Test bank for latest priorities in critical care nursing 6th edition by urden

OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2.. DIF: Cognitive Level: Comprehension REF: 107 OBJ: Nurs

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Test Bank for Latest Priorities in Critical Care Nursing 6th edition by

Urden Chapter 10: End-of-Life Care

Test Bank

MULTIPLE CHOICE

1 The Patient Self-Determination Act is a federal law that supports the patient’s right to:

payers

effectively communicate

treatments

ANS: C

The Patient Self-Determination Act supports the patient’s right to control future treatment

in the event that the individual cannot speak for himself or herself

DIF: Cognitive Level: Comprehension REF: 107

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OBJ: Nursing Process: Implementation TOP: End-of-Life Care

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2 The patient’s family is struggling to make decisions related to treatments for the critically ill patient They ask the nurse about the difference between

“withholding” and “withdrawing” life support The nurse will tell them:

more difficult to support.”

indefensible to withdraw treatment.”

one.”

ANS: D

Withholding and withdrawing are considered to be morally and legally equivalent

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3 The patient’s husband is terrified by the prospect of removing life-sustaining treatments from the patient He asks why anyone would do that The nurse

explains:

financial burden.”

other patients may benefit from them.”

wife and may be very uncomfortable for her.”

treatment would be futile.”

ANS: C

The goal of withdrawal of life-sustaining treatments is to remove treatments that are not beneficial and may be uncomfortable

DIF: Cognitive Level: Application REF: 107

4 All of the patient’s children are distressed by the possibility of removing life-support treatments from their father The most upset tells the nurse, “This is the same as killing him! I thought you were supposed to help him!” The nurse

explains to the family:

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a “This is a process of allowing your father to die naturally

after the injuries that he sustained in a serious accident.”

thing.”

assisted suicide is appropriate in this case.”

ANS: A

Forgoing life-sustaining treatments is not the same as active euthanasia or assisted suicide Killing is an action causing another’s death, whereas allowing dying is avoiding any intervention that interferes with a natural death following illness or trauma

5 To forestall any unwanted resuscitation after life-sustaining treatments have been withdrawn, the nurse should make sure that:

discontinuation of the treatments

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b the family is not allowed to visit until the death occurs

discontinuation of the treatments

the patient is not to be resuscitated

ANS: A

DNR orders should be written before withdrawal of life support; this will prevent any unfortunate errors in unwanted resuscitation during the time period between initiation of withdrawal and the actual death

6 In approaching the family about decisions related to withholding or withdrawing life-sustaining treatments, the nurse should determine what the:

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d staff has determined is the best outcome for the patient

ANS: C

The question is not, “What do you want to do about (patient’s name)?” but rather, “What would (patient’s name) want if he/she knew he/she was in this situation?”

7 After making the decision to discontinue life-sustaining measures for their mother, the family asks the nurse what to expect The nurse explains:

infusions, because they are not doing any good.”

difficulty breathing, we can help her feel more

comfortable with medications.”

the diagnostic procedures.”

as much time with her as you like after that.”

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ANS: B

If a series of interventions is to be withdrawn, usually dialysis is discontinued first, along with diagnostic procedures and vasopressors Next, intravenous fluids, monitoring, laboratory tests, and antibiotics are stopped Withdrawal of dialysis may cause dyspnea from volume overload, which may necessitate the use of opioids or benzodiazepines

8 A patient has received a diagnosis of inoperable cancer of the brain In an ideal situation, palliative care will:

up on all treatment

bereavement

unmanageable

ANS: B

Palliative care ideally begins at the time of diagnosis of a life-threatening illness and continues through cure or until death and into the family’s bereavement period

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MSC: NCLEX: Psychosocial Integrity

9 Recognizing that the patient is dying, the nurse teaches the family what to expect

as death nears This will include the possibility of:

ANS: A

Symptom assessment is necessary for the patient who is near death and should include assessment for dyspnea, nausea and vomiting, edema and pulmonary edema, anxiety and delirium, metabolic derangements, skin integrity, and anemia and hemorrhage

OBJ: Nursing Process: Assessment TOP: End-of-Life Care

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10 The patient’s husband is very upset because his wife, who is near death, has dyspnea and restlessness The nurse explains to him that there are some ways to decrease her discomfort, including:

ANS: B

Dyspnea is best managed with close evaluation of the patient and the use of opioids, sedatives, and nonpharmacological interventions (oxygen, positioning, and increased ambient air flow)

MSC: NCLEX: Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

11 The patient’s wife is very concerned about the fact that her dying husband is vomiting Because he has not had any food in several days, this is confusing to her The nurse explains to her:

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a “The nausea may be due to the medication he is taking

We should discontinue it for a while and see if that

helps.”

work, and sometimes this causes nausea and vomiting

due to intestinal obstruction.”

him feel better at this point.”

see if that helps any?”

ANS: B

Nausea and vomiting are common and should be treated with antiemetics The cause of nausea and vomiting may be intestinal obstruction Treatment for decompression may be uncomfortable in dying patients, so its use should be weighed by considering the

benefit/burden ratio

DIF: Cognitive Level: Analysis REF: 110

OBJ: Nursing Process: Analysis TOP: End-of-Life Care

MSC: NCLEX: Client Need: Physiological Integrity—Basic Care and Comfort

12 The family frequently encourages the dying patient to drink fluids, including tea, soup, and milkshakes They believe that this will help The nurse would explain to them:

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a “This is an excellent idea I’m so glad that you are willing

to do this.”

there is no stress to the body from a hot or cold stimulus.”

increased swelling in the extremities and even in the

lungs.”

related to the process of organ failure.”

ANS: C

The consumption of fluids may contribute to the edema when kidney function is impaired and body functions are slowing

DIF: Cognitive Level: Analysis REF: 110

OBJ: Nursing Process: Analysis TOP: End-of-Life Care

MSC: NCLEX: Client Need: Physiological Integrity—Basic Care and Comfort

13 Which of the following children would be excluded from visiting a dying patient

in the critical care unit?

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b Seven-year-old who has been exposed to chickenpox at

school

ANS: B

Children, unless they represent a significant source of infection, should be able to say good-bye, but they may need adult assistance in understanding the situation

OBJ: Nursing Process: Evaluation TOP: End-of-Life Care

MSC: NCLEX: Client Need: Psychosocial Integrity—Basic Care and Comfort

14 Which of the following statements about comfort care is accurate?

are distinctly different in the eyes of the legal community

patient’s comfort before being implemented

care for him or her

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d Withdrawing life-sustaining treatments is considered

euthanasia in most states

ANS: B

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

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