Deck 27: Assessing the Dying Patient

Question 1

The nurse is providing care to a patient who is terminally ill with lung cancer. During the administration of the prescribed chemotherapy the patient states, "I am ok with this diagnosis as long as I get to see my daughter graduate from college at the end of the month." Based on this data, which coping mechanism is the patient using?

A) Isolation
B) Denial
C) Depression
D) Bargaining

Answer 1

Bargaining

Question 2

The nurse is providing care to a terminal patient who states, "I wonder if my faith is strong enough to allow me to go to heaven." Which stage of Kubler-Ross' grieving process is the patient experiencing?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Answer 2

Stage II

Question 3

Which healthcare provider typically initiates a do-not-resuscitate discussion with a patient who is terminally ill?

A) Chaplain
B) Social worker
C) Physical therapist
D) Nurse

Answer 3

Nurse

Question 4

The nurse is providing care to a patient who is diagnosed with terminal cancer. The patient states, "I am going to get another opinion. I don't feel like I am going to die." Based on this data, which stage of the grieving process is the patient experiencing?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Question 5

The nurse is providing care to a patient with terminal breast cancer. The nurse enters the patient's room and finds that the patient is crying and asking, "Why me? Why is God doing this to me?" Based on this data, which coping mechanism is the patient exhibiting?

A) Denial
B) Isolation
C) Anger
D) Depression

Question 6

The family member of a terminal patient asks, "Why doesn't my mom speak to us anymore? She just gestures for us to come hold her hand. What is going on?" Based on this data, which response by the nurse is most appropriate?

A) "Your mom is losing her ability to talk. That is why she is using gestures."
B) "I think your mom would really prefer to die alone."
C) "Your mom has entered the stage of acceptance. She wants to be close to her family and feel your touch."
D) "I am not sure what you mom is experiencing. It could be that she is not coherent anymore. Do you want me to call the doctor?"

Question 7

The nurse is providing care to a patient who is diagnosed with terminal liver cancer. The patient does not talk much but has asked family members to hold her hand when visiting. Which stage of Kubler-Ross' grieving process is the patient experiencing?

A) Depression
B) Bargaining
C) Acceptance
D) Isolation

Question 8

The nurse educator is teaching a group of students about death. Which statement regarding how death is viewed in the United States is accurate?

A) "Death means that the days are numbered."
B) "Death means that a bad spell has been cast."
C) "Death is viewed as a process requiring hospitalization."
D) "Death is viewed as a failure of the healthcare system."

Question 9

The nurse is providing care to a patient with terminal cancer. The patient prefers to be alone and asks, "What's the use of living?" Based on this data, which coping mechanism is the patient exhibiting?

A) Denial
B) Anger
C) Depression
D) Acceptance

Question 10

Which statement best describes the timing of death?

A) "Death occurs after a long battle with cancer."
B) "Death can occur as a result of accident or injury."
C) "Death can occur anytime during the life cycle."
D) "Death is not grieved when it occurs after a long life."

Question 11

The nurse is providing care to a patient who has just learned about the diagnosis of a terminal illness. Which response does the nurse anticipate from the patient?

A) Anger
B) Depression
C) Acceptance
D) Bargaining

Question 12

The nurse is providing care to a patient who has just learned of a terminal illness. Which resource is most appropriate for the nurse to use in this situation?

A) Hospital chaplain
B) Primary healthcare practitioner
C) Hospice provider
D) Physical therapist

Question 13

The nurse is providing care to a patient who has just been told about a terminal illness. The patient states, "I don't believe that doctor. I am going to get a second opinion." Which stage of the grieving process is the patient exhibiting?

A) Denial
B) Anger
C) Bargaining
D) Depression

Question 14

In which circumstance can Kubler-Ross' stages of grief be applied most appropriately?

A) Death of a child
B) Accidental death
C) Suicide
D) Terminal illness

Question 15

The nurse knocks on the door of a terminal patient's room to conduct a shift assessment. When the nurse enters, the patient's daughter yells, "Just get out of here. I don't have much time left with her. Leave us alone!" Which response by the nurse is most appropriate?

A) Asking the daughter to leave the room to perform the assessment
B) Calling security to escort the daughter to the waiting room
C) Telling the daughter that it is ok to be angry but it is not okay to yell at those caring for her mom
D) Yelling at the daughter and the patient that this is inappropriate behavior and it will not be tolerated

Question 16

The nurse educator is teaching a group of students about cultural customs in relation to the process of death. Which culture may participate in Shiva after the death of a family member?

A) African American
B) Muslim
C) Hindu
D) Jewish

Question 17

The nurse educator is teaching a group of students about the different cultural rituals that are associated with grief and loss. Which statement by a student indicates correct understanding of the information presented?

A) "A patient of Muslim descent may want to have his or her body washed two times after death by a person of the same sex."
B) "A patient of Chinese descent may request Santero near the time of death."
C) "A patient of Arab descent may request that candles are lit in the room after death to light the path to the afterlife."
D) "A patient of Korean descent may want rice wine sprinkled on the grave."

Question 18

The nurse is providing care to a patient who is diagnosed with terminal cancer. The nurse notes that the patient is sleeping a lot and does not wish to see family and friends. Based on this data, which stage of Kubler-Ross' grieving process is the patient experiencing?

A) Denial
B) Acceptance
C) Anger
D) Depression

Question 19

The nurse is providing care to an African American patient who is near death. Which family responses to death does the nurse anticipate based on culture?

A) Family members collapse when learning about the loved one's death.
B) Family members may limit social calls after the death of their loved one.
C) Family members may participate in Shiva.
D) Family members may develop psychosomatic symptoms.

Question 20

The nurse is providing care to a Muslim patient who is near death. Which question by the nurse is appropriate in this situation?

