Question 1

A patient who is intubated has periods of lucidity mixed with periods of confusion or stupor. During one lucid episode, the patient wrote, "take this tube out and let me die." Which of the following should the nurse do?

Accepted Answer

The patient does have periods of lucidity and therefore the nurse should take the patient's comment to the physician for consideration. The nurse should not determine that the patient cannot make decisions because of being intubated. There is no evidence to suggest that the patient has a mental disability. The nurse also does not know if the patient is experiencing side effects of medications and should not ignore the patient's request.

Question 2

A patient tells the nurse that she has a living will and a form that she filled out from her pastor that address the kind of care that she would like if she ever could not make decisions on her own. The nurse realizes the patient is describing which of the following?

Accepted Answer

The patient is describing the Respecting Choices form which has been implemented throughout the United States through religious organizations. The patient stated that she received this form from her pastor which would be considered a religious connection. The Physician Order for Life-Sustaining Treatment form is used to provide direction to emergency medical services personnel. The patient is not describing a Durable Power of Attorney or an advance directive.

Question 3

A patient tells the nurse that he wants to establish a durable power of attorney for health care but can't decide who should be appointed as the surrogate. Which of the following should the nurse tell the patient?

Accepted Answer

Patients should be cautioned to appoint persons as their surrogates who understand what they desire for themselves and who are capable of making hard decisions. Spouses, older children, and/or close friends may not be able to adhere to the patient's wishes and make hard decisions.

Question 4

The nurse, caring for a patient in a persistent vegetative state, is told by the patient's brother that the patient would not want to be kept alive artificially. The nurse realizes that the brother's issue could be addressed under which of the following?

Accepted Answer

The doctrine of substituted judgment is a subjective determination of how persons, if capable of making their opinions and wishes known, would chose to right to accept or refuse medical care. This is where the brother's issue can be addressed. The other choices do not specifically address or identify the issue of continuing care for a patient in a persistent vegetative state.

Question 5

A patient with a history of bipolar depression tells her physician that she no longer wants to live with the breast cancer treatment and wants to die. The patient resides in Oregon. Which of the following should be done first?

Accepted Answer

Within the provisions of the Oregon Death with Dignity Act, if a patient has a psychiatric or psychological disorder which could impair judgment, the physician should refer the patient for counseling and prescribe no medication to end the patient's life until it has been determined whether the disorder is impairing judgment. The patient has a history of bipolar depression and therefore should have counseling before moving forward with the planned assisted suicide. The other choices are incorrect and do not take the patient's history of bipolar depression into consideration.

Question 6

A patient tells the nurse that he has a "piece of paper" signed by his doctor that says what care he is supposed to get if an ambulance needs to come to his home. Which of the following should the nurse also assess in this patient?

Accepted Answer

Persons who have a Physicians Order for Life-Sustaining Treatment form should be advised to complete an advance directive since the physicians order is limited as to what can or cannot be done for the patient at a particular time. This is what the nurse should assess in this patient. A living will, Respecting Choices form, and signed natural death form are all documents that provide direction or planning for care should the person be unable to make decisions regarding their wishes; however, the nurse should assess if the patient has an advance directive.

Question 7

A patient needs emergency surgery for a bleeding ulcer however is unconscious and unable to provide consent and does not have an advance directive. In this situation, who would the physician discuss the patient's care needs?

Accepted Answer

The patient does not have an advance directive and therefore would not have a patient designated surrogate. The situation is acute and the physician would most likely consult with a readily available family member. This is a clinically-designated surrogate and is the correct response. Since the patient is actively bleeding, there is insufficient time to appoint a judicial- or statutorily-designated surrogate, since both of these options necessitate court appearances.

Question 8

An elderly patient tells the nurse that he never really thought about what kind of care he would want if he couldn't make the decisions himself, since he knows that his children would be able to make these decisions for him. Which of the following responses should the nurse give this patient?

Accepted Answer

Having a patient's desires and last wishes known often helps family members make hard decisions. The nurse should respond that making the patient's wishes known would make it easier for his children. The other statements are not necessarily true and the nurse should not agree that the patient leave the decision-making up to the children.

Question 9

A patient tells the nurse that he is sorry that he started chemotherapy because if he knew then what he knows now, he would have refused it. What does this statement indicate to the nurse?

Accepted Answer

Information required for informed consent includes whether pain or discomforting side effects will occur with treatment. It also includes an explanation that the patient can refuse treatment even after the procedure or treatment has begun. Since the patient regrets agreeing to the decision to have chemotherapy, his or her statement should indicate to the nurse with the information that the patient was not fully informed. The statement does not suggest that the patient should have written an advance directive or is improving, not does indicate that the he is experiencing side effects and does not realize what he is saying.

Question 10

The nurse asks to not be assigned to a dying patient because of personal attitudes about the care the patient is receiving. The nurse's request would be considered as which of the following end-of-life competencies?

Accepted Answer

There are 15 core end-of-life competencies for nurses. The one which supports the nurse's request not to provide care to a dying patient because of her personal feelings about the care the patient is receiving would be considered under the competency of recognizing one's own attitudes and feelings about death. This situation would not promote the provision of care of the dying as an important skill nor assess multiple dimensions to improve quality at end of life. This situation is not an attempt to identify barriers to the patient's effective use of resources.

Question 11

A patient tells the nurse that he wants to end his life and asks to talk with the doctor about assisted suicide. Which of the following should the nurse do to assist this patient?

Accepted Answer

Since the patient's request to end his life must be stated to the physician on at least two occasions at least two weeks apart, without any self-contradiction during that time interval, the nurse needs to contact the physician to discuss the patient's decision. The nurse cannot determine whether or not the patient is fully informed. The nurse also cannot falsely tell the patient that his decision cannot be changed since he has stated his intentions. There is not enough information to determine if the patient is incompetent for making healthcare decisions.

