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NSG 430 Exam Final Edition A+ Graded., Exams of Nursing

NSG 430 Exam Final Edition A+ Graded.

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2024/2025

Available from 07/02/2025

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NSG 430 Exam Final Edition A+ Graded.
THE STANDARD POLICY ON THE CARDIAC UNIT STATES, ―NOTIFY THE HEALTH CARE
PROVIDER FOR MEAN
ARTERIAL PRESSURE (MAP) LESS THAN 70 MM HG.‖ WHICH PATIENT'S STATUS WOULD
THE NURSE REPORT
TO THE HEALTH CARE PROVIDER?
A. POSTOPERATIVE PATIENT WITH A BP OF 116/42 MM HG.
B. NEWLY ADMITTED PATIENT WITH A BP OF 150/87 MM HG.
C. PATIENT WITH LEFT VENTRICULAR FAILURE WHO HAS A BP OF 110/70 MM HG.
D. PATIENT WITH A MYOCARDIAL INFARCTION WHO HAS A BP OF 140/86 MM HG.
POSTOPERATIVE PATIENT WITH A BP OF 116/42 MM HG.
THE MEAN ARTERIAL PRESSURE (MAP) IS CALCULATED USING THE FORMULA MAP =
(SYSTOLIC BP + 2
DIASTOLIC BP)/3. THE MAP FOR THE POSTOPERATIVE PATIENT IS 67. THE MAP IN THE
OTHER THREE
PATIENTS IS HIGHER THAN 70 MM HG.
THE NURSE IS ADMITTING A PATIENT FOR A CARDIAC CATHETERIZATION AND CORONARY
ANGIOGRAM. WHICH
INFORMATION IS IMPORTANT FOR THE NURSE TO COMMUNICATE TO THE HEALTH CARE
PROVIDER BEFORE THE
TEST?
A. THE PATIENT'S PEDAL PULSES ARE +1.
B. THE PATIENT IS ALLERGIC TO CONTRAST DYE.
C. THE PATIENT HAD A HEART ATTACK 1 YEAR AGO.
D. THE PATIENT HAS NOT EATEN ANYTHING TODAY.
THE PATIENT IS ALLERGIC TO CONTRAST DYE.
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NSG 430 Exam Final Edition A+ Graded.

THE STANDARD POLICY ON THE CARDIAC UNIT STATES, ―NOTIFY THE HEALTH CARE

PROVIDER FOR MEAN

ARTERIAL PRESSURE (MAP) LESS THAN 70 MM HG.‖ WHICH PATIENT'S STATUS WOULD

THE NURSE REPORT

TO THE HEALTH CARE PROVIDER?

A. POSTOPERATIVE PATIENT WITH A BP OF 116/42 MM HG.

B. NEWLY ADMITTED PATIENT WITH A BP OF 150/87 MM HG.

C. PATIENT WITH LEFT VENTRICULAR FAILURE WHO HAS A BP OF 110/70 MM HG.

D. PATIENT WITH A MYOCARDIAL INFARCTION WHO HAS A BP OF 140/86 MM HG.

POSTOPERATIVE PATIENT WITH A BP OF 116/42 MM HG.

THE MEAN ARTERIAL PRESSURE (MAP) IS CALCULATED USING THE FORMULA MAP =

(SYSTOLIC BP + 2

DIASTOLIC BP)/3. THE MAP FOR THE POSTOPERATIVE PATIENT IS 67. THE MAP IN THE

OTHER THREE

PATIENTS IS HIGHER THAN 70 MM HG.

THE NURSE IS ADMITTING A PATIENT FOR A CARDIAC CATHETERIZATION AND CORONARY

ANGIOGRAM. WHICH

INFORMATION IS IMPORTANT FOR THE NURSE TO COMMUNICATE TO THE HEALTH CARE

PROVIDER BEFORE THE

TEST?

