The nurse should respect the mother’s request and facilitate the family’s emotional needs during the end-of-life care. The nurse should also ensure the patient’s safety and dignity by preparing and organizing the necessary equipment and monitoring before moving the mother next to the patient. The other options are not appropriate because they either deny the mother’s request, imply that the patient is no longer alive, or delay the organ donation process.

References:

• Donor Family Care Service - NHS Blood and Transplant
• Family-Centered Care to Improve Family Consent for Organ Donation

Pulmonary hypertension leads to increased pressure in the pulmonary circulation, which can cause right ventricular hypertrophy and failure. This results in systemic venous congestion, presenting as distended neck veins. Crackles, rhonchi, and pink frothy sputum are more indicative of pulmonary edema or other respiratory conditions rather than pulmonary hypertension. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

A negative apnea test means that the patient does not breathe spontaneously when disconnected from the ventilator and exposed to a high level of carbon dioxide, which normally stimulates breathing. A negative apnea test is one of the criteria for brain death, as it indicates the loss of brainstem function. A positive vestibulo-ocular reflex, also known as the oculocephalic or doll’s eye reflex, means that the eyes move in the opposite direction of the head when the head is turned. A positive cough reflex means that the patient coughs when the trachea is stimulated. A negative cold caloric test means that the eyes do not move when cold water is injected into the ear canal. All these tests assess the integrity of the brainstem, and a positive result would exclude brain death. Therefore, the correct answer is B.

References:

• Diagnosis of brain death - UpToDate, under “Apnea testing”.
• Brain Death | Critical Care Medicine | JAMA | JAMA Network, under “How Is Brain Death Diagnosed?”.
• The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by …, under “Apnea Testing”.

Left shoulder pain, also known as Kehr sign, is a sign of splenic injury and diaphragmatic irritation. It is caused by the irritation of the phrenic nerve, which innervates both the diaphragm and the shoulder, by blood or other fluids in the left upper quadrant. Tachypnea, flank pain, and hiccoughs are not specific signs of splenic injury or diaphragmatic irritation.

References:

• Splenic trauma | Radiology Reference Article | Radiopaedia.org
• Recognition and management of diaphragmatic injury in adults
• Reference Guide for CCRN (Adult), page 14.

Asking the patient to explain what furosemide (Lasix) does for them assesses their understanding and allows the nurse to gauge their knowledge and correct any misconceptions. This method is more effective than asking yes/no questions, as it provides a comprehensive insight into the patient's medication literacy. References: = AACN Handbook for CCRN Certification, pp. 102-105.

A patient with acetaminophen overdose is at risk for acute liver failure, which can lead to coagulopathy. This condition is often marked by an increased International Normalized Ratio (INR) due to impaired synthesis of clotting factors in the liver. Decreasing level of consciousness can also result from hepatic encephalopathy, a complication of liver failure. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

The nurse’s best response is to explore the patient’s reasons for the request and understanding of potential consequences, as this demonstrates respect for the patient’s autonomy and dignity, as well as provides an opportunity to assess the patient’s decision-making capacity, goals of care, and preferences for end-of-life care. The nurse should also provide emotional support, education, and symptom management to the patient and family. Advocating with the care team for a withdrawal of treatment plan, encouraging the patient to continue with current medications and attempts to wean, or referring the patient’s request to the healthcare facility’s ethics committee for review are not appropriate responses, as they may undermine the patient’s right to self-determination, impose the nurse’s own values or beliefs, or delay the implementation of the patient’s wishes.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 19.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
• AACN. (2020). Practice Recommendations for End-of-Life Care in the Intensive Care Unit. Retrieved from [Practice Recommendations], p. 14-15.
• NICE. (2019). End of life care for adults: service delivery. Retrieved from [NICE Guidance], p. 4.