Test bank for medical surgical nursing 1st edition by hoffman and sullivan

The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness.. Which statement from the nurse to family members is appropriate to encourage the

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Medical Surgical Nursing 1st edition by Janice Hoffman and

Identify the choice that best completes the statement or answers the question

1 A competent older adult patient has a living will that expresses the patient’s desire to avoid resuscitation and heroic life support measures The patient’s family, however, is not supportive of this directive and plans to contest the living will Which nursing action is appropriate based on the current situation?

1) Notify the hospital attorney

2) Contact the Social Services department

3) Place the document on the patient’s medical record

4) Explain to the patient that the conflict could invalidate the document

2 The nurse is providing care for a Catholic patient who has suffered a massive cerebral hemorrhage and is not expected to survive Which intervention by the nurse is most appropriate? 1) Contact a priest to deliver the Sacrament of the Sick

2) Make plans for the family to wash the body after death

3) Contact a rabbi so that the patient can participate in prayer

4) Discuss the need to cremate the patient, as burial is not accepted in this faith

3 The nurse is caring for a terminally ill patient and family members The family has been tearful and sad since the terminal diagnosis was given Which should be the nurse’s focus when planning care?

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1) Withhold all care until the patient dies

2) Provide the patient with pain medication as ordered

3) Ask the family what they want to be done for the patient

4) Reposition the patient to a lateral position, with the head elevated as tolerated

5 The nurse is caring for a dying child who is being treated with comfort measures only Which nursing action supports the primary goal for this patient?

1) Assess and medicate, as ordered, for any signs and symptoms of distress

2) Maintain a busy schedule for child and family members

3) Keep the child entertained so she does not think about dying

4) Ensure that a good relationship is maintained with the family

6 The parents of a child with terminal cancer ask the nurse that the child not be told that he will not recover The child asks the nurse if he is dying What should the nurse do at this time? 1) Ignore the child’s question and change the subject

2) Tell the child he is dying and offer to stay with him

3) Suggest a meeting with the health-care team and the parents

4) Offer to bring in the child life therapist to help explain the situation

7 An older school-age child is brought to the emergency department (ED) after a car accident The parents witness and stare at the resuscitation scene unfolding before them The child is not

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responding to the resuscitative efforts after 30 minutes Which is the best communication strategy for the nurse to use in this situation?

1) Ask the parents to leave until the child has stabilized

2) Ask the parents to stand at the foot of the cart to watch

3) Discuss with the parents whether they would like resuscitative efforts to be continued at this point 4) Inform the parents that resuscitative efforts have not been effective and are not beneficial to the child

8 An adolescent patient with terminal cancer tells the nurse that she does not want to continue treatment, even though her parents are planning for her to participate in a study trial that involves

aggressive chemotherapy Which action by the nurse is the most appropriate?

1) Tell her not to worry, that she knows her parents want the best for her

2) Tell the patient that the decision is her parents’ and she has to participate in the study

3) Notify the adolescent that she can make her own decisions no matter what her parents want

4) Request that the parents and daughter meet together with the health-care team to discuss options and the implications of various choices

9 The nurse is providing care for a patient receiving curative care who is experiencing chronic pain due to cancer Which type of care should the nurse plan for upon discharge for this patient?

1) Home health care

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1) “Do you have any financial concerns regarding your care?”

2) “Are you currently experiencing pain?”

3) “Are you experiencing any depression or anxiety?”

4) “Do you have any specific dietary preferences that affect your care?”

14 The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness Which medication should the nurse tell the family to administer for this patient if delirium occurs?

1) Morphine

2) Haloperidol

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3) Diphenhydramine

4) Docusate

15 The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness Which medication should the nurse tell the family to administer to treat the patient’s pain?

1) “A loss of appetite often occurs during this stage.”

2) “Respirations may sound loud and wet during this stage.”

3) “I might notice that he will begin to sleep more during this stage.”

4) “Confusion or disorientation may begin to occur during this stage.”

18 The nurse is providing care to a patient who is approaching death Which family member statement regarding the physical and psychological changes associated with death is reflective of the middle stage?

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1) “A loss of appetite often occurs during this stage.”

2) “Respirations may sound loud and wet during this stage.”

3) “I might notice that he will begin to sleep more during this stage.”

