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NURS 104 Exam 2/231 Complete Questions with Solutions
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NURS 104 Exam 2/231 CompleteQuestions with Solutions
Which of the following statements about comfort care is accurate?
a. Withholding and withdrawing life-sustaining treatment are distinctly
different in the eyes of the legal community.
b. Each procedure should be evaluated for its effect on the patient's comfort
before being implemented.
c. Only the patient can determine what constitutes comfort care for him or
her.
d. Withdrawing life-sustaining treatments is considered euthanasia in most
states. - -b. Each procedure should be evaluated for its effect on the
patient's comfort before being implemented.
The goal of comfort care is to provide only treatments that do not cause pain
or other discomfort to the patient.
-_____ is a powerful influence when the decision-making process is dealing
with recovery or a peaceful death.
a. Hope
b. Religion
c. Culture
d. Ethics - -a. Hope
Hope is a powerful influence on decision making, and a shift from hope for
recovery to hope for a peaceful death should be guided by clinicians with
exemplary communication skills. Ethics, religion, and culture can influence
the decision process regarding care and end-of-life decisions.
-The patient's condition has deteriorated to the point where she can no
longer make decisions about her own care. Which of the following nursing
interventions would be most appropriate?
a. Obtain a verbal DNR order from the physician.
b. Continue caring for the patient as originally ordered because she
obviously wanted this.
c. Consult the hospital attorney for recommendations on how to proceed.
d. Discuss with the family what the patient's wishes would be if she could
make those decisions herself. - -d. Discuss with the family what the patient's
wishes would be if she could make those decisions herself.
,If the patient is not able to make end-of-life decisions for herself, her family
members should be approached to discuss the next steps because they may
have insight into what her wishes would be.
-The two basic ethical principles underlying the provision of health care are
a. beneficence and nonmaleficence.
b. veracity and beneficence.
c. fidelity and nonmaleficence.
d. veracity and fidelity. - -a. beneficence and nonmaleficence.
The two basic ethical principles underlying the provision of health care are
beneficence and nonmaleficence.
-A patient was admitted to the critical care unit several weeks ago with an
acute myocardial infarction and subsequently underwent coronary artery
bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has
been unresponsive. An electroencephalogram shows no meaningful brain
activity. The patient does not have an advance directive. Which of the
following statements would be the best way to approach the family
regarding his ongoing care?
a. "I will refer this case to the hospital ethics committee, and they will
contact you when they have a decision."
b. "What do you want to do about the patient's care at this point?"
c. "Dr. Smith believes that there is no hope at this point and recommends
DNR status."
d. "What would the patient want if he knew he were in this situation?" - -d.
"What would the patient want if he knew he were in this situation?"
Approaching the family and asking what they know about the patient's
wishes and preferences is the best way to begin this discussion. Emotional
support for the patient and the family is important as they discuss advance
care planning in the critical care setting.
-A patient was admitted to the critical care unit several weeks ago with an
acute myocardial infarction and subsequently underwent coronary artery
bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has
been unresponsive. An electroencephalogram shows no meaningful brain
activity. After a family conference, the physician orders a DNR order, and
palliative care is begun. This means:
a. the patient will continue to receive the same aggressive treatment short
of resuscitation if he has another cardiac arrest.
b. all treatment will be stopped, and the patient will be allowed to die.
,c. all attempts will be made to keep the patient comfortable without
prolonging his life.
d. the patient will be immediately transferred to hospice. - -c. all attempts
will be made to keep the patient comfortable without prolonging his life.
When palliative care is begun, the primary goal is to keep the patient
comfortable by continuing assessments and
managing symptoms that might cause pain, anxiety, or distress.
-A patient was admitted to the critical care unit several weeks ago with an
acute myocardial infarction and subsequently underwent coronary artery
bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has
been unresponsive. An electroencephalogram shows no meaningful brain
activity. The patient is placed on a morphine drip to alleviate suspected
operative pain and assist in sedation. The patient continues to grimace and
fight the ventilator. What nursing intervention would be appropriate?
a. Increase the morphine dosage until no signs of pain or discomfort are
present.
b. Increase the morphine drip, but if the patient's respiratory rate drops
below 10 breaths/min, return to the original dosage.
c. Gradually decrease the morphine and switch to Versed to avoid respiratory
depression.
d. Ask the family to leave the room because their presence is causing undue
stress to the patient. - -a. Increase the morphine dosage until no signs of
pain or discomfort are present.
Even though opiates can cause respiratory depression, the goal in palliative
care is to alleviate pain and suffering. A bolus dose of morphine (2-10 mg IV)
and a continuous morphine infusion at 50% of the bolus dose per hour is
recommended. Because many critical care patients are not conscious,
assessment of pain and other symptoms becomes more difficult. Gélinas and
colleagues recommended using signs of body movements, neuromuscular
signs, facial expressions, or responses to physical examination for pain
assessment in patients with altered consciousness.
-A patient was admitted to the critical care unit several weeks ago with an
acute myocardial infarction and subsequently underwent coronary artery
bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has
been unresponsive. An electroencephalogram shows no meaningful brain
activity. The decision is made to remove the patient from the ventilator.
Which of the following statements is most accurate?
a. The cardiac monitor should be left on so everyone will know when the
patient has died.
, b. Opioids, sedatives, and neuromuscular blocking agents should be
discontinued just before removing the ventilator.
c. The family and health care team should decide the best method for
removing the ventilator: terminal wean versus immediate extubation.
d. If terminal weaning is selected, the family should be sent to the waiting
room until the ventilator has actually been removed. - -c. The family and
health care team should decide the best method for removing the ventilator:
terminal wean versus immediate extubation.
The choice of terminal wean as opposed to extubation is based on
considerations of access for suctioning, appearance of the patient for the
family, how long the patient will survive off the ventilator, and whether the
patient has the ability to communicate with loved ones at the bedside.
-A patient was admitted to the critical care unit after having a CVA and MI.
The patient has poor activity tolerance, falls in and out of consciousness, and
has poor verbal skills. The patient has been resuscitated four times in the
past 6 hours. The patient does not have advance directives. Family members
are at the bedside. Who should the physician approach to discuss decisions
of care and possible DNR status?
a. The patient
b. The family
c. The hospital legal system
d. The hospital ethics committee - -a. The patient
Patients' capacity for decision making is limited by illness severity; they are
too sick or are hampered by the therapies or medications used to treat them.
When decision making is required, the patient is the first person to be
approached.
-Organ donation
a. is a choice only the patient can make for him- or herself.
b. is mandated by legal and regulatory agencies.
c. must be requested by the nurse caring for the dying patient.
d. is controlled by individual institutional policies. - -b. is mandated by legal
and regulatory agencies.
The Social Security Act Section 1138 requires that hospitals have written
protocols for the identification of potential
organ donors. The Joint Commission has a standard on organ donation. The
nurse must notify the organ procurement official to approach the family with
a donation request.
-Hospice care can help families with
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