Deck 8: Communications

Question 1

The nurse, new to hospice care, is uncomfortable talking with patients and families about end-of-life care and issues. Which of the following should she do to become more comfortable with the patients and their families?

A) Observe another staff nurse working with the patients and families
B) Avoid the conversations until a comfort level is reached
C) Provide care in a detached manner
D) Consider another type of nursing and ask for a transfer

Answer 1

Observe another staff nurse working with the patients and families

Question 2

The physician is planning to discuss a new diagnosis of cancer with a patient but is concerned that he may not be prepared to hear the information. Which of the following can the nurse do to facilitate this discussion?

A) Suggest that the physician avoid the discussion until absolutely necessary
B) Ask the patient if there is anyone he would like to have present when the physician discusses his diagnosis and plan of care
C) Suggest that the physician not tell the patient about the diagnosis but provide treatment under another reason
D) Contact the patient's clergy member and schedule the physician to arrive at the same time to provide the information

Answer 2

Ask the patient if there is anyone he would like to have present when the physician discusses his diagnosis and plan of care

Question 3

A terminally ill patient tells the nurse that he wishes that someone would talk with him about his prognosis so that he can make plans. Which of the following should the nurse do to help this patient?

A) Tell the patient that he must not be that ill since no one has talked with him about it
B) Ask the patient what he does know about his prognosis as a first step
C) Ask the patient what kind of plans he needs to make
D) Suggest the patient focus on getting better so that he can go home and make the plans

Answer 3

Ask the patient what he does know about his prognosis as a first step

Question 4

The family of a terminally ill patient is unhappy with the care the patient is receiving because the nurse just comes into the room, does activities, and then leaves without conversation. The nurse's behavior could be explained by which of the following?

A) The nurse does not want to interrupt the patient's time with the family
B) The nurse is distracted by the volume of care the patient needs
C) The nurse is planning activities that need to be accomplished
D) The nurse is distancing herself from the dying patient and family

Question 5

A terminally ill patient is in a coma. The spouse tells the nurse that the patient would not want to live on life support, whereas the eldest daughter tells the nurse to do "everything possible" to keep her father alive. Which of the following should the nurse do?

A) Locate the patient's advance directive
B) Follow the spouse's direction
C) Follow the eldest daughter's direction
D) Allow the patient to naturally live out his life

Question 6

A terminally ill patient has been intubated because the advance directive included intubation and ventilatory support if needed. The family, upset to see the "breathing tube," wants to know why he was not permitted to die and demands that something be done immediately. Which of the following should be done in this situation?

A) Call the physician to inform him that the breathing tube was used accidentally
B) Coordinate a conference with the family and physician to discuss the patient's advance directive
C) Call Security to have the family removed from the hospital
D) Remind the family that the breathing tube does not mean that the patient will recover

Question 7

After the physician communicates the prognosis for a terminally ill patient, the nurse stays in the patient's room and sits with the family to answer any questions and address concerns. Which of the following is this nurse doing?

A) Taking a break from providing care to other patients
B) Interpreting the physician's information
C) Discharge planning
D) Engaging in active listening

Question 8

A terminally ill patient tells the nurse that even though the news about his health is not good, he feels less anxious about what to expect. The nurse realizes the conversation held with the patient was:

A) A mechanism to place the patient into denial about his prognosis
B) Not truthful
C) A conversation given to most dying patients to instill hope
D) Helpful in reducing the patient's anxiety and fears

Question 9

The family of a terminally ill patient tells the nurse that there is to be no talk about death in front of the patient. The nurse realizes this family's request would be considered:

A) A barrier to communication
B) A loving gesture to the patient
C) A way for the family and patient to deal with the patient's death
D) A characteristic of their culture

Question 10

The nurse is considering working with patients and families who are near the end of life but does not really know the type of nursing care that is provided. Which of the following would be helpful for her at this time?

A) Take a vacation away from patient care and make the decision during that time
B) Delay making a decision until she has had time to think about it
C) Realize that nursing care is nursing care regardless of the patient's prognosis
D) Attend a conference or educational program about end-of-life patient care

Question 11

Family members of a patient have just learned that the patient is terminally ill and will not recover from the current illness. The nurse sits quietly with them and is seen holding the spouse's hand. Which of the following is this nurse doing?

A) Mourning
B) Grieving
C) Being present
D) Helping the family with conflict

Question 12

A patient diagnosed with cancer tells the nurse that he is "sorry" he completed an advance directive because he would have done it differently today. Which of the following responses can the nurse give to this patient?

A) Let the patient know that he has a long time to worry about his advance directive
B) Ask him what he would do differently if he could
C) Tell him that the advance directive may or may not be followed anyway
D) Inform him that the advance directive can be changed at any time

Question 13

The nurse explains to the terminally ill patient that the medication being given in the IV will remove excess phagocytes from the blood stream, facilitating a normal inflammatory response in his tissues. The nurse's conversation with the patient would be considered as which of the following?

A) An effective explanation
B) A barrier to communication
C) An excellent instructional episode
D) A method to distract the patient

Question 14

While providing morning care to a terminally ill patient, the patient tells the nurse that he would like to return home as soon as possible so that he can die knowing he is in his home, surrounded by his belongings and loved ones. He does not feel comfortable telling the doctor this but knows that the nurse understands. Which of the following does this tell the nurse?

A) The patient will die during the ride back to his home
B) The patient is unrealistic
C) The patient is delusional
D) The nurse has facilitated effective communication with the patient about his end-of-life wishes

Question 15

The wife of a terminally ill patient asks him to tell her about the time when he was in the Marines and thought the enemy was approaching when he realized it was just a herd of deer. The nurse realizes that the spouse is engaging in which of the following activities?

A) Orienting the patient
B) Storytelling as distraction
C) Clarification of the story
D) Helping the patient relive his youth

Question 16

A terminally ill patient is resting and the spouse is sitting quietly alone in the room. Which of the following can the nurse do at this time?

A) Leave the spouse alone to sit quietly
B) Talk with the spouse about the patient's needs and what the nurse can do to help
C) Suggest the spouse return to home to get rest
D) Encourage the spouse to stimulate the patient to keep him as alert as possible

Question 17

The nurse tells the manager that she does not want to care for patients who are near death since she "doesn't handle" those situations very well. Which of the following explains this nurse's request?

A) The nurse does not like the amount of care needed by patients who are nearing the end of life
B) The nurse has not handled or examined her own mortality
C) The nurse is reconsidering her decision to be a nurse
D) The nurse would rather care for patients whose health will improve with nursing care

Question 18

The primary nurse of a terminally ill patient is consoling the family, completing after- death care, and documenting everything that has occurred. Afterwards, she asks for a new patient to replace the one she lost and says that she is caught up with all care needed for her other patients. This nurse's behavior would indicate:

A) Expert nursing care
B) Good organization and management skills
C) Denying the grief associated with losing a patient
D) Good self-care and balance

Question 19

A terminally ill patient has asked that any treatments be eliminated that will not add years to his life since they are just a waste of money and cause him more pain. The nurse realizes that this patient's decision will do which of the following?

A) Shift healthcare spending from the hospital to home
B) Speed up the patient's recovery
C) Reduce healthcare spending and not cause the patient unnecessary pain and suffering
D) Anger the physician and lead to an untimely death