A. THE PATIENT'S PEDAL PULSES ARE +1.

B. THE PATIENT IS ALLERGIC TO CONTRAST DYE.

C. THE PATIENT HAD A HEART ATTACK 1 YEAR AGO.

D. THE PATIENT HAS NOT EATEN ANYTHING TODAY.

THE PATIENT IS ALLERGIC TO CONTRAST DYE.

PATIENTS WHO HAVE ALLERGIES TO CONTRAST DYE WILL REQUIRE TREATMENT WITH

MEDICATIONS, SUCH AS

CORTICOSTEROIDS AND ANTIHISTAMINES BEFORE THE ANGIOGRAM. THE OTHER

INFORMATION MAY BE

COMMUNICATED TO THE HEALTH CARE PROVIDER BUT WILL NOT REQUIRE A CHANGE IN

THE USUAL

PRE-CARDIAC CATHETERIZATION ORDERS OR MEDICATIONS.

A TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE) IS PLANNED FOR A PATIENT

HOSPITALIZED WITH POSSIBLE

ENDOCARDITIS. WHICH ACTION INCLUDED IN THE STANDARD TEE ORDERS WILL THE

NURSE NEED TO

ACCOMPLISH FIRST?

A. START AN IV LINE.

B. START O2 PER NASAL CANNULA.

C. PLACE THE PATIENT ON NPO STATUS.

D. GIVE LORAZEPAM (ATIVAN) 1 MG IV.

PLACE THE PATIENT ON NPO STATUS.

THE PATIENT WILL NEED TO BE NPO FOR 6 HOURS PRECEDING THE TEE, SO THE NURSE

SHOULD PLACE THE

PATIENT ON NPO STATUS AS SOON AS THE ORDER IS RECEIVED. THE OTHER ACTIONS

ALSO WILL NEED TO BE

ACCOMPLISHED BUT NOT UNTIL JUST BEFORE OR DURING THE PROCEDURE.

WE HAVE AN EXPERT-WRITTEN SOLUTION TO THIS PROBLEM!

THE NURSE AND ASSISTIVE PERSONNEL (AP) ON THE TELEMETRY UNIT ARE CARING FOR

FOUR PATIENTS.

WHICH ACTION COULD THE NURSE DELEGATE TO THE AP?

A. TEACHING A PATIENT ABOUT EXERCISE ELECTROCARDIOGRAPHY

THAT NEED IMMEDIATE INTERVENTION.

WHICH HEMODYNAMIC PARAMETER MOST DIRECTLY REFLECTS THE EFFECTIVENESS OF

DRUGS GIVEN TO

REDUCE A PATIENT'S LEFT VENTRICULAR AFTERLOAD?

A. CARDIAC OUTPUT (CO)

B. SYSTEMIC VASCULAR RESISTANCE (SVR)

C. PULMONARY VASCULAR RESISTANCE (PVR)

D. PULMONARY ARTERY WEDGE PRESSURE (PAWP)

SYSTEMIC VASCULAR RESISTANCE (SVR)

SVR REFLECTS THE RESISTANCE TO LEFT VENTRICULAR EJECTION, OR AFTERLOAD. OTHER

PARAMETERS MAY BE

MONITORED BUT DO NOT REFLECT LEFT-SIDED AFTERLOAD AS DIRECTLY.

AFTER SURGERY, A PATIENT'S CENTRAL VENOUS PRESSURE (CVP) MONITOR INDICATES

LOW PRESSURES.

WHICH ACTION WOULD THE NURSE TAKE?

A. ADMINISTER IV DIURETIC MEDICATIONS.

B. INCREASE THE IV FLUID INFUSION PER PROTOCOL.

C. INCREASE THE INFUSION RATE OF IV VASODILATORS.

D. ELEVATE THE HEAD OF THE PATIENT'S BED TO 45 DEGREES.

INCREASE THE IV FLUID INFUSION PER PROTOCOL

A LOW CVP INDICATES DECREASED PRELOAD FROM HYPOVOLEMIA AND A NEED FOR AN

INCREASE IN THE

INFUSION RATE. DIURETIC ADMINISTRATION WILL CONTRIBUTE TO HYPOVOLEMIA AND

ELEVATION OF THE HEAD

OR INCREASING VASODILATORS MAY DECREASE CEREBRAL PERFUSION.

