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NURSING 303Critical Care Nursing Ch 4

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Chapter 4: End-of-Life Care in the Critical Care Unit Test Bank MULTIPLE CHOICE 1. A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated. The patient is on a continuous morphine infusion and has an additional order for lorazepam (Ativan) 1 to 2 mg IV as needed (prn). The patient has received no lorazepam (Ativan) during this course of illness. What is the most appropriate nursing intervention to control agitation? a. Administer fentanyl (Duragesic) 25 mg IV bolus. b. Administer lorazepam (Ativan) 1 mg IV now. c. Increase the rate of the morphine infusion by 50%. d. Request an order for a paralytic agent. ANS: B Lorazepam (Ativan) 1 mg IV is an appropriate loading dose for a patient who is benzodiazepine naïve and experiencing agitation during withdrawal of life support. Fentanyl treats pain and morphine controls pain. Paralytic agents are not warranted. DIF: Cognitive Level: Analysis REF: Figure 4-1 OBJ: Describe nursing interventions to support the patient and family during the end-of-life stage. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 2. A 75-year-old patient, who suffered a massive stroke 3 weeks ago, has been unresponsive and has required ventilatory support since the time of the stroke. The physician has approached the spouse regarding placement of a permanent feeding tube. The spouse states that the patient never wanted to be kept alive by tubes and personally didn’t want what was being done. After holding a family conference with the spouse, the medical team concurs and the feeding tube is not placed. This situation is an example of: a. euthanasia. b. palliative care. c. withdrawal of life support. d. withholding of life support. ANS: D Because the tube feeding had not been placed in the care of this patient, this scenario is an example of withholding of life support. Withholding of life support does not constitute euthanasia. Withdrawal of life support involves discontinuation of previously established therapies in a terminally ill patient. DIF: Cognitive Level: Analysis REF: p. 40 OBJ: Discuss concepts of end-of-life care, including palliative care; communication and conflict resolution; withholding or withdrawing therapy; and psychological support of the patient, family members, and healthcare providers. TOP: Nursing Process Step: Planning MSC: NCLEX: Safe and Effective Care Environment 3. What were the findings of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)?

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