Question 12

The family of a deceased patient tells the nurse that they believe the physician provided the patient with an overdose of pain medication in order to assist the patient to die. Which of the following needs to be determined in this situation?

Accepted Answer

Although suicide as a crime has been abolished in all states, most states still prohibit assisted suicide. Some states treat assisted suicide harshly while others prohibit only causing suicide and not assisting it. Therefore, it needs to be determined, according to the state, if the patient medication dose caused the patient's suicide or assisted it. The other three choices might need to be discussed at a later date; however the first step would be to determine what the state deems as suicide versus assisted suicide.

Question 13

A patient, admitted with a grave head injury, does not have an advance directive. The patient is unmarried and does not have living parents. With whom should the health care provider discuss the patient's ongoing care?

Accepted Answer

If a person is unable to make decisions regarding his or her health care, the physician will ask the family about the patient's continuing care needs. The order of selection would be the spouse, adult children or grandchildren, parents, grandparents or adult brothers and sisters, and adult nieces and nephews. Since the patient is unmarried and is without living parents, the adult brother should be approached to discuss the patient's needs. The adult niece would be next. The minor sister and best friend would not be considered.

Question 14

The nurse, caring for a terminally ill patient in a coma, reads the patient's living will and realizes that most of the care provided has been in violation of the will. Which of the following will most likely occur with the nurse, physician, and care organization?

Accepted Answer

Since the language of the living will is broad and vague, there is typically no legal enforcement of the will and health care providers can choose to follow or ignore it as the need arises. But since there is no protection against criminal or civil liability, the care providers will most likely ignore the will's direction for fear of charges of wrongful death. In this situation, most likely nothing will be done. The nurse, physician and care organization will not be sued for not following the will. Because the will is broad and vague, care does not necessarily have to be provided according to the will.

Question 15

A patient tells the nurse that he does not want surgery to remove an abdominal tumor but would like to discuss other treatment options including pain medication and radiation. The nurse realizes that the patient's requests for additional discussion would be included in which of the following?

Accepted Answer

Informed consent includes an explanation of alternatives to the process of treatment, including the risk of doing nothing at all. It also includes an explanation that the patient can refuse the therapy or procedure. The patient's request to discuss other treatments besides surgery, the need for pain medication, or possibly radiation would not be included within a living will, the natural death act, or the Physician Order for Life-Sustaining Treatment.

Question 16

The nurse meets with a social worker to discuss hospice options with a patient approaching end-of-life and then discusses the options with the patient and family. The nurse was implementing which of the following end-of-life competencies for nurses?

Accepted Answer

The nurse actively sought out a social worker to discuss the patient's hospice options and then met with the patient and family about the options. This is an example of identifying barriers to the patient's effective use of resources. The other three competencies are incorrect and do not exemplify the activity of the nurse in identifying hospice options for the patient.

Question 17

The Ethics Committee is meeting to discuss continuing care for a patient in a persistent vegetative state. The husband wants the patient to continue to receive care yet the mother and sister of the patient claim that they were told repeatedly by their daughter/sister that in no way did she want to be a burden to the healthcare industry. Which of the following should the Ethics Committee members do regarding the patient's care?

Accepted Answer

There is no clear cut, easy answer for this situation. Since the Schiavo case, three lessons were provided. The first is that states need to address issues regarding end-of-life decision making. The second is that the courts need to clarify what is considered clear and convincing evidence regarding what the incapacitated person would want. And the third is that the interests of family members or those persons closest to the patient should be at the forefront of and included in the decision-making process. The Ethics Committee should take the information provided by the mother and sister into consideration. The committee should not do everything to keep the patient safe and alive nor should they take this situation to the state Supreme Court. The husband and in-laws have not been able to work this situation out and since the Ethics Committee needed to meet this is not the correct answer.

Question 18

A patient being treated for a terminal illness tells the nurse that even though he signed a natural death act a few years ago, he does not want to have it followed. Which of the following should be done to support this patient?

Accepted Answer

Once signed and witnessed, most natural death acts are effective until revoked. The document can be revoked by the patient's stating that he no longer wants the document to be followed. This is considered oral revocation and is legal. The document should be deemed invalid. Since it can be revoked it does not need to be followed once signed and it is up to the doctor whether to follow the document or not. The patient's attorney does not need to go to court to have the document revoked.

Question 19

A clinically-designated surrogate decision maker is discussing with the physician the choices that most effectively address the patient's ongoing healthcare needs. This surrogate is utilizing which of the following standards when determining the patient's wishes?

Accepted Answer

There are three standards used to assist healthcare providers in determining the patient's wishes. The Best Interest standards is an objective test that allows the decision-maker to implement what he or she sees as being in the patient's best interest . This is what the clinically-designated surrogate is doing. The substituted judgment standard is subjective; the decision-maker is attempting to determine what the patient would want if he was able to make his wishes known. The futility standard centers on whether further treatment would be considered futile. There is not a consent standard.

Question 20

The nurse, attending a basic cardiac life support review session, learns that cardiopulmonary resuscitation impacted patient care in which of the following ways?

Accepted Answer

During the 1960s, the advent of cardiopulmonary resuscitation changed the way in which acute care hospitals approached death by mandating that performance of the rescue technique was the new standard of care for patients who experience cardiac arrest and cessation of respirations. Organ transplantation was not occurring to the extent that it is today during the 1960s. Cardiopulmonary resuscitation did not ensure positive patient outcomes. There is no evidence to suggest that cardiopulmonary resuscitation was the only way to keep patients alive in the 1960s.

Quiz 3: Ethical Issues