The wife is concerned because her terminally ill husband does not want to eat.
What is the nurse's highest priority response?
"Force him to eat even if he doesn't feel hungry, or he will die sooner.”.
"Let him know that food is available when he wants it but don't insist that he eat.”.
"He is getting all the nutrients he needs from his IV.”.
"A feeding tube can be placed in the nose to provide important nutrients.”.
The Correct Answer is B
Choice A rationale
Forcing a terminally ill patient to eat is medically and ethically inappropriate. As the body nears death, the metabolic rate slows down, and the digestive system begins to shut down. Forcing intake can lead to complications such as aspiration, nausea, vomiting, and increased physical distress. The goal of care at this stage shifts from nutrition and life extension to comfort and symptom management, respecting the patient's natural physiological decline and their personal autonomy.
Choice B rationale
This response addresses the wife's concern while prioritizing the patient's comfort and autonomy. In terminal illness, anorexia is a natural part of the dying process as the body no longer requires or can process significant caloric intake. Providing food only when requested prevents the discomfort associated with forced feeding. This approach supports the family emotionally by providing a clear strategy that honors the patient's wishes while ensuring that the opportunity for nourishment remains available.
Choice C rationale
Stating that a patient is getting all needed nutrients from an IV is often scientifically inaccurate in terminal care. IV fluids provided for hydration do not typically contain sufficient calories or proteins to maintain nutritional status. Furthermore, over-hydration in a dying patient can lead to pulmonary edema, increased secretions, and discomfort. This response dismisses the wife's concern with potentially false information and fails to address the underlying physiological reality of the patient's condition and nutritional needs.
Choice D rationale
Placing a feeding tube in a terminally ill patient is generally discouraged unless it aligns with specific goals of care or temporary recovery. In the end-of-life phase, enteral nutrition does not improve survival or quality of life and can cause significant complications like infection, agitation, and the need for restraints. Suggesting a feeding tube focuses on a technical intervention that may increase suffering rather than addressing the natural transition toward death and the need for comfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
A patient with type 1 diabetes experiencing vomiting and a heart rate of 140 is highly unstable and likely entering diabetic ketoacidosis. Tachycardia above 100 beats per minute combined with metabolic distress requires advanced assessment and rapid intravenous interventions. This complexity and instability fall under the scope of the registered nurse, as the patient requires frequent monitoring and adjustment of complex medication protocols that exceed the standard role of the LPN.
Choice B rationale
A blood pressure of 88/58 mm Hg in a patient with active gastrointestinal bleeding indicates hemodynamic instability and possible hypovolemic shock. Normal systolic blood pressure should be above 90 mm Hg. This patient requires aggressive fluid resuscitation, blood products, and constant reassessment of their circulatory status. Because the patient is unstable and the risk of rapid deterioration is high, they must be managed by a registered nurse rather than an LPN.
Choice C rationale
A respiratory rate of 32 breaths per minute is significantly higher than the normal range of 12 to 20. When combined with decreased breath sounds in a pneumonia patient, it suggests potential respiratory failure or a large pleural effusion. This patient is experiencing acute respiratory distress and requires complex assessment and potential escalation of care. The instability of the respiratory status makes this an inappropriate assignment for an LPN, requiring the RN's expertise.
Choice D rationale
This patient is hemodynamically stable with a normal oxygen saturation of 95 percent, which is within the typical target range of 94 to 99 percent for non-COPD patients. Receiving a low dose of 1 L/min of oxygen indicates a chronic or resolving condition that is currently controlled. This patient is the most stable of the four options and has predictable outcomes, making it a safe and appropriate assignment for an experienced LPN.
Correct Answer is ["A","B"]
Explanation
Choice A rationale
Norepinephrine is a potent alpha-1 adrenergic agonist that causes significant peripheral vasoconstriction. By increasing the systemic vascular resistance, the heart must work harder to eject blood into the aorta. This increase in the resistance against which the left ventricle must pump is the definition of afterload. At a dose of 4 mcg/min, the alpha-adrenergic effects are prominent, directly raising the arterial pressure and increasing the workload and oxygen demand of the myocardial tissue.
Choice B rationale
Dopamine at high doses (10 to 20 mcg/kg/min) primarily stimulates alpha-1 adrenergic receptors in the systemic vasculature. This stimulation results in profound vasoconstriction and an increase in systemic vascular resistance. Consequently, the afterload is significantly elevated. While it also has beta-1 effects that increase contractility, the dominant vascular effect at this high dosage range is the constriction of arterioles, which requires the heart to overcome greater resistance during the systolic phase of the cardiac cycle.
Choice C rationale
Nitroglycerin is a potent vasodilator that primarily acts on the venous system at low doses and the arterial system at higher doses. By relaxing the smooth muscle in blood vessels, it decreases systemic vascular resistance and venous return. This action results in a decrease in afterload and preload, rather than an increase. It is frequently used in clinical practice to reduce the workload of the heart and improve myocardial oxygen balance in conditions like heart failure or angina.
Choice D rationale
Metoprolol is a cardioselective beta-1 adrenergic antagonist that reduces heart rate, contractility, and cardiac output. While it blocks the compensatory tachycardia associated with some forms of heart failure, it does not typically increase afterload. In fact, by reducing the overall sympathetic drive and potentially lowering blood pressure over time, it may lead to a decrease or stabilization of afterload. It does not possess the alpha-adrenergic stimulating properties required to cause systemic vasoconstriction and increase resistance.
Choice E rationale
At a moderate dose of 5 mcg/kg/min, dopamine primarily targets beta-1 adrenergic receptors, which increases myocardial contractility and heart rate. While there is some dopaminergic stimulation that improves renal blood flow, the alpha-adrenergic effects that cause vasoconstriction and increased afterload are usually not dominant at this level. This dosage is often referred to as the cardiac dose, focusing on improving cardiac output through inotropy rather than significantly altering the systemic vascular resistance or afterload.
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