A hospice patient with end-stage renal disease refuses to eat or drink and is very weak but reports no pain. Which nursing action is most appropriate?

Correct Answer: C

Rationale: The most appropriate nursing action in this scenario is choice C: Provide support for the patient’s decision and ensure comfort measures. This is because the patient is in hospice care, indicating a focus on comfort and quality of life rather than aggressive treatments. By respecting the patient’s decision and providing comfort measures, the nurse promotes dignity and autonomy. Choices A and B are not suitable as they go against the patient's wishes and may cause distress. Choice D, while important, is not the immediate priority when the patient is not in pain and has chosen to refuse food and fluids. Overall, choice C aligns with the principles of hospice care and prioritizes the patient's comfort and autonomy.

Correct Answer: D

Rationale: Correct Answer: D - Give acetaminophen (Tylenol) 650 mg per nasogastric tube. Rationale: LPNs/LVNs are trained to administer medications, including oral and nasogastric routes. Giving acetaminophen via nasogastric tube is within their scope of practice. LPNs/LVNs should have the knowledge and skills to safely administer this medication as part of the hypothermia protocol. Summary of other choices: A: Continuously monitor heart rhythm - This requires specialized training and skills typically within the scope of registered nurses or cardiac monitoring technicians. B: Check neurologic status every 2 hours - Assessing neurologic status requires critical thinking and clinical judgment, which are typically responsibilities of registered nurses. C: Place cooling blankets above and below the patient - Positioning and managing cooling devices may require specific training and should be done under the supervision of a registered nurse.

Correct Answer: C

Rationale: The correct answer is C because inquiring about specific cultural rituals and preferences shows respect for the patient's cultural beliefs and values. By asking about these aspects, the nurse can provide care that aligns with the patient's cultural background, promoting comfort and understanding. This action also demonstrates a commitment to individualized care. Choice A is incorrect because standardized care may not always be culturally appropriate. Choice B is incorrect as avoiding discussions about death can hinder effective communication and support. Choice D is incorrect as advising families to strictly follow hospital guidelines may overlook the importance of cultural considerations in end-of-life care.

Correct Answer: B

Rationale: The correct answer is B: Administer a prescribed PRN opioid analgesic. This is the priority intervention because severe breakthrough pain requires immediate relief, and opioids are the most effective for managing severe pain in terminally ill patients. Warm compresses (A) may provide some comfort but do not address the underlying pain. Reassessing pain after 2 hours (C) delays necessary relief. Distraction techniques (D) are not appropriate for severe breakthrough pain as they do not directly address the pain itself. Administering the prescribed opioid analgesic promptly is crucial for providing timely and effective pain management in this situation.

Correct Answer: C

Rationale: The correct answer is C because the synergy model of practice emphasizes considering the needs of patients and their families, which in turn drives nursing competency. This approach recognizes that patient care is not just about the individual but also about the broader support system. This holistic viewpoint helps nurses tailor their care to meet the unique needs of each patient and their family, ultimately leading to better outcomes. Choices A, B, and D are incorrect: A: Allowing unrestricted visiting for the patient 24 hours is not directly related to the focus of the synergy model which is more about patient-centered care. B: Providing holistic and alternative therapies is a valid approach, but it is not the primary focus of the synergy model. D: Addressing the patients' needs for energy and support is important but does not capture the comprehensive nature of the synergy model which encompasses the needs of both patients and their families.