Question 1

A nurse explained hospice services to a patient with metastatic cancer.In evaluating the teaching,the nurse determines the need for further information when the patient states that one of the services provided in hospice care is:

Accepted Answer

Hospice care would not include any form of chemotherapy,which is a therapy generally intended to treat or cure cancer.Hospice care does involve pain and symptom management,nutritional counseling,physical/occupational/speech therapies,home health services for personal care,psychosocial and emotional support,grief counseling,and crisis care during medical emergencies.

Question 2

A patient has just been diagnosed with an inoperable brain tumor.Which patient statement about concerns should the nurse expect initially?

Accepted Answer

Patients and families have concerns immediately after receiving a diagnosis of terminal illness.Concerns frequently include how long people live after diagnosis,emotional effect or inconvenience to family or friends,being a burden,financial concerns,suffering pain or disfigurement,feelings of loss of control,feelings of still having much to do in life,and dying alone.

Question 3

A patient underwent surgery for cancer and now needs follow-up chemotherapy.The patient reports anorexia,fatigue,and trouble concentrating and sleeping.A nurse would place highest priority on responding to which statement by the family member?

Accepted Answer

A persistent myth proposes that if a person "has a reason" to be depressed,no treatment is needed because this "functional depression" is a normal response.However,this myth denies that the patient has a need for effective treatment.For this reason,the nurse should first follow up on that response.

Question 4

A patient with metastasized cancer says to the nurse,"I've been reading about some of the cancer research,and I am still hoping for a cure in the next few months." In formulating a response to the patient,which should the nurse consider first?

Accepted Answer

Having "hope against hope" may not mean that the patient is in denial,but rather that he or she is using denial as an adaptive defense mechanism.The nurse should first consider what purpose confrontation would serve at this time.

Question 5

When a terminally ill patient is attempting to make the decision to withhold further treatment,the nurse would indicate that which medication would no longer be prescribed if treatment were to be withheld?

Accepted Answer

Antibiotics are used to treat infection and therefore would be withheld in the care of a patient who has designated that life-sustaining treatment should be withheld.The medications in the other options promote comfort and would continue to be administered.

Question 6

The adult child of a critically ill patient has been keeping vigil,remaining at the bedside constantly for 3 days.Which communication from the nurse would be most appropriate when the child becomes demanding and impatient with the staff providing the parent's care?

Accepted Answer

The correct response is one that acknowledges the family member's situation and then explores an alternative.

Question 7

When the parents of a terminally ill teenager whose death is imminent are approached and counseled regarding the possibility of organ donation,the parents refuse.The nurse is concerned that they may not have fully considered the positive effect organ donation has on both the surviving family members as well as organ recipients.Which nursing action will have the greatest therapeutic effect regarding the parents' decision?

Accepted Answer

Even when a nurse finds it difficult to accept an informed decision a parent has made,professional ethics clearly require that the decision be supported.

Question 8

A nurse is caring for a patient awaiting test results that will indicate whether the patient has cancer.Which communication would be most helpful initially to facilitate a therapeutic nurse-patient relationship?

Accepted Answer

Between the development of symptoms and a definitive diagnosis,patients and their family members or loved ones have to endure a time of uncertainty.Often the best way to begin the intervention is to tell the person the behavior or emotion that you are observing and give it a name (shock,disbelief,fear,or sadness).It is important to validate and seek the person's agreement with or refinement of this perception.The correct response "offers self," a therapeutic communication technique.

Question 9

A nurse is working with the family of a terminally ill child with leukemia.The nurse shares with the parents that which sibling will likely have a more factual than emotional response to the sibling's death?

Accepted Answer

Below the age of 6 years,attitudes toward death are often matter-of-fact rather than emotional.

Question 10

A nurse advocating for an anxious patient newly diagnosed with a life-threatening illness would ask the health care provider to prescribe which type of medication?

Accepted Answer

The patient's symptoms of anxiety need not meet the criteria for a formal psychiatric diagnosis in order to be treated.Pharmacological treatment with benzodiazepines is common practice,and nurses should initiate requests for a prescription if the patient does not already have one.