WHICH PARAMETER WILL THE NURSE USE TO EVALUATE CHANGES IN A PATIENT'S RIGHT

VENTRICULAR

AFTERLOAD?

A. CENTRAL VENOUS PRESSURE (CVP)

B. SYSTEMIC VASCULAR RESISTANCE (SVR)

C. PULMONARY VASCULAR RESISTANCE (PVR)

D. PULMONARY ARTERY WEDGE PRESSURE (PAWP)

PULMONARY VASCULAR RESISTANCE (PVR)

PVR IS A MEASURE OF RIGHT VENTRICULAR AFTERLOAD, WHICH IS ELEVATED IN

CONDITIONS SUCH AS

PULMONARY HYPERTENSION THE OTHER PARAMETERS DO NOT DIRECTLY ASSESS FOR

RIGHT VENTRICULAR

AFTERLOAD.

WE HAVE AN EXPERT-WRITTEN SOLUTION TO THIS PROBLEM!

A PATIENT REQUIRES ARTERIAL PRESSURE MONITORING. WHICH ACTION WOULD THE

NURSE PLAN TO TAKE?

A. BALANCE AND CALIBRATE THE MONITORING EQUIPMENT EVERY 2 HOURS.

B. POSITION THE ZERO-REFERENCE STOPCOCK LINE LEVEL WITH THE PHLEBOSTATIC AXIS.

C. DISCONNECT THE LOW PRESSURE ALARM TO AVOID DISTURBING THE PATIENT'S SLEEP.

D. ENSURE THAT THE PATIENT IS SUPINE WITH THE HEAD OF THE BED FLAT FOR ALL

READINGS.

POSITION THE ZERO-REFERENCE STOPCOCK LINE LEVEL WITH THE PHLEBOSTATIC AXIS.

FOR ACCURATE MEASUREMENT OF PRESSURES, THE ZERO-REFERENCE LEVEL WOULD BE

AT THE PHLEBOSTATIC

AXIS. THERE IS NO NEED TO REBALANCE AND RECALIBRATE MONITORING EQUIPMENT

EVERY 2 HOURS.

OBSERVE FOR DYSRHYTHMIAS

THE LOW PRESSURE ALARM INDICATES A DROP IN THE PATIENT'S BLOOD PRESSURE,

WHICH MAY BE CAUSED

BY DYSRHYTHMIAS OR LINE DISCONNECTION. THERE IS NO INDICATION TO RE-ZERO THE

EQUIPMENT. PALLOR

OF THE LEFT HAND WOULD BE CAUSED BY OCCLUSION OF THE RADIAL ARTERY BY THE

ARTERIAL CATHETER.

FLUSHING THE LINE WOULD BE USEFUL IF THERE IS A DAMPENED WAVEFORM.

WE HAVE AN EXPERT-WRITTEN SOLUTION TO THIS PROBLEM!

WHICH ACTION WOULD THE NURSE TAKE WHEN PREPARING TO ASSIST WITH THE

INSERTION OF A PULMONARY

ARTERY CATHETER?

A. DETERMINE IF THE CARDIAC TROPONIN LEVEL IS ELEVATED.

B. PLACE THE PATIENT ON NPO STATUS BEFORE THE PROCEDURE.

C. AUSCULTATE HEART SOUNDS BEFORE AND DURING CATHETER INSERTION.

D. ASSURE THAT THE CARDIAC MONITOR IS VISIBLE DURING THE PROCEDURE.

ASSURE THAT THE CARDIAC MONITOR IS VISIBLE DURING THE PROCEDURE.

DYSRHYTHMIAS CAN OCCUR AS THE CATHETER IS FLOATED THROUGH THE RIGHT ATRIUM

AND VENTRICLE, AND IT

IS IMPORTANT FOR THE NURSE TO MONITOR FOR THESE DURING INSERTION.

