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NURS 104 Exam 2 Questions And Answers With Verified Solutions
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NURS 104 Exam 2 Questions And Answers With Verified Solutions
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NURS 104 Exam 2 Questions And Answers WithVerified 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. ANS 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 ANS 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. ANS 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. ANS 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?" ANS 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. ANS 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. ANS 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. ANS 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 ANS 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. ANS 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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