End of Life

 

MULTIPLE CHOICE

     1.   Which of the following statements best describes assisted suicide?

a.
It is a form of withdrawal of treatment.
b.
It is a passive process, and the patient is mentally competent.
c.
It is an active process, and the patient is mentally incompetent.
d.
It is an active process, and the patient is mentally competent.

ANS:  D

Correct D: In assisted suicide, active steps are taken to end the life of a debilitated but mentally competent patient who requests this of another person.

Incorrect A: Assisted suicide does not involve a withdrawal of treatment.

Incorrect B: This statement does not accurately describe assisted suicide.

Incorrect C: This statement does not accurately describe assisted suicide.

DIF:    Cognitive level: Comprehension     REF:   p. 251

     2.   Which of the following situations is an example of an ethical dilemma that can arise while the nurse on a medical unit is caring for a terminally ill patient who is near death?

a.
The family wishes that the patient will live longer.
b.
The family requests IV fluids for hydration of the patient.
c.
The family requests administration of narcotics for the patient’s pain relief.
d.
The family refuses to allow the patient’s transfer to a Palliative Care Unit.

ANS:  B

Correct B: Hydrating the patient may create respiratory discomfort, potentially prolonging his or her suffering and postponing death; therefore, this request is an example of an ethical dilemma for the nurse.

Incorrect A: A family’s wish that a terminally ill patient live longer is not unethical and is a normal aspect of grief and loss.

Incorrect C: Administering narcotics prescribed for pain management is not unethical.

Incorrect D: This may conflict with the nurse’s values, but it is not unethical because the patient can still receive palliative care on the medical unit.

DIF:    Cognitive level: Synthesis               REF:   p. 242

     3.   Which of the following activities will help to ensure the dignity of older adult clients, regardless of their capacity?

a.
Use terminology that older adult clients can understand, such as “diapers.”
b.
Engage in conversation with older adult clients about their lives.
c.
Take over control from older adult clients as much as possible to conserve their energy.
d.
Call older adult clients by their first name only.

ANS:  B

Correct B: Engaging in conversation with older adult clients about their lives helps these clients feel valued. Older adults need stimulation and socialization and want to share their stories and to be treated with the respect they have earned throughout their lives.

Incorrect A: Using the term “diapers” is disrespectful and demeaning to older adults.

Incorrect C: Giving older adult clients as much control as possible allows them to feel valued and helps to ensure their dignity.

Incorrect D: Calling older adult clients by their first name may be disrespectful, depending on the clients’ culture and background. If the nurse is unsure, it is more appropriate to use their entire name, or family name only.

DIF:    Cognitive level: Synthesis               REF:   p. 247

     4.   Euthanasia and assisted suicide are illegal in Canada due to the ethical principle of the sanctity of life. In light of this, which other ethical principle might be in conflict for nurses who work with dying patients?

a.
Autonomy
b.
Veracity
c.
Informed choice
d.
Responsibility and accountability

ANS:  A

Correct A: Autonomy is the right of individuals to make decisions that affect their lives. Some patients might request assisted suicide if it were available, and in such cases the ethical principle of autonomy would conflict with the principle of the sanctity of life.

Incorrect B: Veracity is the duty to tell the truth. This ethical principle is central to ensuring trust within the nurse–patient or nurse–client relationship but would not likely be in conflict for nurses working with the dying.

Incorrect C: Informed choice is not an ethical principle.

Incorrect D: Responsibility and accountability is a professional standard, not an ethical principle.

DIF:    Cognitive level: Synthesis               REF:   p. 253

     5.   The nurse administers larger and larger doses of narcotics prescribed for pain control, which hastens the terminally ill patient’s death. In which of the following acts has the nurse participated?

a.
Euthanasia
b.
Assisted suicide
c.
Passive euthanasia
d.
Withdrawal of treatment

ANS:  C

Correct C: Passive euthanasia is generally accepted as a potential result of narcotic administration in palliative care. It is not “active,” as death is the result of the effects of the necessary medications.

Incorrect A: Euthanasia, or “painless death,” is an act that brings about the immediate death of a terminally ill patient; this does not describe what this nurse is doing.

Incorrect B: In assisted suicide, active steps are taken to end the life of a debilitated but mentally competent patient who requests this of another person; this is not what this nurse is doing.

Incorrect D: In withdrawal of treatment, nothing active is done to end the patient’s life; rather, all life-sustaining treatment is withdrawn, and death is allowed to occur through natural processes. This does not describe what this nurse is doing.

DIF:    Cognitive level: Analysis                REF:   p. 258

     6.   The nurse decides not to raise the issue of organ donation with a patient’s family because of fear of interfering with the grieving process. Which of the following statements describes how this nurse is acting?

a.
The nurse is acting in the best interests of the family.
b.
The nurse is acting in the best interests of the patient.
c.
The nurse is being disrespectful of the patient’s autonomy.
d.
The nurse is acting this way because she knows the patient’s organs are unsuitable.

