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 A
Explanation
Pyloric obstruction involves a mechanical blockage at the stomach outlet, leading to the accumulation of gastric contents. Knowledge of gastrointestinal decompression and the therapeutic purpose of nasogastric tubes in managing increased intragastric pressure and preventing emesis is required here.
Choice A rationale
Pyloric obstruction causes gastric stasis and distension because contents cannot enter the duodenum. Nasogastric intubation provides decompression by removing accumulated secretions and gas, which relieves pressure, prevents vomiting, and reduces the risk of aspiration in the client.
Choice B rationale
Providing nutrition via tube feeding is contraindicated in pyloric obstruction. Because the outlet of the stomach is blocked, any enteral formula introduced would accumulate in the stomach, worsening distension and significantly increasing the risk of reflux or aspiration.
Choice C rationale
While gastric pH can be measured via a nasogastric tube, it is not the primary therapeutic rationale for tube placement in a client with a mechanical obstruction. Decompression is a critical intervention to ensure safety and comfort.
Choice D rationale
Administering oral medications through a nasogastric tube is ineffective during an obstruction. The medication cannot pass the pylorus to be absorbed in the small intestine, and it adds volume to an already overfilled and pressurized stomach.
Correct Answer is D
Explanation
Post stroke education focuses on secondary prevention through risk factor modification. Applying knowledge of pharmacology and lifestyle changes is necessary to ensure the patient understands how to manage hypertension, smoking cessation, and safe medication use to avoid recurrence.
Choice A rationale
Daily exercise is a recommended lifestyle modification that helps manage weight and lower blood pressure. It improves cardiovascular health and reduces the risk of recurrent ischemic events by enhancing vascular tone and reducing systemic inflammation.
Choice B rationale
Smoking cessation is critical because nicotine causes vasoconstriction and accelerates atherosclerosis. Stopping tobacco use significantly lowers the risk of thrombus formation and further ischemic damage to the cerebral vasculature in post stroke patients.
Choice C rationale
Reducing high fat intake and increasing fruits and vegetables helps manage cholesterol levels. Lowering low density lipoprotein levels prevents the progression of carotid artery plaque, which is a major contributor to the occurrence of ischemic strokes.
Choice D rationale
While aspirin is often prescribed for its antiplatelet properties, clients should not self medicate with over the counter versions without clinical supervision. Aspirin increases bleeding risks, and its use must be coordinated with other prescribed anticoagulants..
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