A) "Will you want an autopsy performed after death?"
B) "Will you want to wash your loved one's body once death occurs?"
C) "Will you want Santero at the bedside for a prayer?"
D) "Will you want candles lit in the room after your loved one passes?"

Question 21

The nurse is assessing a terminal patient who is near death for mottling. Which locations will the nurse inspect for this clinical manifestation early in the dying process? Select all that apply.

A) Toes
B) Feet
C) Knees
D) Lips
E) Face

Question 22

The nurse is conducting an admission assessment for a patient diagnosed with terminal cancer. Which question is appropriate when collecting information on the current health history?

A) "Do you have advance directives?"
B) "Who has the Medical Power of Attorney?"
C) "Do you have any young children?"
D) "What is the list of current medications that you are prescribed?"

Question 23

The nurse is admitting a patient with terminal brain cancer who is legally blind in both eyes. When planning care for this patient, which is the priority for the nurse to consider?

A) Nutrition
B) Mobility
C) Communication
D) Hygiene

Question 24

Which assistive devices would be appropriate for the nurse to recommend for a terminal patient who is having difficulties with mobility? Select all that apply.

A) Wheelchair
B) Walker
C) Bedside commode
D) Adult briefs
E) Blue pads

Question 25

The nurse is assessing a terminal patient who is in the process of dying. Which cardiovascular changes will the nurse monitor for during the physical assessment early in the dying process? Select all that apply.

A) Increased blood pressure
B) Decreased blood pressure
C) Increased heart rate
D) Decreased heart rate
E) Decreased peripheral pulses

Question 26

The nurse is conducting an assessment for a hospice patient being cared for in the home. The caregiver appears to be experiencing stress. Which action by the nurse is most appropriate?

A) Asking the caregiver whether the patient should be admitted to an inpatient hospice
B) Telling the caregiver it will get worse before it gets better
C) Assessing the caregiver for burnout
D) Prescribing the caregiver a sedative to allow for more restful sleep

Question 27

The nurse assesses a dying patient and documents terminal restlessness. Which clinical manifestations did the nurse observe? Select all that apply.

A) Having flaccid extremities
B) Seeing deceased family members
C) Attempting to get out of bed
D) Exhibiting confusion
E) Being noncommunicative

Question 28

The nurse is collecting biographical data during the physical assessment for a terminal patient. Which question is appropriate for the nurse to ask?

A) "How long have you been ill?"
B) "Do you have advance directives?"
C) "What is your current functional capacity?"
D) "Are you allergic to any medications?"

Question 29

During a hospice home care visit the caregiver states, "My mom has stopped eating. Should we consider tube feedings?" Based on this conversation with the caregiver, which response by the nurse is appropriate?

A) "I will speak to the doctor about an order for tube feedings."
B) "Did your mom want to have tube feedings?"
C) "A decrease in appetite is normal in the dying process."
D) "A feeding tube is not going to prolong your mom's life."

Question 30

During the admission assessment the patient states, "I am allergic to morphine." Which response by the nurse is the priority?

A) "I will note this on your chart and we will be sure not to use this if you are in pain."
B) "I will ask your doctor to prescribe diphenhydramine, which will allow us to administer morphine safely."
C) "What medication can you take for pain that you are not allergic to?"
D) "What symptoms did you experience when you were given morphine?"

Question 31

The nurse is providing home hospice care to a terminal patient. The caregiver states, "My dad has not had a bowel movement in several days. Can you call the doctor for a stool softener?" Which response by the nurse is appropriate?

A) "Constipation is better than diarrhea; count your blessings."
B) "How much is your dad eating?"
C) "Constipation is a common side effect when prescribed narcotics.'
D) "A stool softener is not appropriate; I will ask for a stimulant."

Question 32

Which will the nurse include when conducting a pain assessment for a terminal patient? Select all that apply.

A) Physiological responses
B) Psychological responses
C) Social responses
D) Spiritual responses
E) Manic responses

Question 33

The home hospice nurse is conducting a review of systems during the health history interview. Which assessment question will allow the nurse to plan for the delivery of necessary supplies?

A) "Is the patient having trouble swallowing?"
B) "Is the patient able to verbally communicate?"
C) "Is the patient incontinent?"
D) "Is the patient eating or drinking at least once per day?"

Question 34

The nurse is conducting an admission assessment for a terminal patient. The patient's caregiver is assisting with the health history. Which question asked during the family history should the nurse direct at the caregiver?

A) "Have you ever provided care to a patient who is dying?"
B) "Do you have Medical Power of Attorney?"
C) "Who will be helping you provide care to your family member?"
D) "Do you work full-time outside of the home?"

Question 35

When conducting a review of systems as part of the health history interview, the nurse notes that the patient is immobile. Which question is the priority when planning hospital care to reduce the risk of impaired skin integrity?

A) "Do you have a pressure-reducing mattress at home?"
B) "How often do you turn the patient?"
C) "What and how often is the patient eating?"
D) "Have you told the doctor that the patient is having problems walking?"

Question 36

The nurse is providing care to a terminal patient who is experiencing pain. The patient is unable to take oral medication. Which routes does the nurse prepare to administer pain medications to this patient? Select all that apply.

A) Sublingual
B) Rectal
C) Enteral
D) Intramuscular
E) Intravenous

Question 37

The caregiver asks the nurse, "What behaviors should I expect during the dying process?" Which responses by the nurse are appropriate? Select all that apply.

A) "The patient will have increased levels of consciousness during the dying process."
B) "The patient may talk to deceased family members."
C) "The patient may appear confused."
D) "The patient will have an increased appetite."
E) "The patient will have changes in pulse and blood pressure."