ANS:  C

Correct C: The nurse is being disrespectful of the patient’s autonomy. By avoiding the topic of organ donation, the nurse is making the decision for the patient not to donate.

Incorrect A: This nurse is not acting in the best interests of the family.

Incorrect B: This nurse is not acting in the best interests of the patient.

Incorrect D: There is not enough information in this scenario to know if the patient’s organs are suitable or not.

DIF:    Cognitive level: Analysis                REF:   p. 266

     7.   Which of the following approaches is the best way to increase the number of potential organ donors?

a.
The nurse should approach all patients who are admitted through a hospital Emergency Ward and ask them about organ donation.
b.
The nurse should wait until the patient is settled in an inpatient unit before asking about organ donation.
c.
The nurse should only ask the families of dying patients in an Intensive Care Unit about organ donation.
d.
The nurse should provide organ donor information to patients who are discharged from the hospital.

ANS:  D

Correct D: This is the best approach for the nurse to take, as education, communication, and awareness will help individuals to make informed decisions about available donation options.

Incorrect A: This is not the best approach, because patients presenting in the Emergency Room are often highly anxious due to the urgent nature of their health status, and this stress can compromise their ability to make autonomous decisions based on informed choice.

Incorrect B: This is not the best approach, because inpatients may be highly stressed and dealing with uncertainty, which compromises their ability to make autonomous decisions based on informed choice.

Incorrect C: In some cases, this may result in an actual organ donation, but this approach does not increase the number of potential organ donors overall.

DIF:    Cognitive level: Synthesis               REF:   p. 264

     8.   Which of the following people can make the decision to donate postmortem tissue?

a.
The nurse on duty at the time of the patient’s death
b.
The patient’s spouse
c.
The physician
d.
The funeral director

ANS:  B

Correct B: There is a hierarchy of persons who may be approached to make this decision. The patient’s spouse would be asked first, followed by the patient’s adult children (if there is no spouse), then either of the patient’s parents or legal guardian, then siblings, then next of kin, and if none of these is available, anyone who is in lawful possession of the body can make the decision to donate.

Incorrect A: Tissue donation must occur soon after death, so often the nurse is involved in the suggestion, process, or coordination of the donation. However, the nurse does not make the decision to donate.

Incorrect C: Tissue donation must occur soon after death, so often the physician is involved in the suggestion, process, or coordination of the donation. However, the physician does not make the decision to donate.

Incorrect D: The funeral director has nothing to do with this decision.

DIF:    Cognitive level: Analysis                REF:   p. 277

TRUE/FALSE

     1.   The daughter of a patient in the nurse’s care states that her mother has verbally expressed her wishes for treatment. This is an example of an advance directive or living will.

ANS:  T

Correct: An advance directive or living will is a person’s instructions regarding decisions about care if she is ever rendered incompetent. Advance directives can be made either verbally or in writing.

Incorrect: This statement is true.

DIF:    Cognitive level: Knowledge            REF:   p. 239

     2.   When discussing the condition of a terminally ill patient with his family members, the terminology “Do Not Resuscitate” should never be discussed and offered, because the family may think it means “do nothing.”

ANS:  F

Correct: The terminology “Do Not Resuscitate” can be interpreted by families as meaning “do nothing,” and this can put a burden of guilt on families when they are asked to make this decision on behalf of an incapable family member. However, this choice should still be discussed with the patient’s family at an appropriate time. Framing the decision around whether to allow a “natural death” can help relieve some of the burden on the family.

Incorrect: This statement is false.

DIF:    Cognitive level: Analysis                REF:   p. 241

     3.   For nurses, an ethical dilemma is resolved when a seriously brain-injured child, who is now brain dead, is removed from life support.

ANS:  F

Correct: The world of the dying child is extremely emotional and presents highly complex moral and ethical challenges for the nurse. The nurse may find his personal or professional values are in conflict with the values of the family. Ethical dilemmas are not necessarily resolved through a death or the removal of a situation; moral distress may linger long after the child has passed away.

Incorrect: This statement is false.

DIF:    Cognitive level: Synthesis               REF:   p. 245

     4.   The nurse is working with a dying patient and his family. The nurse should incorporate cultural factors into the evaluation of care.

ANS:  F

Correct: Cultural factors should be built into all aspects of care, not just the evaluation phase. The nurse should incorporate cultural considerations into the overall initial assessment, so that they form part of the plan and implementation, as well as the evaluation. The nurse’s attention to such needs can improve the quality of the dying process and constructively influence the ensuing bereavement.

Incorrect : Cultural considerations should be built into all aspects of care, not just the evaluation phase.

DIF:    Cognitive level: Application           REF:   p. 247

     5.   Euthanasia means that all life-sustaining treatment is withdrawn.

ANS:  F

Correct: Euthanasia, or “painless death,” is an act that brings about the immediate death of a terminally ill patient. In withdrawal of treatment, nothing active is done to end the patient’s life; rather, all life-sustaining treatment is withdrawn, and death is allowed to occur through natural processes.

Incorrect: This statement is false.

DIF:    Cognitive level: Analysis                REF:   p. 250