PULMONARY ARTERY CATHETER

INSERTION DOES NOT REQUIRE ANESTHESIA, AND THE PATIENT WILL NOT NEED TO BE

NPO. CHANGES IN

CARDIAC TROPONIN OR HEART AND BREATH SOUNDS ARE NOT EXPECTED DURING

PULMONARY ARTERY CATHETER

INSERTION.

THE NURSE IS ASSISTING WITH THE PLACEMENT OF A PULMONARY ARTERY (PA)

CATHETER. WHAT WOULD

THE NURSE EXPECT TO SEE ON THE MONITOR DURING THE PROCEDURE AS AN

INDICATION THAT THE CATHETER

WITH INFLATED BALLOON IS PLACED CORRECTLY?

A. PA PRESSURE WAVEFORM

B. PA WEDGE PRESSURE (PAWP) WAVEFORM

C. TRACING OF THE SYSTEMIC ARTERIAL PRESSURE

D. TRACING OF THE SYSTEMIC VASCULAR RESISTANCE

PA WEDGE PRESSURE (PAWP) WAVEFORM

THE PURPOSE OF A PA LINE IS TO MEASURE PAWP, SO THE CATHETER IS FLOATED

THROUGH THE

PULMONARY ARTERY UNTIL THE DILATED BALLOON WEDGES IN A DISTAL BRANCH OF THE

PULMONARY ARTERY,

AND THE PAWP READINGS ARE AVAILABLE. AFTER INSERTION, THE BALLOON IS

DEFLATED, AND THE PA

WAVEFORM WILL BE OBSERVED. SYSTEMIC ARTERIAL PRESSURES ARE OBTAINED USING

AN ARTERIAL LINE, AND

THE SYSTEMIC VASCULAR RESISTANCE IS A CALCULATED VALUE, NOT A WAVEFORM.

WHICH FINDING BY THE NURSE CARING FOR A PATIENT WITH A RIGHT RADIAL ARTERIAL

LINE INDICATES A NEED

FOR THE NURSE TO TAKE ACTION?

A. THE LEFT HAND FEELS WARMER THAN THE RIGHT HAND.

B. THE MEAN ARTERIAL PRESSURE (MAP) IS 77 MM HG.

C. THE SYSTEM IS DELIVERING 3 ML OF FLUSH SOLUTION PER HOUR.

D. THE FLUSH BAG AND TUBING WERE CHANGED 2 DAYS PREVIOUSLY.

THE LEFT HAND FEELS WARMER THAN THE RIGHT HAND.

WE HAVE AN EXPERT-WRITTEN SOLUTION TO THIS PROBLEM!

A PATIENT WITH RESPIRATORY FAILURE HAS ARTERIAL PRESSURE-BASED CARDIAC

OUTPUT (APCO)

MONITORING AND IS RECEIVING MECHANICAL VENTILATION WITH PEAK END-

EXPIRATORY PRESSURE (PEEP)

OF 12 CM H2O. WHICH INFORMATION INDICATES THAT A CHANGE IN THE VENTILATOR

SETTINGS MAY BE

REQUIRED?

A. THE ARTERIAL PRESSURE IS 90/46.

B. THE HEART RATE IS 58 BEATS/MIN.

C. THE STROKE VOLUME IS INCREASED.

D. THE STROKE VOLUME VARIATION IS 12%.

THE ARTERIAL PRESSURE IS 90/

THE HYPOTENSION SUGGESTS THAT THE HIGH INTRATHORACIC PRESSURE CAUSED BY THE

PEEP MAY BE

DECREASING VENOUS RETURN AND (POTENTIALLY) CARDIAC OUTPUT. THE OTHER

ASSESSMENT DATA WOULD

NOT BE A DIRECT RESULT OF PEEP AND MECHANICAL VENTILATION.

WE HAVE AN EXPERT-WRITTEN SOLUTION TO THIS PROBLEM!

A YOUNG ADULT PATIENT WHO IS BEING SEEN IN THE CLINIC HAS EXCESSIVE SECRETION

OF THE ANTERIOR

PITUITARY HORMONES. WHICH LABORATORY TEST RESULT WOULD THE NURSE EXPECT?

