurse's request does not mean that she does not like the amount of care needed by patients who are nearing the end of life or is reconsidering her decision to be a nurse. The request also does not mean that the nurse would rather care for patients whose health will improve with nursing care.

Question 18

The primary nurse of a terminally ill patient is consoling the family, completing after- death care, and documenting everything that has occurred. Afterwards, she asks for a new patient to replace the one she lost and says that she is caught up with all care needed for her other patients. This nurse's behavior would indicate:

Accepted Answer

It is normal for the nurse to suffer grief when losing someone that is close to them. This includes the death of a patient. It is important that she acknowledge the grief and work through it, as with any other loss that may occur. The nurse should take the opportunity to attend support groups or seek counseling as needed, and to pursue balance in her personal life and career. The nurse's behavior does not indicate good organization and management skills or expert nursing care. This behavior does not indicate good self-care and balance.

Question 19

A terminally ill patient has asked that any treatments be eliminated that will not add years to his life since they are just a waste of money and cause him more pain. The nurse realizes that this patient's decision will do which of the following?

Accepted Answer

Open and clear communication at the end of life has an economic impact, often helping to eliminate unnecessary and unwanted treatments, as well as reducing length of stay in acute care units. Reduction in costs related to human suffering is also a benefit of ongoing communication. The patient has made a decision to stop the treatments because of money and possible pain. This decision will not speed up the patient's recovery. There is no way of knowing if the patient will be discharged to home or will need home care. There is also no way of knowing if this decision will anger the physician and lead to an untimely death of the patient.

Quiz 8: Communications