ATI LPN
Lewis's Medical Surgical Nursing in Canada, 5th Edition
Chapter 13 Questions
Question 1 of 5
The nurse is providing hospice care to a patient who is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28. Which of the following is the basis for the nurses' response about these symptoms?
Correct Answer: B
Rationale: An increase in heart and respiratory rate may occur before the slowing of these functions in the dying patient. Heart and respiratory rate typically slow as the patient progresses further toward death. In a dying patient, high respiratory and pulse rates do not indicate improvement, and it would be inappropriate for the nurse to indicate this to the family. The changes in pulse and respirations are not reflex responses.
Question 2 of 5
The nurse has been caring for a terminally ill patient for the past 10 months. The nurse and the family are present when the patient dies and feels saddened and tearful as the family members begin to cry. Which of the following actions should the nurse take at this time?
Correct Answer: B
Rationale: It is appropriate for the nurse to cry and express sadness in other ways when a patient dies, and the family is likely to feel that this is therapeutic. Contacting a grief counsellor, leaving the family to grieve privately, and considering whether hospice continues to be a satisfying place to work are all appropriate actions as well, but the nurse's initial action at this time should be to share the grieving process with the family.
Question 3 of 5
The spouse of a patient with terminal lung cancer visits daily and cheerfully talks with the patient about vacation plans for the next year. When the nurse asks about any concerns, the spouse says, 'I'm busy at work, but otherwise things are fine.' Which of the following nursing diagnoses is appropriate?
Correct Answer: A
Rationale: The spouse's behaviour and statements indicate the absence of anticipatory grieving, which may lead to impaired adjustment as the patient progresses toward death. The spouse does not appear to feel overwhelmed, hopeless, or anxious about the partner's impending death.
Question 4 of 5
The nurse is caring for a patient who has been diagnosed with metastatic cancer and plans a trip across the country 'to settle some issues with my sisters and brothers.' Which of the following responses should the nurse recognize that the patient is manifesting?
Correct Answer: C
Rationale: The patient's statement indicates that there is some unfinished family business that the patient would like to address before dying. Restlessness is frequently a behaviour associated with an inability to express emotional or physical distress, but this patient does not express distress and is able to communicate clearly. There is no indication that the patient is protesting the prognosis, or that there is any fear that the patient's life has been meaningless.
Question 5 of 5
The nurse is caring for a patient in a hospice palliative care program who is experiencing continuous, increasing amounts of pain. Which of the following time schedules should the nurse implement for the administration of opioid pain medications?
Correct Answer: A
Rationale: The principles of beneficence and nonmaleficence indicate that the goal of pain management in a terminally ill patient is adequate pain relief even if the effect of pain medications could hasten death. Administration of analgesics on a PRN basis will not provide the consistent level of analgesia the patient needs. Patients usually do not require so much pain medication that they are oversedated and unaware of stimuli. Adequate pain relief may require a dosage that will result in a decrease in respiratory rate.