A. INCREASED URINARY CORTISOL

B. DECREASED SERUM THYROXINE

C. ELEVATED SERUM ALDOSTERONE

D. LOW URINARY CATECHOLAMINES

INCREASED URINARY CORTISOL

INCREASED SECRETION OF ADRENOCORTICOTROPIC HORMONE (ACTH) BY THE ANTERIOR

PITUITARY GLAND

WILL LEAD TO AN INCREASE IN SERUM AND URINARY CORTISOL LEVELS. AN INCREASE,

RATHER THAN A

DECREASE, IN THYROXINE LEVEL WOULD BE EXPECTED WITH INCREASED SECRETION OF

THYROID-STIMULATING

HORMONE (TSH) BY THE ANTERIOR PITUITARY. THE ANTERIOR PITUITARY DOES NOT

CONTROL ALDOSTERONE

AND CATECHOLAMINE LEVELS.

WE HAVE AN EXPERT-WRITTEN SOLUTION TO THIS PROBLEM!

WHICH STATEMENT MADE BY A 50-YR-OLD FEMALE PATIENT INDICATES TO THE NURSE

THAT FURTHER

ASSESSMENT OF THYROID FUNCTION MAY BE NEEDED?

A. ―I AM SO THIRSTY THAT I DRINK ALL DAY LONG.‖

B. ―I GET UP SEVERAL TIMES AT NIGHT TO URIN ATE.‖

C. ―I FEEL A LUMP IN MY THROAT WHEN I SWA LLOW.‖

D. ―I NOTICE MY BREA STS ARE ALWAYS TENDE R LATELY.‖

―I FEEL A LUMP IN MY THROAT WHEN I SWALLO W.‖

AN ENLARGED THYROID GLAND CAN CAUSE PROBLEMS SWALLOWING OR A CHANGE IN

NECK SIZE. NOCTURIA

IS ASSOCIATED WITH DISEASES SUCH AS DIABETES, DIABETES INSIPIDUS, OR CHRONIC

KIDNEY DISEASE.

BREAST TENDERNESS WOULD OCCUR WITH EXCESSIVE GONADAL HORMONE LEVELS.

THIRST IS A SIGN OF

DISEASE SUCH AS DIABETES.

WE HAVE AN EXPERT-WRITTEN SOLUTION TO THIS PROBLEM!

A PATIENT IS SCHEDULED IN THE OUTPATIENT CLINIC FOR BLOOD CORTISOL TESTING.

WHICH INSTRUCTION

WOULD THE NURSE PROVIDE?

A. ―AVOID ADDING ANY SALT TO YOUR FOODS FOR 24 HOURS BEFORE T HE TEST.‖

B. ―YOU WILL NEED TO LIE DOWN FOR 30 MINUTES BEFORE THE BLOOD IS DRAWN.‖

C. ―COME TO THE LABORATORY TO HAVE THE BLOOD DRAWN EARLY IN THE MORNING .‖

D. ―DO NOT HAVE ANYT HING TO EAT OR DRINK BEFORE THE BLOOD TES T IS OBTAINED.‖

COME TO THE LABORATORY TO HAVE THE BLOOD DRAWN EARLY IN THE M ORNING.‖

CORTISOL LEVELS ARE USUALLY DRAWN IN THE MORNING, WHEN LEVELS ARE HIGHEST.

THE OTHER

INSTRUCTIONS WOULD BE GIVEN TO PATIENTS WHO WERE HAVING OTHER ENDOCRINE

TESTING.

A PATIENT ADMITTED WITH PNEUMONIA HAS A TOTAL SERUM CALCIUM LEVEL OF 13.

MG/DL. WHICH

SERUM LEVEL WOULD THE NURSE ANTICIPATE WILL BE TESTED NEXT?

