Deck 5: Palliative Care and End-Of-Life Issues

Question 1

The nurse provides care to a terminally ill patient who is in the late stage of the dying process. Which family member statement indicates an accurate understanding of this stage of the dying process?
1)"My mom is having trouble swallowing her saliva."
2)"My mom is beginning to lose her appetite at this stage."
3)"My mom's body temperature is rising at this stage."
4)"My mom's activity level is decreasing, and she may sleep more."

Answer 1

1

Question 2

Which response by the nurse indicates the use of reflective listening when communicating with the family of a patient who is in the process of dying?
1)"I can see this is difficult for you."
2)"Thank you for taking such good care of your mother."
3)"Your mother is experiencing quite a bit of pain at the moment."
4)"A social worker will be able to answer all the questions that you have."

Answer 2

1

Question 3

The nurse is providing care to a patient who is diagnosed with terminal lung cancer. The patient is lying in the supine position with noisy wet respirations noted and is not breathing well. The patient has an advance directive that designates the implementation of comfort measures only. Which action by the nurse is the priority at this time?
1)Withholding ordered opiates
2)Providing the patient with pain medication as ordered
3)Asking the family what they want to be done for the patient
4)Repositioning the patient to a lateral position, with the head elevated as tolerated

Answer 3

4

Question 4

The nurse is assessing the patient for palliative care. When assessing the physical aspects of care, which should the nurse include?
1)Dietary preferences
2)Pain
3)Depression
4)Spiritual concerns

Question 5

It is most important for the nurse to provide education regarding hospice services to which patient?
1)The patient with stage 4 liver cancer who is classified as terminal
2)The patient with stage 2 lung cancer who is receiving radiation therapy
3)The patient with stage 4 brain cancer who is receiving intravenous chemotherapy
4)The patient with stage 4 breast cancer experiencing bone pain and hormone therapy treatment

Question 6

The nurse is assessing the patient for palliative care. When assessing the cultural domain, which question does the nurse include?
1)"Do you have any financial concerns regarding your care?"
2)"Are you currently experiencing pain?"
3)"Are you experiencing any depression or anxiety?"
4)"Do you have any specific dietary preferences that affect your care?"

Question 7

The nurse is educating the family of a patient in hospice care who is receiving morphine for pain because of a terminal illness. Which statement by the family member indicates the need for further teaching?
1)"I can only give the pain medications when requested."
2)"I can give the pain medications if the patient is groaning and restless."
3)"It is important to try to give these medications to manage the pain."
4)"The morphine may also help the breathing difficulties."

Question 8

The nurse is educating the family of a patient who is receiving hospice care because of a terminal illness. The nurse instructs the family to administer which medication for this patient if delirium occurs?
1)Morphine
2)Haloperidol
3)Diphenhydramine
4)Docusate

Question 9

The nurse is educating the family of a patient who is receiving hospice care because of a terminal illness. Which medication does the nurse tell the family to administer to treat the patient if hyperactive delirium occurs?
1)Morphine
2)Docusate
3)Diphenhydramine
4)Lorazepam

Question 10

The nurse is providing care to a patient who is approaching death. Which family member statement regarding the physical and psychological changes associated with death is reflective of the middle stage?
1)"A loss of appetite often occurs during this stage."
2)"Respirations may sound loud and wet during this stage."
3)"I might notice that he will begin to sleep more during this stage."
4)"Confusion or disorientation may begin to occur during this stage."

Question 11

A competent older adult patient has an advance directive that expresses the patient's desire to avoid resuscitation and heroic life support measures. The patient's family, however, is not supportive of this directive and plans to contest the living will. Which nursing action is appropriate based on the current situation?
1)Notify the hospital attorney.
2)Contact the social services department.
3)Place the document on the patient's medical record.
4)Explain to the patient that the conflict could invalidate the document.

Question 12

Which is a team action that nurses can employ as a stress-reducing strategy?
1)Practicing yoga on a daily basis
2)Journaling feelings related to patient care
3)Engaging in aerobic exercise several times per week
4)Having staff sign and send a bereavement card to the family of a patient who recently died

Question 13

The wife of a patient with end-stage chronic obstructive pulmonary disease (COPD) tells the nurse that she wishes her husband were eligible for hospice care, but she thinks that hospice is only available for cancer patients and would require a change in healthcare providers. Which responses by the nurse are appropriate? Select all that apply.
1)Inform her that hospice care is very expensive.
2)Inform her that a diagnosis of cancer is not required for hospice care.
3)Inform her that all hospice programs provide care 24 hours per day, 7 days per week.
4)Inform her that her husband can retain his provider when transitioning to hospice care.
5)Inform her that her husband is not eligible for hospice care with the current diagnosis of COPD.

