A client with Amyotrophic Lateral Sclerosis (ALS) tells the hospice nurse they do not want to be intubated and placed on mechanical ventilation.
How should the nurse best respond?
"You should discuss your wishes with your healthcare provider.”.
"What would you prefer I do if you experience difficulty breathing?"
"Incentive spirometer use every hour will delay the need for being placed on the ventilator.”.
"Why don't you want to be on the breathing machine?"...
The Correct Answer is B
Addressing end of life care for patients with neurodegenerative diseases requires therapeutic communication and clarification of advance directives. The nurse must apply principles of patient advocacy and ethics to ensure that specific treatment preferences are understood and documented for future implementation.
Choice A rationale
While the healthcare provider must be informed, this response shifts the responsibility away from the nurse at a critical moment of sharing. The nurse should first explore the patient preferences to provide comprehensive support and advocate for their wishes.
Choice B rationale
This open ended question facilitates an exploration of the patient values and specific desires for comfort care. It allows the nurse to document alternative interventions, such as morphine or oxygen, while respecting the patient refusal of invasive life support.
Choice C rationale
An incentive spirometer helps with lung expansion but will not prevent the ultimate neuromuscular respiratory failure associated with ALS. Giving false hope about delaying ventilation is nontherapeutic and ignores the patient expressed desire to avoid intubation entirely.
Choice D rationale
Asking why can be perceived as defensive or judgmental in therapeutic communication. It may make the patient feel they need to justify their choice, rather than allowing them to express their feelings and plan for their end of life..
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The clinical scenarios involve managing procedural safety in hematology, post-surgical electrolyte monitoring, emergency cardiac stabilization for potassium imbalance, and surgical intervention for burn-induced compartment syndrome. Knowledge of hemostasis, calcium metabolism, membrane potential stabilization, and tissue perfusion mechanics is required to provide safe nursing care.
Choice A rationale
Administering platelets during a procedure is impractical and increases the risk of bleeding before the infusion takes effect. Platelets must be present in the vascular system prior to tissue trauma to facilitate immediate clot formation at the site.
Choice B rationale
Post-procedural administration fails to address the high risk of hemorrhage during the biopsy itself. In severe thrombocytopenia, where counts are often below 20,000 cells/uL, the primary goal is pre-emptive stabilization to prevent uncontrolled internal bleeding.
Choice C rationale
Infusing platelets immediately before the biopsy ensures peak circulating levels during the most invasive phase. This timing optimizes the aggregation of platelets at the puncture site, mitigating the risk of hematoma or severe hemorrhage in high-risk patients.
Choice D rationale
Platelets have a short half-life and are rapidly consumed or sequestered. Administering them 1 to 2 hours early may lead to decreased efficacy at the actual time of the biopsy, increasing the risk of procedural bleeding.
Correct Answer is A
Explanation
This scenario involves recognizing early signs of hypovolemic shock following surgery. Knowledge of compensatory mechanisms, such as tachycardia and peripheral vasoconstriction, is essential to identify the most sensitive indicators of deteriorating hemodynamic status after significant intraoperative blood loss.
Choice A rationale
Tachycardia is typically the earliest compensatory sign of shock. As stroke volume falls due to blood loss, the heart rate increases to maintain cardiac output. A jump from 88 to 118 bpm is a significant clinical alarm.
Choice B rationale
While 20 mL/hr is below the normal 30 mL/hr threshold, decreased urine output often occurs after heart rate changes. It reflects reduced renal perfusion as a later compensatory response to sustain blood flow to the brain.
Choice C rationale
Incisional pain is an expected postoperative finding and does not indicate hypovolemic shock. Pain may actually cause a sympathetic surge that increases heart rate, but it is not a diagnostic marker for circulatory collapse in this context.
Choice D rationale
Capillary refill less than 2 seconds is a normal finding indicating adequate peripheral perfusion. In hypovolemic shock, skin becomes cool and pale, and capillary refill would typically be prolonged beyond 2 to 3 seconds.
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