A. CALCITONIN

B. CATECHOLAMINE

C. THYROID HORMONE

D. PARATHYROID HORMONE

PARATHYROID HORMONE

PARATHYROID HORMONE (PTH) IS THE MAJOR CONTROLLER OF BLOOD CALCIUM LEVELS.

ALTHOUGH

CALCITONIN SECRETION IS A COUNTER MECHANISM TO PTH, IT DOES NOT PLAY A MAJOR

ROLE IN CALCIUM

BALANCE. CATECHOLAMINE AND THYROID HORMONE LEVELS DO NOT AFFECT SERUM

CALCIUM LEVEL

DURING THE PHYSICAL EXAMINATION, THE NURSE CANNOT FEEL THE PATIENT'S THYROID

GLAND. WHICH

ACTION WOULD THE NURSE TAKE?

A. PALPATE THE PATIENT'S NECK MORE DEEPLY.

B. DOCUMENT THAT THE THYROID WAS NONPALPABLE.

C. NOTIFY THE HEALTH CARE PROVIDER IMMEDIATELY.

D. TEACH THE PATIENT ABOUT THYROID HORMONE TESTING

DOCUMENT THAT THE THYROID WAS NONPALPABLE.

THE THYROID IS USUALLY NONPALPABLE. THE NURSE WOULD SIMPLY DOCUMENT THE

FINDING. DEEP

PALPATION OF THE NECK IS NOT APPROPRIATE; DO NOT PRESS TOO HARD OR MASSAGE

AN ENLARGED THYROID

GLAND AS THIS CAN CAUSE A SUDDEN RELEASE OF THYROID HORMONE INTO AN

ALREADY OVERLOADED

SYSTEM. THERE IS NO NEED TO NOTIFY THE HEALTH CARE PROVIDER IMMEDIATELY

ABOUT A NORMAL

FINDING. THERE IS NO INDICATION FOR THYROID-STIMULATING HORMONE (TSH) TESTING

UNLESS THERE IS

EVIDENCE OF THYROID DYSFUNCTION.

WHICH LABORATORY VALUE WOULD THE NURSE REVIEW TO DETERMINE WHETHER A

PATIENT'S

HYPOTHYROIDISM IS CAUSED BY A PROBLEM WITH THE ANTERIOR PITUITARY GLAND?

A. THYROXINE (T4) LEVEL

B. TRIIODOTHYRONINE (T3) LEVEL

C. THYROID-STIMULATING HORMONE (TSH) LEVEL

D. THYROTROPIN-RELEASING HORMONE (TRH) LEVEL

THYROID-STIMULATING HORMONE (TSH) LEVEL

C. DOCUMENT THE PATIENT'S RESPIRATORY PATTERN.

D. PLACE THE PATIENT IN HIGH FOWLER'S POSITION.

DOCUMENT THE PATIENT'S RESPIRATORY PATTERN

CHEYNE-STOKES RESPIRATIONS ARE CHARACTERIZED BY PERIODS OF APNEA

ALTERNATING WITH DEEP AND

RAPID BREATHS. THIS RESPIRATORY PATTERN IS EXPECTED IN THE LAST DAYS OF LIFE AND

IS NOT POSITION

DEPENDENT. THERE IS ALSO NO NEED FOR SUPPLEMENTAL OXYGEN BY FACE MASK OR

SUCTIONING THE

PATIENT.

THE NURSE IS CARING FOR A DYING ADOLESCENT PATIENT WHO IS COMATOSE. THE

PATIENT'S PARENTS ARE

INTERESTED IN ORGAN DONATION AND ASK THE NURSE HOW THE HEALTH CARE

PROVIDERS DETERMINE BRAIN

DEATH. WHICH RESPONSE BY THE NURSE ACCURATELY DESCRIBES BRAIN DEATH

DETERMINATION?

