COCN COCN Palliative and End-of-Life Care 3

Question 1

When a cancer patient's family asks if 'increasing the morphine will hasten death,' the nurse's best response is based on which ethical principle?

Accepted Answer

Doctrine of double effect — the intent is relief of suffering, not hastening death

Answer

Principle of justice — it is unjust to withhold pain relief

Answer

Beneficence only — whatever benefits the patient is acceptable

Answer

Autonomy — the patient decides dose regardless of outcome

Question 2

A patient with stage IV cancer shows signs of imminent death (mottling, Cheyne-Stokes respirations, unresponsive). Family is asking if fluids should be started. The nurse's response should prioritize:

Accepted Answer

Explaining that terminal dehydration is a natural part of the dying process and IV fluids may increase discomfort

Answer

Starting IV fluids to prevent dehydration as a comfort measure

Answer

Requesting aggressive hydration per hospital protocol

Answer

Deferring entirely to the family's wishes without guidance

Question 3

Which communication approach is recommended when delivering bad news to a cancer patient, such as disease progression?

Accepted Answer

SPIKES protocol: Setting, Perception, Invitation, Knowledge, Emotions, Summary/Strategy

Answer

Deliver all information in one session without pause to avoid multiple difficult conversations

Answer

Only share information with the family first to protect the patient

Answer

Use clinical jargon to maintain professional distance

Question 4

Cachexia in advanced cancer is characterized by:

Accepted Answer

Systemic inflammation-driven metabolic changes causing muscle wasting not fully reversible with nutrition

Answer

Reversible weight loss correctable solely with nutritional supplementation

Answer

Appetite loss without muscle catabolism

Answer

Weight loss due solely to reduced caloric intake

Question 5

A nurse notices signs of complicated grief in a family member 2 months after the patient's death. Which referral is most appropriate?

Accepted Answer

Refer to a grief counselor or bereavement support program

Answer

Refer to a nutritionist

Answer

Advise the family to 'give it time' without further intervention

Answer

Recommend the family return to the oncology clinic for a medical evaluation only

Question 6

Nausea in a patient receiving opioids for cancer pain may be best managed by which mechanism-targeted intervention?

Accepted Answer

Dopamine antagonists (e.g., prochlorperazine, haloperidol) targeting the chemoreceptor trigger zone

Answer

Stopping all opioids immediately

Answer

Increasing opioid dose to override the nausea sensation

Answer

Antihistamines only, regardless of cause