COCN Palliative and End-of-Life Care Flashcards

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?

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

The doctrine of double effect holds that an action intended to relieve suffering is ethical even if death could be an unintended secondary effect.

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:

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

Terminal dehydration reduces secretions and edema, and forced hydration can increase respiratory congestion, nausea, and discomfort at end of life.

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

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

The SPIKES protocol provides a structured, compassionate framework for breaking bad news while assessing patient understanding and providing emotional support.

Cachexia in advanced cancer is characterized by:

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

Cancer cachexia involves complex cytokine-driven catabolism of muscle and fat that cannot be reversed by caloric supplementation alone.

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

Answer: Refer to a grief counselor or bereavement support program

Complicated grief (persistent, impairing bereavement) benefits from specialized bereavement counseling or grief support programs.

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

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

Opioid-induced nausea is primarily mediated through the chemoreceptor trigger zone (CTZ), making dopamine antagonists the targeted first-line treatment.