A. ―IF CPR DOES NOT RESTORE A HEARTBEAT, THE BRAIN CANNOT FUNCTION ANY

LONGER.‖

B. ―BRAIN DEATH HAS OCCURRED IF THERE IS NOT ANY BREATHING OR BRAINSTEM

REFLEXES.‖

C. ―BRAIN DEATH HAS OCCURRED IF A PERSON HAS FLACCID MUSCLES AND DOES NOT

AWAKEN.‖

D. ―IF RESPIRATORY E FFORTS CEASE AND NO APICAL PULSE IS AUDIBLE, BRAIN DEATH IS

PRESENT.‖

―BRAIN DEATH HAS OCC URRED IF THERE IS NOT ANY BREATHING OR BRAINSTEM

REFLEXES.‖

THE DIAGNOSIS OF BRAIN DEATH IS BASED ON IRREVERSIBLE LOSS OF ALL BRAIN

FUNCTIONS, INCLUDING

BRAINSTEM FUNCTIONS THAT CONTROL RESPIRATIONS AND BRAINSTEM REFLEXES. THE

OTHER DESCRIPTIONS

DESCRIBE OTHER CLINICAL MANIFESTATIONS ASSOCIATED WITH DEATH BUT ARE

INSUFFICIENT TO DECLARE A

PATIENT BRAIN DEAD.

A PATIENT IN HOSPICE IS MANIFESTING A DECREASE IN ALL BODY SYSTEM FUNCTIONS

EXCEPT FOR A HEART

RATE OF 124 BEATS/MIN AND A RESPIRATORY RATE OF 28 BREATHS/MIN. WHICH

STATEMENT WOULD BE

ACCURATE FOR THE NURSE TO MAKE TO THE PATIENT'S FAMILY?

A. ―THESE VITAL SIGN S WILL CONTINUE TO INCREASE UNTIL DEATH FINALLY OCCURS.‖

B. ―THESE VITAL SIGN S DEMONSTRATE THE BODY'S ABILITY TO COMPENSATE AND

HEAL.‖

C. ―THESE VITAL SIGN S ARE AN EXPECTED RESPONSE NOW BUT WILL SLOW DOWN

LATER.‖

D. ― THESE VITAL SIGNS MAY INDICATE AN IMPROVEMENT IN THE PATIENT'S

CONDITION.‖

―THESE VITAL SIGNS A RE AN EXPECTED RESPONSE NOW BUT WILL SLO W DOWN LATER.‖

AN INCREASE IN HEART AND RESPIRATORY RATE MAY OCCUR BEFORE THE SLOWING OF

THESE FUNCTIONS IN A

DYING PATIENT. HEART AND RESPIRATORY RATE TYPICALLY SLOW AS THE PATIENT

PROGRESSES FURTHER

TOWARD DEATH. IN A DYING PATIENT, HIGH RESPIRATORY AND PULSE RATES DO NOT

INDICATE IMPROVEMENT

OR COMPENSATION, AND IT WOULD BE INAPPROPRIATE FOR THE NURSE TO INDICATE

THIS TO THE FAMILY

A PATIENT WHO HAS BEEN DIAGNOSED WITH INOPERABLE LUNG CANCER AND HAS A

POOR PROGNOSIS PLANS

A TRIP ACROSS THE CO UNTRY ―TO SETTLE SOM E ISSUES WITH FAMILY MEMBERS.‖ THE

NURSE RECOGNIZES

MAY LEAD TO IMPAIRED ADJUSTMENT AS THE PATIENT PROGRESSES TOWARD DEATH.

THE SPOUSE DOES NOT

APPEAR TO FEEL FEARFUL, HOPELESS, OR ANXIOUS

AS THE NURSE ADMITS A PATIENT IN END-STAGE RENAL DISEASE TO THE HOSPITAL, THE

PATIENT TELLS THE

NURSE, ―IF MY HEART OR BREATHING STOP, I DO NOT WANT TO BE RE SUSCITATED.‖

WHICH ACTION SHOULD

THE NURSE TAKE FIRST?

A. PLACE A ―DO NOT RESUSCITATE‖ (DNR) NO TATION IN THE PATIENT'S CARE PLAN.

B. INVITE THE PATIENT TO ADD A NOTARIZED ADVANCE DIRECTIVE IN THE HEALTH

RECORD.

