link full download test bank for latest priorities in critical care nursing 6th edition by urden

Test Bank for Latest Priorities in Critical Care Nursing 6th edition by Urden MULTIPLE CHOICE The Patient Self-Determination Act is a federal law that supports the patient’s right to: a receive fair and equal treatment under the law b obtain maximum health care benefits from third-party payers c control treatment in the future, even if unable to effectively communicate d exclude family members from decision making related to 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 OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 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: a “Morally they are the same, but legally withdrawal is more difficult to support.” b “Legally they are on the same level, but morally it is indefensible to withdraw treatment.” c “Withdrawal is a legal issue and withholding is a moral one.” d “Morally and legally they are considered to be equal.” ANS: D Withholding and withdrawing are considered to be morally and legally equivalent DIF: Cognitive Level: Comprehension REF: OBJ: TOP: Nursing Process: Implementation 107 End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care The patient’s husband is terrified by the prospect of removing lifesustaining treatments from the patient He asks why anyone would that The nurse explains: a “It is to save you money so you won’t have such a large financial burden.” b “It will preserve limited resources for the hospital so other patients may benefit from them.” c “It is to discontinue treatments that are not helping your wife and may be very uncomfortable for her.” d “We have done all we can for your wife and any more 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 OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care All of the patient’s children are distressed by the possibility of removing lifesupport 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: a “This is a process of allowing your father to die naturally after the injuries that he sustained in a serious accident.” b “The hospital would never allow us to that kind of thing.” c “Let’s talk about this calmly and I will explain why assisted suicide is appropriate in this case.” d “He’s lived a long and productive life.” 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 DIF: Cognitive Level: Application REF: 107 OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care To forestall any unwanted resuscitation after life-sustaining treatments have been withdrawn, the nurse should make sure that: a do-not-resuscitate (DNR) orders are written before discontinuation of the treatments b the family is not allowed to visit until the death occurs c DNR orders are written as soon as possible after the discontinuation of the treatments d the change-of-shift report includes the information that 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 DIF: Cognitive Level: Application REF: 108 OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care In approaching the family about decisions related to withholding or withdrawing life-sustaining treatments, the nurse should determine what the: a family wants for the patient b patient’s religious beliefs would indicate should be done c patient would want to have done d staff has determined is the best outcome for the patient ANS: C The question is not, “What you want to about (patient’s name)?” but rather, “What would (patient’s name) want if he/she knew he/she was in this situation?” DIF: Cognitive Level: Application REF: 107 OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care After making the decision to discontinue life-sustaining measures for their mother, the family asks the nurse what to expect The nurse explains: a “The first thing we will is stop the intravenous infusions, because they are not doing any good.” b “Dialysis will be discontinued; if your mother has difficulty breathing, we can help her feel more comfortable with medications.” c “We will continue to laboratory tests, but we will stop the diagnostic procedures.” d “We will stop everything this afternoon You may spend as much time with her as you like after that.” 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 DIF: Cognitive Level: Application REF: 109 OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care A patient has received a diagnosis of inoperable cancer of the brain In an ideal situation, palliative care will: a begin in several months when the patient decides to give up on all treatment b progress through the patient’s death and the family’s bereavement c commence when the patient’s pain becomes unmanageable d start when the patient requests it and end at death 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 DIF: Cognitive Level: Application REF: 109 OBJ: Nursing Process: Implementation TOP: End-of-Life Care MSC: NCLEX: Psychosocial Integrity Recognizing that the patient is dying, the nurse teaches the family what to expect as death nears This will include the possibility of: a respiratory difficulty b increased hunger c excessive thirst d decreased swelling in the lower extremities 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 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Assessment TOP: MSC: NCLEX: Psychosocial Integrity REF: 110 End-of-Life Care 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: a respiratory therapy treatments b opioid medications given as needed c incentive spirometry d increased hydration 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) DIF: Cognitive Level: Application REF: 110 OBJ: Nursing Process: Implementation TOP: End-of-Life Care 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: a “The nausea may be due to the medication he is taking We should discontinue it for a while and see if that helps.” b “As the body shuts down, the organ systems slow their work, and sometimes this causes nausea and vomiting due to intestinal obstruction.” c “There is no medication he can be given that will make him feel better at this point.” d “Would you like to fix him a nice hot bowl of soup and 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: OBJ: TOP: Nursing Process: Analysis 110 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: a “This is an excellent idea I’m so glad that you are willing to this.” b “You must only offer liquids at room temperature, so there is no stress to the body from a hot or cold stimulus.” c “As the kidneys slow down, giving fluids can result in increased swelling in the extremities and even in the lungs.” d “We must keep the patient hydrated to flush out toxins 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: OBJ: TOP: Nursing Process: Analysis 110 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? a Four-year-old who wants to see her grandmother b Seven-year-old who has been exposed to chickenpox at school c Eleven-year-old who is “emotional” d Twenty-five-year-old with moderate mental retardation 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 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Evaluation TOP: REF: 113 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? 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 The goal of comfort care is to provide only those treatments that not cause pain or other discomfort to the patient DIF: Cognitive Level: Comprehension REF: 111 OBJ: TOP: End-of-Life Care Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity