1. A 68-year-old patient with metastatic lung cancer expresses hopelessness and states, "I'm just a burden." Their spouse tearfully reports avoiding discussions about prognosis. The patient's PHQ-9 score is 18. Which intervention best addresses both parties' immediate psychosocial needs?
Answer: A
A family meeting addresses both the patient's expressed hopelessness (PHQ-9 indicating depression) and the spouse's avoidance by creating a safe space for shared communication, aligning with NCP guidelines for concurrent patient-family support. Option B addresses symptoms but fragments care and ignores relational dynamics. Option C is passive and doesn't leverage therapeutic interaction. Option D separates interventions, missing the opportunity for mutual understanding. The cues (PHQ-9, spouse's avoidance, "burden" statement) indicate intertwined needs requiring integrated intervention.
2. A patient with metastatic cancer and severe pain requests hospice consultation but the family insists on continued curative treatment. Which documentation approach reflects appropriate care coordination?
Answer: A
Option A initiates timely interdisciplinary resolution of conflicting goals, prioritizing patient autonomy while engaging family and specialists. Option B addresses symptom management but ignores the ethical dilemma. Option C escalates prematurely before team-based mediation attempts. Option D explores hospice unilaterally despite family opposition. CMSRN guidelines emphasize documenting steps to reconcile care disagreements through team conferences before ethics consultation. Recording the scheduled meeting ensures accountability for resolving this coordination challenge.
3. An oncology patient with oral mucositis from chemotherapy rates pain at 8/10 and consumes <25% of meals. Which intervention addresses both malnutrition and symptom management?
Answer: B
Oral strategies are preferred for mucositis. Option B directly reduces pain (discriminating cue: 8/10 pain) enabling oral intake. Option A is invasive for temporary mucositis. Option C risks infection when GI function exists. Option D neglects nutrition needs. MASCC guidelines prioritize symptom control for oral intake over artificial nutrition unless severe malnutrition persists.
4. A nurse receives report on a patient with ovarian cancer who refused antidepressants. During assessment, the patient whispers, "I saved my pain pills." They have no suicide contract. Which action takes precedence?
Answer: A
The statement indicates hoarding of lethal means, creating imminent risk that must be addressed before further assessment. Option B is premature without confirming current intent. Option C addresses pain management but ignores acute safety threats. Option D delays securing means. CMSRN protocols prioritize removing accessible lethal methods immediately when hoarding is suspected, as this is a key risk factor for completed suicide.
5. A cancer patient receiving hospice care moans during movement. Family declines opioids fearing sedation. Which advocacy approach is best?
Answer: C
This addresses misconceptions through interdisciplinary education while respecting decision-makers, per hospice ethics. Option A accepts preventable suffering. Option B bypasses informed consent. Option D violates autonomy. Effective advocacy involves clarifying options, not overriding surrogate decisions.
6. A 50-year-old construction worker with Fitzpatrick skin type I requests sun protection advice after his father's melanoma diagnosis. Which primary prevention strategy addresses his occupational exposure and genetic risk?
Answer: C
Primary prevention reduces UV exposure before damage occurs. Option C offers practical, occupational-specific protection (cue: construction worker) with sunscreen/clothing, addressing familial risk (cue: father's melanoma). Option A/B are secondary prevention (screening), not primary. Option D's limited shade-seeking ignores continuous outdoor exposure in construction. Skin Cancer Foundation guidelines prioritize sun-protective gear and correct sunscreen use (including reapplication) for high-risk outdoor workers over sole reliance on screening.
7. A Filipino family requests "no bad news" for their mother with metastatic cancer, fearing it will hasten her death. The patient asks, "Am I getting better?" How should the nurse respond?
Answer: C
Assessing understanding (C) navigates autonomy and cultural concerns by eliciting the patient’s perspective first. Vague reassurance (A) deceives. Full disclosure (B) ignores cultural/family dynamics. Consulting family first (D) violates patient-centered communication. AMSN protocols emphasize assessing readiness before information-sharing.
8. A healthy 42-year-old transgender male (assigned female at birth) who had a total hysterectomy for gender affirmation 5 years ago asks about cervical cancer screening. He has no history of cervical dysplasia. Which action follows ACS guidelines?
Answer: C
ACS guidelines state cervical screening isn't needed after total hysterectomy (with cervix removal) unless there's history of high-grade precancer. Transgender status doesn't alter this. Option A inappropriately screens based on gender identity rather than anatomy. Option B ignores that screening is asymptomatic. Option D applies only to those with intact cervixes. The patient's hysterectomy and absence of dysplasia meet discontinuation criteria.