Question 14

The nurse is providing care for a patient receiving curative care who is experiencing chronic pain as a result of cancer. Which type of care should the nurse plan for on discharge for this patient?
1)Home healthcare
2)Palliative care
3)Hospice care
4)Rehabilitative care

Question 15

The nurse is caring for a patient with an advance directive that includes the instruction that no invasive measures be implemented. The family and nursing staff do not agree on specific actions, and the patient is nonresponsive. Who can provide the best guidance in this situation?
1)Pastoral care office
2)Ethics committee
3)Medical staff committee
4)Chief nurse executive

Question 16

The hospice nurse receives a phone call from the family of a patient who is experiencing the late stage of the dying process. Which family member statement indicates the need for additional education regarding the treatment of respiratory issues?
1)"I will administer the prescribed morphine to my dad."
2)"I will remove the extra pillows from behind my dad's head."
3)"I will give my dad the anticholinergic medication to dry the secretions."
4)"I will turn my dad's head to the side and place a washcloth to absorb the mucus."

Question 17

Which concept exemplifies a well-managed death experience for a patient with a terminal diagnosis and the patient's family members?
1)Allowing the patient to die alone
2)Withholding pain medication to decrease sedative effects
3)Encouraging a lengthy dying process to allow for goodbyes
4)Preparing the patient and the family for the process of dying

Question 18

The nurse is assessing the patient for palliative care. When assessing the psychosocial and psychiatric domain, which should the nurse include?
1)Financial concerns
2)Pain
3)Depression
4)Spiritual concerns

Question 19

The nurse is assessing the patient for palliative care. When assessing the social domain, which should the nurse include?
1)Financial concerns
2)Funeral preferences
3)Depression
4)Spiritual concerns

Question 20

The nurse is providing care to a patient who is approaching death. Which family member statement regarding the physical and psychological changes associated with death is reflective of this late stage?
1)"A loss of appetite often occurs during this stage."
2)"Respirations may sound loud and wet during this stage."
3)"I might notice that he will begin to sleep more during this stage."
4)"Confusion or disorientation may begin to occur during this stage."

Question 21

The nurse is caring for a patient who died unexpectedly, and an autopsy has been ordered. In providing postmortem care, which actions by the nurse are correct? Select all the apply.
1)Limiting the family from visiting because of the ordered autopsy
2)Removing all catheters and tubes from the body
3)Allowing the family to spend time with the deceased patient
4)Retaining all catheters and tubes in the body
5)Allowing the family to pray with the body before transport

Question 22

The nurse manager is planning activities to support the staff when a patient well known to them dies of a terminal illness. Which strategies can be planned for the staff to support this loss? Select all the apply.
1)Encouraging staff to spend time with the family
2)Distracting staff by changing patient assignments
3)Supporting staff to complete postmortem care together
4)Facilitating moment of silence to remember this patient
5)Sending the family a card acknowledging their loss

Question 23

Which factors can create moral distress for nurses? Select all that apply.
1)Supportive management staff
2)Low-stress patient environment
3)High-technology patient care situations
4)Cultural differences with the patient population
5)Resource pressures when providing patient care

Question 24

Which actions does the nurse implement when providing care to the family of a patient who is actively dying? Select all that apply.
1)Educating the family to apply a normal saline to the patient's lips to keep them moist
2)Suggesting that family members record stories from the past to share with the patient
3)Teaching the family to avoid massage of patient's bony prominences because this increases pain
4)Recommending to the family that young children not visit the patient because it may scare them
5)Encouraging the family to bring quilts and pictures from the patient's home to provide comfort

Question 25

The nurse is providing care to a patient who is diagnosed with terminal lung cancer. Which clinical manifestations indicate imminent death? Select all that apply.
1)Diaphoresis
2)Increased cardiac output
3)Decreased blood pressure
4)Tachycardia followed by bradycardia
5)An increase in urine output

Question 26

Which statement from the nurse to family members is important to support their participation in the physical care to the patient during the dying process? Select all that apply.
1)"You can bring in pictures of the family to comfort your loved one."
2)"Apply lip balm to your loves one's mouth if you feel the lips are dry."
3)"You can massage your loved one's arms and legs to provide comfort."
4)"Bring in music that your loved one likes to listen to with headphones."
5)"Your child can call your loved one if you don't want to expose him to this process."

Question 27

The nurse is providing care to a terminal patient who is experiencing delirium. Which should the nurse assess before administering haloperidol to this patient? Select all that apply.
1)Last stool
2)Blood pressure
3)Respiratory rate
4)Bladder distention
5)Medication regimen

Question 28

A patient with a terminal illness has opted to stop treatment. The family, however, believes the patient is no longer competent to make this decision. Which data support that the patient is capable of making this treatment decision? Select all that apply.
1)The patient is aware of the current date and location.
2)The patient does not want to be a burden on the family.
3)The patient communicates the decision with the healthcare team.
4)The patient understands the nature and consequences of treatment.
5)The patient states the benefits and risks associated with the treatment.