A 32 year old client with end stage lung cancer tells the nurse he wants to go home and die. Which of the following is the most important action for the nurse to take?
Tell the health care provider that the client wants to die at home and suggest placing the patient on an antidepressant.
Inform the patient that this is not in their best interest.
Coordinate with the case manager to transfer the client to a long term care facility.
Discuss a referral for home health hospice services with the client and family.
The Correct Answer is D
Choice A rationale
Suggesting an antidepressant is inappropriate because wanting to die at home during the terminal stage of lung cancer is a rational preference for comfort and autonomy, not necessarily a sign of clinical depression. Pathologizing a client's end of life wishes ignores their right to self-determination. Furthermore, antidepressants take weeks to reach therapeutic levels, which may not align with the client's immediate terminal prognosis and the urgent need for a discharge plan focused on comfort.
Choice B rationale
Informing a patient that their wish to go home is not in their best interest is a paternalistic approach that violates the ethical principle of autonomy. A nurse's role is to support the client's informed decision-making process rather than imposing personal or professional biases. In end stage lung cancer, the focus shifts from curative care to quality of life. Denying the client's request can cause moral distress and prevent a peaceful death in their preferred environment.
Choice C rationale
Transferring a client to a long term care facility does not honor the client's specific request to go home. While long term care provides nursing assistance, it is still an institutional setting and may not provide the specialized end of life care required for a terminal diagnosis. This action bypasses the client's expressed wish for a home environment. The nurse should focus on resources that facilitate the client's transition to their own residence with appropriate medical support.
Choice D rationale
Discussing hospice services is the most important action because hospice provides palliative care for clients with a terminal illness and a life expectancy of six months or less. Hospice focuses on pain management, symptom control, and emotional support for both the client and family in the home setting. By coordinating this referral, the nurse ensures the client's wish to die at home is honored while maintaining safety and professional care standards during the dying process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Hyperthyroidism is a metabolic condition characterized by an overactive thyroid gland, leading to symptoms like weight loss, tachycardia, and anxiety. While it can cause tremors or muscle weakness in severe cases, it is not traditionally classified as a primary or high-risk factor for falls compared to sensory deficits. Medical management usually stabilizes these symptoms. Fall risk assessments prioritize factors that directly impair the patient's ability to perceive their environment or maintain physical balance.
Choice B rationale
Hearing impairment can affect a person's awareness of their surroundings and their ability to hear warnings or verbal cues. While it is a sensory deficit, it does not impact physical stability or depth perception as significantly as visual impairment does. Most fall risk assessment tools, like the Morse Fall Scale, focus more heavily on gait, history of falling, and visual cues. Hearing loss is a concern for communication but is not the primary physiological driver of falls.
Choice C rationale
Hyperlipidemia involves elevated levels of lipids in the blood, which increases the long-term risk for cardiovascular disease and stroke. It is a chronic metabolic condition that does not acutely affect a patient’s balance, strength, or coordination. Unless the condition leads to a secondary event like a stroke, it does not contribute to the immediate risk of falling. Therefore, it is rarely included in the criteria used by nurses to determine a patient's fall risk.
Choice D rationale
Visual impairment is a significant risk factor for falls because it directly affects a client’s ability to navigate their environment safely. Reduced acuity, loss of peripheral vision, or poor depth perception makes it difficult to see obstacles, changes in floor levels, or hazards like spills. The inability to process visual information accurately leads to missteps and loss of balance. Ensuring adequate lighting and the use of corrective lenses is a standard intervention for these high-risk clients.
Correct Answer is D
Explanation
Choice A rationale
Proper ophthalmic hygiene requires wiping the eyelid from the inner canthus to the outer canthus. This specific direction prevents the introduction of debris or pathogens from the skin and tear duct into the lacrimal system. Moving from the outer to the inner canthus increases the risk of contaminating the eye with microbes or environmental contaminants that typically reside on the surrounding facial skin surfaces or the temporal edge.
Choice B rationale
Squeezing the eyelids tightly immediately after medication instillation causes the liquid to be expelled from the conjunctival sac. This action significantly reduces the absorption time of the medication and forces the solution out onto the cheek or into the tear ducts. Instead, the patient should be instructed to close their eyes gently or blink normally to allow the medication to distribute evenly across the surface of the eye for optimal therapeutic effect.
Choice C rationale
The cornea is a highly sensitive and avascular tissue filled with numerous pain receptors. Placing drops directly onto the cornea causes significant discomfort and can trigger a strong blink reflex that expels the medication. Proper technique involves pulling down the lower eyelid to create a small pocket in the conjunctival sac, which safely holds the medication and allows it to absorb through the conjunctiva without causing trauma to the corneal surface.
Choice D rationale
Applying gentle pressure to the nasolacrimal duct for approximately 1 to 2 minutes after instillation prevents the medication from entering the systemic circulation through the nasal mucosa. This technique, known as punctal occlusion, is essential for medications that could cause systemic side effects, such as beta-blockers. It ensures that the drug remains localized in the ocular area for the maximum duration possible while reducing risk to the rest of the body.
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