9. A patient with metastatic cancer and chronic pain is transitioning to home hospice. The spouse reports exhaustion from caregiving. Which discharge component best supports family-centered care?
Answer: C
The spouse's exhaustion threatens care continuity. Regular respite (C) prevents caregiver burnout while maintaining home care. Pain techniques (B) and equipment (D) benefit the patient but ignore the caregiver's crisis. On-call support (B) addresses emergencies but not chronic fatigue. Supporting caregiver capacity is essential in hospice per CMSRN palliative care standards.
10. A 78-year-old with metastatic pancreatic cancer and severe dementia becomes unresponsive. The patient's advance directive states "no life-sustaining treatment," but the daughter insists on intubation, stating, "I promised Mom I'd fight for her." The healthcare team recommends comfort care. Which action aligns with ethical principles?
Answer: C
The advance directive represents the patient's autonomous wishes, taking precedence under ethical principles of autonomy and self-determination. Option C respects this while avoiding non-beneficial treatment (non-maleficence). Option A disregards the patient's documented wishes. Option B delays ethically mandated care and may prolong suffering. Option D inappropriately prioritizes family consensus over legal documents. AMSN guidelines emphasize honoring advance directives unless revoked, especially when decisional capacity is absent.
11. A Buddhist patient with terminal cancer declines opioids due to belief that clear-mindedness aids rebirth. Pain escalates to 9/10. The daughter pleads, "Give medication secretly." How should the nurse respond?
Answer: C
Option C respects autonomy while addressing pain through ethically permissible alternatives. Option A violates trust and informed consent. Option B ignores the nurse's duty to alleviate suffering within patient-defined limits. Option D still breaches the explicit refusal of opioids. AMSN standards require honoring cultural/religious values while exploring acceptable symptom management. Non-pharmacological options (e.g., positioning, massage) align with beneficence without overriding autonomy.
12. A 62-year-old patient with newly diagnosed stage III colon cancer, limited English proficiency, and no personal transportation expresses feeling overwhelmed by upcoming chemotherapy appointments and insurance paperwork. Which interprofessional action by the medical-surgical nurse best addresses immediate barriers to care coordination?
Answer: C
Patient navigators specialize in overcoming systemic barriers like transportation, language, and insurance navigation, which are prominent here. While education (A) is important, it doesn't resolve logistical hurdles. Telehealth (B) addresses clinical concerns but not the expressed overwhelm about appointments/paperwork. Community resource education (D) is incomplete without active coordination. Navigators provide personalized support aligning with AMSN's focus on reducing care fragmentation through interprofessional collaboration for complex cases.
13. A patient receiving IV chemotherapy has Braden score 16 but nutrition subscore 2. The nurse notes oral mucositis and 5% weight loss. Which action integrates Braden subscale data?
Answer: B
Nutrition subscore 2 with mucositis/weight loss indicates protein-calorie malnutrition despite acceptable total score. Option B targets the specific deficient subscale. Option A addresses mucosal integrity but not systemic nutrition. Option C focuses on sensory issues (subscore 4—unchanged). Option D is unwarranted with adequate mobility/friction subscores. Malnutrition directly compromises tissue tolerance per Braden Scale guidelines, requiring nutritional intervention before pressure injuries develop.
14. During admission screening, an elderly patient with metastatic cancer scores positive on the ASQ tool, stating, "I won't be a burden much longer." Their spouse reveals hidden medication hoarding. What is the nurse's priority environmental action?
Answer: B
ASQ positivity + explicit burden statement + means access (hoarded meds) meets high-risk criteria. Securing medications prevents self-poisoning, the most common elderly suicide method per CDC. Option A may increase isolation. Option C is less urgent than removing lethal means. Option D addresses jumping risk, but medication access is more imminent. Distractors ignore the specific cue of hoarded pills.
15. A 72-year-old patient with metastatic lung cancer receiving home hospice care develops new Cheyne-Stokes respirations and periods of apnea lasting 15 seconds. Vital signs show BP 84/50 mmHg, irregular pulse 112/min, and SpO₂ 88% on room air. The patient is unresponsive to verbal stimuli but withdraws from pain. Which assessment finding most specifically indicates imminent death within hours?
Answer: B
Prolonged apnea with absent brainstem reflexes (e.g., corneal, pupillary) is a cardinal sign of imminent death, reflecting brainstem shutdown. Option A is common in respiratory distress but reversible with oxygen. Option C indicates shock but may occur days before death. Option D suggests neurological impairment but not necessarily imminent demise. Hospice guidelines prioritize brainstem reflex loss over vital sign changes for predicting death within hours, as cardiopulmonary changes often precede neurological signs.
