Question 1

A terminally ill patient asks his family to leave the room while the nurse provides his "liquid lunch." The nurse realizes that the patient is considering the tube feeding as being:

Accepted Answer

Artificial nutrition and hydration is not the same thing as eating and drinking naturally. The patient does not want his family to watch the procedure and asks them to leave. Many patients view tube feedings as medical procedures rather than meals, so it might be best to ask the family to leave and not observe. The patient most likely is not going to enjoy receiving the tube feeding. The patient may or may not want his family to leave but asks because of the timing of the tube feeding. The patient may or may not want his family to realize that he is getting fed. There is not enough information to make this determination at this time.

Question 2

The wife of a terminally ill patient tells the nurse that she is "sorry" that they started tube feedings since it seems now that he will be dependent on them for the rest of his life. The nurse should respond with which of the following?

Accepted Answer

Tube feedings in a terminally ill patient can be conducted on a trial basis. The tube feedings can be discontinued if it is proven that they are not helping or are actually hurting the patient. The nurse should not tell the wife that someone should have explained that the tube feedings will go on indefinitely. The nurse may or may not have to instruct the wife on how to administer the tube feedings. The nurse should also not explain that the tube feedings are better for the patient and that they always improve health since this is a false statement.

Question 3

The physician of a terminally ill patient suggests that the time-limited trial of artificial hydration and nutrition be stopped since the patient's status has not improved. Which of the following does this suggest to the nurse?

Accepted Answer

Like any other treatment, if there is no improvement in the patient's condition and no clinical evidence that positively affects the patient's comfort level or increases the quality of life, then there is no reason to continue the therapy. The physician is not trying to kill or starve the patient. The physician does not want the patient to die more quickly by discontinuing food and fluids.

Question 4

The daughter of a terminally ill patient is upset and asks the nurse "what are you doing for my father, since you aren't even giving him anything to eat or drink?" The nurse realizes that the family member is equating foods and fluids with:

Accepted Answer

Eating and drinking represent basic enjoyment in life and are often associated with social activities. Eating and drinking offer opportunities for nurturing and being nurtured; however, could have different goals. Eating and drinking may be for nourishment or for pleasure. Because there is no way of knowing what eating and drinking means to the patient or family member, the lack of food or fluids can lead to distress in family members. The family member may or may not equate the lack of food or fluids with poor care. The lack of food or fluids may or may not mean to the family member that the patient is being encouraged to die. There is not enough information to determine if the family member believes that the patient is so ill that eating or drinking would be futile.

Question 5

A patient diagnosed with cancer is unable to eat because of painful mouth sores. The nurse realizes that which of the following might be helpful for this patient?

Accepted Answer

For some patients, artificial hydration and nutrition have the benefit of prolonging life and preventing wasting, emaciation, or cachexia, as well as weight loss in stable patients. The patient is diagnosed with cancer; however, it is not certain at this time if his condition is terminal. Therefore, artificial hydration and nutrition would be indicated for this patient. Beginning natural anorexia or terminal dehydration might be premature. Keeping the patient on nothing-by-mouth status until the sores heal would be a form of terminal dehydration or natural anorexia and should not be done.

Question 6

The healthcare team is planning to meet with the family of a terminally ill patient to discuss continuing or discontinuing hydration and nutrition. Which of the following should be included in this discussion?

Accepted Answer

There are several considerations that need to be discussed when deciding hydration and nutrition at the end -of life. The first is the patient's physical condition and prognosis. The other choices are not considerations and should not be discussed by the healthcare team with the patient's family.

Question 7

A patient tells the nurse that since he stopped eating, he does not feel nauseated and can actually breathe better. The nurse realizes the patient is describing:

Accepted Answer

Refusing food and drink has been identified as the last phase of a terminal condition. Natural anorexia, or the refusal to eat, is associated with less nausea and vomiting and less exertion to chew, swallow, and breathe. There is not enough information to determine if the patient is experiencing delirium. Terminal dehydration is the natural loss of thirst. Xerostomia is a dry mouth.

Question 8

A terminally ill patient is receiving tube feedings. When the meal tray for the roommate arrives, the patient says "that smells so good. I wish I could eat something." Which of the following should the nurse do?

Accepted Answer

The patient is stating that the smell of the food is good and he desires to eat something. The best response is to ask the patient if he is hungry or thirsty. Receiving tube feedings does not remove the natural desire for the pleasure associated with eating and drinking normally. The patient realizes that he is getting fed through the tube and the nurse explaining it to him will not take the desire for food away. The nurse has no way of knowing if the patient's desire for food will pass. Saying that the hospital meals are not that great also will not take away the patient's desire for food.

Question 9

Around-the-clock tube feedings have been discontinued for a terminally ill patient. The family is concerned that death will occur faster without nutrition. Which of the following might be appropriate ways for the nurse to respond to the family?

Accepted Answer

At times, implementing artificial nutrition and hydration can be seen as harmful to the patient and could cause greater harm than death itself. The best response would be to explain how the feedings were hurting the patient more than helping and that they have been stopped for now. The nurse should not say that the patient is fading fast and that nutrition prolongs the agony. Tube feedings would not be stopped if a patient stated a lack of feeling hungry. The patient is terminal and was receiving tube feedings. It is highly unlikely that the patient is going to be started on a regular diet.