C. ADVISE THE PATIENT TO DESIGNATE A PERSON TO MAKE FUTURE HEALTH CARE

DECISIONS.

D. ASK IF THE DECISION HAS BEEN DISCUSSED WITH THE PATIENT'S HEALTH CARE

PROVIDER.

ASK IF THE DECISION HAS BEEN DISCUSSED WITH THE PATIENT'S HEALTH CARE PROVIDER.

A HEALTH CARE PROVIDER'S ORDER SHOULD BE WRITTEN DESCRIBING THE ACTIONS THAT

THE NURSES SHOULD

TAKE IF THE PATIENT REQUIRES CPR, BUT THE PRIMARY RIGHT TO DECIDE BELONGS TO

THE PATIENT OR

FAMILY. THE NURSE SHOULD DOCUMENT THE PATIENT'S REQUEST BUT DOES NOT HAVE

THE AUTHORITY TO

PLACE THE DNR ORDER IN THE CARE PLAN UNTIL IT IS PRESCRIBED BY THE HCP. A

NOTARIZED ADVANCE

DIRECTIVE MAY BE COMPLETED BUT IS NOT NEEDED TO ESTABLISH THE PATIENT'S

WISHES. THE PATIENT

MAY NEED A DURABLE POWER OF ATTORNEY FOR HEALTH CARE (OR THE EQUIVALENT),

BUT THIS DOES NOT

ADDRESS THE PATIENT'S CURRENT CONCERN WITH POSSIBLE RESUSCITATION.

A YOUNG ADULT PATIENT WITH METASTATIC CANCER WHO IS VERY CLOSE TO DEATH

APPEARS RESTLESS. THE

PATIENT KEEPS REPEAT ING, ―I AM NOT READY TO DIE.‖ WHICH ACTIO N BY THE NURSE

WOULD SHOW

RESPECT FOR THE PATIENT?

A. REMIND THE PATIENT THAT NO ONE FEELS READY FOR DEATH.

B. SIT AT THE BEDSIDE AND ASK IF THERE IS ANYTHING THE PATIENT NEEDS.

C. INSIST THAT FAMILY MEMBERS REMAIN AT THE BEDSIDE WITH THE PATIENT.

D. TELL THE PATIENT THAT EVERYTHING POSSIBLE IS BEING DONE TO DELAY DEATH.

SIT AT THE BEDSIDE AND ASK IF THERE IS ANYTHING THE PATIENT NEEDS.

STAYING AT THE BEDSIDE AND LISTENING ALLOWS THE PATIENT TO DISCUSS ANY

UNRESOLVED ISSUES OR

PHYSICAL DISCOMFORTS THAT SHOULD BE ADDRESSED. STATING THAT NO ONE FEELS

READY FOR DEATH DOES

NOT ADDRESS THE PATIENT'S CONCERNS. TELLING THE PATIENT THAT EVERYTHING IS

BEING DONE DOES NOT

ADDRESS THE PATIENT'S FEARS ABOUT DYING, ESPECIALLY BECAUSE THE PATIENT IS

LIKELY TO DIE SOON.

FAMILY MEMBERS MAY NOT FEEL COMFORTABLE STAYING AT THE BEDSIDE OF A DYING

PATIENT, AND THE

NURSE SHOULD NOT INSIST THAT THEY STAY THERE.

THE NURSE IS CARING FOR A TERMINALLY ILL PATIENT WHO IS EXPERIENCING

CONTINUOUS AND SEVERE PAIN.

HOW WOULD THE NURSE SCHEDULE THE ADMINISTRATION OF OPIOID PAIN

MEDICATIONS?

A. PLAN AROUND-THE-CLOCK ROUTINE ADMINISTRATION OF PRESCRIBED ANALGESICS.

B. PROVIDE PRESCRIBED DOSES OF MEDICATION WHENEVER THE PATIENT REQUESTS

THEM.

C. SUGGEST SMALL ANALGESIC DOSES TO AVOID DECREASING THE RESPIRATORY RATE.