4) “Confusion or disorientation may begin to occur during this stage.”

19 Which response by the nurse indicates the use of reflective reasoning when

communicating with the family of a patient who is in the process of dying?

1) “I can see this is difficult for you.”

2) “Thank you for taking such good care of your mother.”

3) “Your mother is experiencing quite a bit of pain at the moment.”

4) “A social worker will be able to answer all the questions that you have.”

20 Which concept exemplifies a well-managed death experience for a terminal patient and family members?

1) Allowing the patient to die alone

2) Withholding pain medication to decrease addiction

3) Encouraging a lengthy dying process to allow for goodbyes

4) Preparing the patient and the family for the process of dying

21 Which is a team action that nurses can employ as a stress-reducing strategy?

1) Practicing yoga on a daily basis

2) Journaling feelings related to patient care

3) Engaging in aerobic exercise several times per week

4) Sending a bereavement card to the family of a patient who recently passed

Multiple Response

Identify one or more choices that best complete the statement or answer the question

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22 Which factors can create moral distress for nurses? Select all that apply

1) Supportive management staff

2) Low stress patient environment

3) High technology patient care situations

4) Cultural differences with the patient population

5) Resource pressures when providing patient care

23 The nurse is providing care to a patient who is diagnosed with terminal lung cancer Which

clinical manifestations indicate imminent death? Select all that apply

1) Diaphoresis

2) Increased cardiac output

3) Decreased blood pressure

4) Tachycardia followed by bradycardia

5) An increase in the volume of Korotkoff’s sounds

24 The wife of a patient with end-stage chronic obstructive pulmonary disease (COPD) tells the nurse that she wishes her husband were eligible for hospice care but she thinks that hospice is only available for cancer patients and would require a change in health-care providers Which

responses by the nurse are appropriate? Select all that apply

1) Inform her that hospice care is very expensive

2) Inform her that a diagnosis of cancer is not required for hospice care

3) Inform her that all hospice programs provide care 24 hours per day, 7 days per week

4) Inform her that her husband can retain his provider when transitioning to hospice care

5) Inform her that her husband is not eligible for hospice care with the current diagnosis of COPD 25 The nurse is providing care to a terminal patient who is experiencing delirium Which

should the nurse assess prior to administering haloperidol to this patient? Select all that apply

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26 Which statement from the nurse to family members is appropriate to encourage the

participation of providing physical care to the patient during the dying process? Select all that apply

1) “You can bring in pictures of the family to comfort your loved one.”

2) “Apply lip balm to your loves one’s mouth if you feel the lips are dry.”

3) “You can massage your loved one’s arms and legs to provide comfort.”

4) “Bring in music that your loved one likes to listen to with headphones.”

5) “Your child can call your loved one if you don’t want to expose him to this process.”

27 A terminal patient has opted to stop treatment The family, however, believes the patient is

no longer competent to make this decision Which data supports that the patient is capable of

making this treatment decision? Select all that apply

1) The patient is aware of the current date and location

2) The patient does not want to be a burden on the family

3) The patient communicates the decision with the health-care team

4) The patient understands the nature and consequences of treatment

5) The patient states the benefits and risks associated with the treatment

Chapter 5: Palliative Care and End-of-Life Issues

Answer Section

MULTIPLE CHOICE

1.ANS:3

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Chapter number and title: 5, Palliative Care and End-of-Life Issues

Chapter learning objective: Analyzing the nursing care priorities for patients near the end of life

Chapter page reference: 051

Heading: Domain 8: Ethical and Legal Aspects of Care

Integrated Processes: Nursing Process – Implementation

Client Need: Safe and Effective Care Environment – Management of Care

Cognitive level: Application [Applying]