Question 10

A terminally ill patient asks to be provided with artificial nutrition for a few months to see if he can regain his strength. Which of the following should the nurse do to support this patient?

Accepted Answer

The patient is asking for a time-limited trial of artificial hydration and nutrition. The nurse should support this request. The nurse should not suggest that the patient is prolonging the agony and could have a more painful death. Time-limited trials of artificial hydration and nutrition can be stopped, and can be provided for longer than one month.

Question 11

A patient with a terminal illness is receiving continuous tube feedings through a pump. The nurse assesses that the patient is becoming progressively weaker and suspects which of the following is occurring with the patient?

Accepted Answer

One risk or burden of artificial hydration and nutrition for patients who are at the end of life is that of decreased mobility because of being attached to equipment and machines... The reduction in activity could be causing the patient to become weaker. There is not enough information to determine if the tube feeding is not providing enough calories for the patient. There is no way of knowing if the patient's illness is becoming worse. There is also not enough information to determine if the patient's tube feeding should be stopped and the patient permitted to begin natural anorexia.

Question 12

A terminally ill patient tells the nurse that though he has no appetite and is fatigued after he eats, the food does give him more energy. The nurse realizes that this patient might consider which of the following?

Accepted Answer

Even though eating fatigues the patient, he states an improvement in energy level after eating. Because of this, he might consider artificial hydration and nutrition to reduce the fatigue associated with eating. Natural anorexia, terminal dehydration, and voluntarily stopping of eating and drinking would not be choices at this time.

Question 13

A terminally ill patient receiving tube feedings has developed a productive cough and increasing shortness of breath. Which of the following should the nurse do?

Accepted Answer

The patient is demonstrating signs of aspiration by a productive cough and increasing shortness of breath. The nurse should stop the tube feeding, raise the head of the bed, and report the patient's status. There is an increased risk of aspiration with tube displacement in the patient who is terminally ill. The nurse should not lower the patient's head of the bed. The tube feedings should be stopped but the head of the bed should be kept elevated. The nurse should not continue the feedings with the head of the bed lowered. The rate of the tube feedings should not be slowed; rather, the tube feeding should be stopped.

Question 14

A terminally ill patient receiving tube feedings tells the nurse that he "misses" having a cup of coffee. The nurse realizes that the patient is describing which of the following?

Accepted Answer

The patient is terminally ill and receiving tube feedings. When being provided with artificial nutrition and hydration, the patient may miss the basic enjoyment or pleasure that eating and drinking "normally" used to provide. Since the patient is receiving fluid-based nutrition, this statement most likely does not mean that the patient is requesting fluids. The patient may or may not like the flavor of coffee. It is uncertain whether the caffeine in the coffee provided stimulation or if the patient is missing that aspect of having coffee.

Question 15

A terminally ill patient tells the nurse that he has had a good life, would like to die in peace, and does not want any more food or fluids. The nurse realizes that which of the following has occurred with this patient?

Accepted Answer

The patient has told the nurse that he had a good life and wants to die in peace. The patient also said that he does not want any more food or fluids. He has made an autonomous decision that needs to be supported by the nurse and healthcare team. There is no evidence to support a lack of oxygen, fluid volume deficit, or hepatic failure.

Question 16

A terminally ill patient wants to stop all foods and fluids but the family is trying to dissuade him from this decision. Which of the following can be done to help the family and patient?

Accepted Answer

The family is concerned that the patient's decision to stop eating and drinking will hasten his death. The nurse needs to support the patient's decision and talk with the family about the advantages of voluntarily stopping eating and drinking. The nurse should not falsely ensure the family that the patient will continue to receive intravenous fluids since there is not enough information to support this. Nor should the nurse falsely tell the family that the patient will most likely not stop eating and drinking. There is no way of knowing if the patient will start eating again in a day or two.

Question 17

A terminally ill patient says that he feels better when he does not drink fluids. The nurse realizes that which of the following is occurring with this patient?

Accepted Answer

The patient is terminally ill and tells the nurse that he feels better when he does not drink fluids. This could mean that the lack of fluids is reducing the amount of pain the patient is experiencing. There is no way of knowing if the patient is confused. The lack of fluids would reduce edema and not reduce the need to drink fluids. The patient is refusing fluids and is most likely also refusing to eat food.

Question 18

The family of a terminally ill patient is upset that the patient is no longer receiving intravenous fluids or tube feedings and believes that the hospital is "trying to kill" the patient. Which of the following should be done to assist this family?

Accepted Answer

The family is upset because it appears the patient is being "killed" by not being given fluids or food. The family should be advised of the benefits that anorexia and terminal dehydration have on the patient's comfort. The family should not be reminded that the patient is terminal and that food or hydration is futile at this time. The lack of food or fluids will not impact the amount of care the patient receives. The family should also not be told that the lack of food or fluids is short term and that they will be restarted in a few days since there is no way of knowing if this will be done.

Question 19

The family of a terminally ill patient who has voluntarily stopped eating and drinking asks the nurse how long the patient will survive without food of fluids. Which of the following responses should the nurse give to the family?

Accepted Answer

Following the cessation of continuing nutrition and hydration, death generally occurs in one to three weeks, though the family should be informed that it may take longer. The other choices are incorrect and should not be provided to the family.

Quiz 6: Hydration and Nutrition at the End of Life