Question 11

A patient with end-stage renal disease does not want further aggressive treatment but is reluctant to withdraw life-sustaining treatment.The nurse would help the patient to understand that life-sustaining treatment includes maintaining:

Accepted Answer

The patient who wants to withhold further aggressive therapy but not withdraw life-sustaining therapy would be informed that nutrition,hydration,and current treatments such as dialysis would be maintained.

Question 12

A patient undergoing chemotherapy is experiencing anxiety-induced anticipatory nausea and vomiting.A nurse could assist this patient by requesting a prescription for which preferred medication?

Accepted Answer

Because the nausea and vomiting are anxiety-induced,lorazepam (a benzodiazepine) may be used to reduce both the anxiety and the nausea and vomiting.The other medications listed are useful in treatment of nausea and vomiting.

Question 13

A nurse should use which measure initially to reduce dyspnea in a patient with end-stage chronic obstructive pulmonary disease?

Accepted Answer

Dyspnea occurs in many chronic and end-stage diseases and the nurse can assist the patient with shortness of breath by raising the head of the bed to a comfortable position.Bronchodilators may be used as an aid,but positioning is noninvasive and is a first-line intervention.Incentive spirometry,coughing,and deep breathing would prevent atelectasis but would not treat the symptom of dyspnea resulting from the end-stage disease process.

Question 14

A patient receiving palliative care is treated with large doses of narcotic analgesics to control pain.To minimize side effects of this medication the nurse should ensure that there is a prn prescription for which type of medication?

Accepted Answer

Constipation occurs in as many as two thirds of patients receiving palliative care.Patients taking narcotic pain-control agents regularly should have prophylactic treatment for constipation,which could include stool softeners and laxatives.

Question 15

A nurse enters the room of a patient newly diagnosed with multiple sclerosis and notes that the patient is crying quietly while lying in bed.Which communication by the nurse would be most appropriate?

Accepted Answer

The most appropriate statement is the one that attempts to use therapeutic communication to determine whether the patient is depressed.The correct option is the only one that attempts to elicit more information about the patient's feelings.This would be the most effective means of assessing the patient's emotional status.

Question 16

An older adult patient diagnosed with Parkinson-induced dementia becomes critically ill with severe pneumonia.No family is available.After repeated failed attempts to contact the patient's agent designated by the Health Care Power of Attorney,which standard should the health care team use as the best method for decision making in planning care for this patient?

Accepted Answer

The best interests standard is applied when the patient lacks decisional capacity and no other designated health care proxy is available.This standard is based on what would promote the welfare of the "average" patient.

Question 17

A nurse working in the pediatric intensive care unit is assigned to pediatric patients who are experiencing pain.The nurse would select the Wong FACES Pain Rating Scale for use in which child?

Accepted Answer

The Wong FACES Pain Rating Scale can be used for children ages 3 years (36 months) and above.The patient is asked to point to the face that best describes the pain,from a smiley face to a tearful one.

Question 18

A patient diagnosed with amyotrophic lateral sclerosis says to the nurse,"I've been looking on the Internet to get more information about this disease.Which of the sites has the most reliable information?" Which site would the nurse recommend?

Accepted Answer

The NIH is a reputable and accurate website for obtaining health-related information.The CDC is appropriate for information about communicable diseases.OSHA oversees workplace safety,and the FDA oversees food and drug standards.

Question 19

A patient with liver failure rings the call bell and tells the nurse,"The lunch is cold,and my sheets are wrinkled.You never seem to have enough help to give me the care I need." Which intervention should the nurse implement initially?

Accepted Answer

Ways in which the nurse can respond to patient or family concerns include,among others,listening without interrupting or defending,and providing what is requested if possible.For this reason,the nurse should initially listen to the patient before attempting to correct the perceived problems.

Question 20

The adult child of a terminally ill patient tells a nurse,"The doctor recommended considering end-of-life care." The nurse interprets that this most likely means that the patient will not live more than _____ month(s).

Accepted Answer

End of life is generally accepted as the probable last 6 months of life.

Quiz 40: Psychological Care of Patients with Life-Threatening Illness