Concept: Critical Thinking; Legal

Difficulty: Moderate

Feedback

1 There is no need to notify the hospital attorney at this time

2 If there are concerns about the authenticity of the document, the Social Services department or the unit

supervisor will need to be contacted

3 This patient is competent; therefore, the wishes of the client take priority The document should be placed

on the patient’s medical record and the health-care provider notified

4 A lack of support by the family, or a plan to contest, does not invalidate the document legally

PTS: 1 CON: Critical Thinking | Legal

2.ANS:1

Chapter learning objective: Listing the domains of palliative care

Chapter page reference: 048

Heading: Domain 5: Spiritual, Religious, and Existential Aspects of Care

Client Need: Psychosocial Integrity

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Concept: Spirituality

Feedback

1 In the Catholic faith, it is common to receive the Sacrament of the Sick from a priest in order to receive

spiritual strength and prepare for death

2 Making plans for the family to wash the body after death is appropriate for a patient who is Muslim, not

Catholic

3 Contacting a rabbi would be appropriate for a Jewish, not Catholic, patient

4 Cremation is not preferred over burial in the Catholic faith

PTS: 1 CON: Spirituality

3.ANS:3

Chapter learning objective: Developing communication and support strategies for family members Chapter page reference: 050-051

Heading: Family Support

Integrated Processes: Nursing Process – Planning

Concept: Grief and Loss

Feedback

1 There are no assessment findings that indicate complicated grieving or hopelessness

2 This reaction is typical of family members, so there is no indication that the family is exhibiting caregiver

role strain

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3 Grieving prior to the actual loss is termed anticipatory grieving

4 There are no assessment findings that indicate complicated grieving or hopelessness

PTS:1CON:Grief and Loss

4.ANS:1

Chapter page reference: 048-050

Heading: Symptom Management

Client Need: Physiological Integrity – Basic Care and Comfort

Feedback

1 “Comfort measures only” indicates that the patient does not want extraordinary measures to sustain life This does not mean that nursing care ceases but that nursing care to provide patient comfort is intensified and maintained through the end stages of the patient’s life

2 The nurse did not note the patient had any verbal or nonverbal signs or symptoms of pain, so medicating

the patient for pain is not appropriate

3 Asking the family what they want to be done is inappropriate when a patient has written a living will

4 Repositioning the patient from the supine position to a lateral position with the head elevated as tolerated

would be the first step to address the patient’s symptoms The nurse may need to medicate the patient with an anticholinergic agent to dry the secretions if ordered If not ordered, the patient may need to contact the health-care provider to get an order for this type of medication for comfort measures

5.ANS:1

Ans: 1

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Heading: Symptom Management

Client Need: Physiological Integrity – Basic Care and Comfort

Feedback

1 The major goal for the dying child is to promote comfort and keep the child symptom-free

2 A dying child does not have the energy to maintain a busy schedule

3 Keeping the child entertained is good, but the pediatric patient needs to voice her feelings about death

and dying

4 Maintaining a good relationship is important but not a major goal for the child’s care

6.ANS:3

Chapter learning objective: Developing communication and support strategies for family members Chapter page reference: 050-051

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Feedback

1 Avoiding the subject is not an option Changing the subject or ignoring the child is not appropriate

telling their child the truth is the best action by the nurse

4 The nurse should explain that the parents will talk to the child about this The child has asked the nurse,

but because the child is a minor, the nurse must consult with the parents first Legally they cannot talk to the child

7.ANS:4

Chapter learning objective: Developing communication and support strategies for family members

Integrated Processes: Communication and Documentation

Feedback

1 This is not an effective communication strategy in this situation

2 This is not an effective communication strategy in this situation

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3 When asking to withhold therapy such as cardiopulmonary resuscitation, it is helpful to indicate that the

therapy is not effective in reversing overwhelming illness or brain damage

4 Care must be used in how the parents are asked to withdraw therapies An effective communication

strategy is to inform the parents that an intervention was initiated to give the child the best chance of recovery, but it has not been effective and is not beneficial to the child

8.ANS:4

Chapter learning objective: Developing communication and support strategies for family members

Integrated Processes: Communication and Documentation

Client Need: Safe and Effective Care Environment – Management of Care

Concept: Grief and Loss; Legal

Feedback

1 Telling her not to worry does not address the problem

2 This is not an accurate statement from the nurse

3 This is not an accurate statement from the nurse

4 Adolescents with a serious medical condition are more capable of making treatment decisions than most

teenagers However, the Patient Self- Determination Act of 1990 limits the legal rights of individuals younger than 18 to make their own health-care decisions If the adolescent states a desire to withdraw from or refuse treatment, her parents and health-care team should discuss the reasons for her decision and help her understand the implications of her decision and any treatment alternatives that may

influence her choice

PTS: 1 CON: Grief and Loss | Legal

9.ANS:2

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