Gerontology Mastery Ronald-Librando PDF

Ronald Allan Librando Gerontology Mastery Mam Joji Castellano
1. An elderly woman told her daughters that if she ever ended up with dementia she wouldn't want to
live like that. Years later she developed senile dementia and her daughters had her move into a nursing
home. Although she did not recognize family or friends, she enjoyed the company of others and the
nursing home's cat. When she stopped eating, her daughters were asked whether she should receive a
feeding tube.
a.The daughters may approve the insertion of a feeding tube with the proviso that future triggers could
lead to its removal or nonuse.
b.The daughters should consider their mother’s previously stated wishes as an advance directive and
must not place a feeding tube.
c.The daughters cannot decide for their mother because of lack of both a power of attorney for health
care and an advance directive.
d.Before placing a feeding tube, the daughters should obtain a court order.
2. A patient who has coronary artery disease and congestive heart failure shows his nurse his advance
directive that states he wants to receive cardiopulmonary resuscitation and other forms of life-
sustaining treatment has deeply held beliefs that suggest that not trying to live is tantamount to
committing suicide. What should the nurse do and say to the patient in response to this?
a.The nurse should educate the patient about the near futility of CPR under these circumstances.
b.The nurse might want to ask the patient to explore this further with the chaplain.
c.The patient's expression of a preference should be explored to understand its origins.
d.All the above.
3. A patient tells his family that he would never want to be "kept alive like a vegetable". The term
"vegetable" should be understood by the nurse to mean:
a.The patient does not want any heroics or extraordinary treatments.
b.Pull the plug if the patient is ever in terminal state on a respirator.
c.If the patient is in a comatose state, let him die.

d.The nurse should interpret the term as vague and not helpful in advance care planning discussions
unless it is clarified.
4. An elderly man with end-stage emphysema presents to the emergency room awake and alert and
complaining of shortness of breath. An evaluation reveals that he has pneumonia. His condition
deteriorates in the emergency room and he has impending respiratory failure, though he remains awake
and alert. A copy of a signed and witnessed living will is in his chart stipulates that he wants no
"invasive" medical procedures that would "serve only to prolong my death." No surrogate decision
maker is available.
Should mechanical ventilation be instituted?
a.The presence of a living will or other advance directive obviates the responsibility to involve a
competent patient in medical decision making.
b.If the patient has remained awake and alert, his living will is irrelevant to medical decision making.
c.The potential risks and benefits of mechanical ventilation need not be presented to patient because of
the presence of a valid living will.
d.Even if the patient refuses mechanical ventilation therapy, his wishes need not be honored because
he is in the emergency room.
5. The same patient described in Question #4 presents confused and somnolent. A copy of a signed and
witnessed living will is in his chart stipulates that he wants no "invasive" medical procedures that would
"serve only to prolong my death." No surrogate decision maker is available.
Should mechanical ventilation be instituted?
a.Mechanical ventilation should NOT be instituted because it serve only to "prolong death" in this
patient.
b.Mechanical ventilation should be instituted because of the intent of the directive in the living will is
evident.
c.Mechanical ventilation should be instituted because the patient’s pneumonia represents a potentially
reversible condition from which the patient may recover fully.
d.The living will is NOT a helpful guide to mechanical ventilation decision-making in this patient.

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Ronald Allan Librando Gerontology Mastery Mam Joji Castellano

c.The patient's expression of a preference should be explored to understand its origins.

d.All the above.

a.The patient does not want any heroics or extraordinary treatments.

b.Pull the plug if the patient is ever in terminal state on a respirator.

c.If the patient is in a comatose state, let him die.

Should mechanical ventilation be instituted?

Should mechanical ventilation be instituted?

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