A hospice patient is unable to tolerate food or fluids and has advance directives that indicate that he does not want IV fluids or tube feedings if he is unable to take oral feedings. His family is concerned that he will be very uncomfortable without food or fluids. The nurse should tell them that:
IV fluids or tube feeding would likely make the patient more uncomfortable, and dehydration has been shown to decrease pain and discomfort.
Once the patient is unconscious, his health care proxy can order IV fluids or tube feedings to prevent dehydration.
IV fluids or a tube feeding would make the patient much more comfortable, and they should try to talk him into accepting them.
dehydration is painful, and medication can be given to overcome any pain.
The Correct Answer is A
A. This response aligns with best practices in hospice care, which prioritize comfort and quality of life for terminally ill patients. Dehydration is a common occurrence at the end of life and is generally not associated with discomfort when managed appropriately. IV fluids or tube feedings may cause discomfort, contribute to fluid overload, or lead to complications such as aspiration pneumonia.
B. While the healthcare proxy may have the authority to make decisions on behalf of the patient, the focus should be on honoring the patient's wishes as expressed in advance directives. If the patient has clearly indicated a preference against IV fluids or tube feedings in their advance directives, this should be respected.
C. Encouraging the family to try to talk the patient into accepting IV fluids or tube feedings goes against the principles of patient autonomy and informed decision-making. The decision regarding medical interventions should be based on the patient's preferences and comfort.
D. While dehydration can be uncomfortable in some circumstances, providing adequate symptom management, including pain medication, is essential in hospice care. However, IV fluids or tube feedings are not typically used to manage dehydration in patients who are at the end of life, as they may not improve comfort and can lead to complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Bargaining: Bargaining is a stage in Kübler-Ross's model where the patient may attempt to negotiate with a higher power or medical professionals to change their fate. An increase in daily function is not typically associated with this stage.
B. Acceptance: In Kübler-Ross's model of the stages of grief, acceptance is the final stage. It is characterized by the patient coming to terms with their diagnosis and prognosis. When a terminal patient demonstrates an increase in the level of daily function, it can indicate that they have reached a state of acceptance. This means they have acknowledged their situation and are finding ways to live their life as fully as possible, despite their illness.
C. Depression: Depression is another stage in Kübler-Ross's model where the patient experiences feelings of sadness, hopelessness, and despair. While depression may occur at any point during the grieving process, an increase in daily function suggests movement beyond this stage.
D. Yearning: Yearning, also known as the stage of "pain and guilt" in Kübler-Ross's model, involves feelings of longing for what was lost or what cannot be. It is characterized by emotional distress and a desire to return to a previous state. An increase in daily function is not indicative of this stage.
Correct Answer is A
Explanation
A. "I am hoping this will help relieve my discomfort": This statement reflects an understanding of the palliative nature of the care the client is receiving. The client acknowledges the goal of palliative care, which is focused on symptom management and improving quality of life rather than curative treatment. By expressing hope for relief from discomfort, the client demonstrates acceptance of the prognosis and is aligning with the goals of palliative care.
B. "This is not working, and I plan to stop treatment" : This statement suggests frustration with the current treatment but does not necessarily indicate acceptance of the prognosis. The client may still be seeking alternative treatments or may not fully understand the terminal nature of their condition.
C. "This is making me stronger every day": This statement implies a belief in the effectiveness of the treatment and a focus on improvement rather than acceptance of the prognosis. It does not address the client's understanding of their condition or prognosis.
D. "I am thinking of getting a second opinion": This statement indicates that the client is considering alternative perspectives on their diagnosis and treatment plan. While seeking a second opinion is a valid decision, it does not necessarily reflect acceptance of the prognosis. It suggests a desire for further information or clarification rather than a recognition of the terminal nature of the illness.
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