Deck 10: End of Life Care

Question 1

Haloperidol is recommended as useful treatment of _____.

A) anxiety
B) dyspnea
C) delirium
D) pain

Answer 1

delirium

Question 2

The patient's condition has deteriorated to the point where she can no longer make decisions about her own care.Which of the following nursing interventions would be most appropriate?

A) Obtain a verbal DNR order from the physician.
B) Continue caring for the patient as originally ordered because she obviously wanted this.
C) Consult the hospital attorney for recommendations on how to proceed.
D) Discuss with the family what the patient's wishes would be if she could make those decisions herself.

Answer 2

Discuss with the family what the patient's wishes would be if she could make those decisions herself.

Question 3

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago, the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.After a family conference, the physician orders a DNR order, and palliative care is begun.This means

A) the patient will continue to receive the same aggressive treatment short of resuscitation if he has another cardiac arrest.
B) all treatment will be stopped, and the patient will be allowed to die.
C) all attempts will be made to keep the patient comfortable without prolonging his life.
D) the patient will be immediately transferred to hospice.

Answer 3

all attempts will be made to keep the patient comfortable without prolonging his life.

Question 4

Hospice care can help families with

A) organ donations.
B) aggressive symptom management and family support.
C) writing advance directives and living wills.
D) legal euthanasia.

Question 5

The two basic ethical principles underlying the provision of health care are

A) beneficence and nonmaleficence.
B) veracity and beneficence.
C) fidelity and nonmaleficence.
D) veracity and fidelity.

Question 6

Disagreement and distress among physicians, nurse practitioners, and critical care nurses can lead to

A) emotional distress only.
B) ethical distress only.
C) emotional and ethical distress.
D) pessimistic opinions of care.

Question 7

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago, the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The decision is made to remove the patient from the ventilator.Which of the following statements is most accurate?

A) The cardiac monitor should be left on so everyone will know when the patient has died.
B) Opioids, sedatives, and neuromuscular blocking agents should be discontinued just before removing the ventilator.
C) The family and health care team should decide the best method for removing the ventilator: terminal wean versus immediate extubation.
D) If terminal weaning is selected, the family should be sent to the waiting room until the ventilator has actually been removed.

Question 8

Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts?

A) The patient's wishes
B) Experience of the staff
C) The family's need to participate in all aspects of the patient's care
D) State regulatory issues
E) Seeing the resuscitation may confirm the impact of decisions made or delayed

Question 9

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago, the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient does not have an advance directive.Which of the following statements would be the best way to approach the family regarding his ongoing care?

A) "I will refer this case to the hospital ethics committee, and they will contact you when they have a decision."
B) "What do you want to do about the patient's care at this point?"
C) "Dr. Smith believes that there is no hope at this point and recommends DNR status."
D) "What would the patient want if he knew he were in this situation?"

Question 10

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago, the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation.The patient continues to grimace and fight the ventilator.What nursing intervention would be appropriate?

A) Increase the morphine dosage until no signs of pain or discomfort are present.
B) Increase the morphine drip, but if the patient's respiratory rate drops below 10 breaths/min, return to the original dosage.
C) Gradually decrease the morphine and switch to Versed to avoid respiratory depression.
D) Ask the family to leave the room because their presence is causing undue stress to the patient.

Question 11

A patient was admitted to the critical care unit after having a CVA and MI.The patient has poor activity tolerance, falls in and out of consciousness, and has poor verbal skills.The patient has been resuscitated four times in the past 6 hours.The patient does not have advance directives.Family members are at the bedside.Who should the physician approach to discuss decisions of care and possible DNR status?

A) The patient
B) The family
C) The hospital legal system
D) The hospital ethics committee

Question 12

Which of the following statements apply to DNR orders?

A) DNR orders are often delayed because of difficulty predicting the time of death.
B) The patient's wishes are often not known or are vaguely stated.
C) A DNR order indicates that all care should be stopped.
D) End-of-life care skills are not emphasized in medical curricula.
E) DNR orders do not address pain management.

Question 13

Antiemetics should be used to treat

A) dyspnea.
B) nausea and vomiting.
C) anxiety.
D) edema.

Question 14

Which of the following statements about comfort care is accurate?

A) Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal community.
B) Each procedure should be evaluated for its effect on the patient's comfort before being implemented.
C) Only the patient can determine what constitutes comfort care for him or her.
D) Withdrawing life-sustaining treatments is considered euthanasia in most states.

Question 15

A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes.The patient is sure he will not be here tomorrow because his grandparent is waiting for him.This is an example of

A) signs and symptoms of anxiety.
B) signs and symptoms of delirium.
C) the need for hospice care.
D) near-death awareness.

Question 16

_____ is a powerful influence when the decision-making process is dealing with recovery or a peaceful death.

A) Hope
B) Religion
C) Culture
D) Ethics

Question 17

Family members become dissatisfied and stressed because of a lack of _____ among health care providers.

A) care provided
B) communication
C) patient's prognosis
D) patient's outcome

Question 18

Organ donation

A) is a choice only the patient can make for him- or herself.
B) is mandated by legal and regulatory agencies.
C) must be requested by the nurse caring for the dying patient.
D) is controlled by individual institutional policies.

Question 19

According to the Society for Critical Care Medicine, which of the following are among the most important needs of the family of the dying patient?

A) To be helpful
B) To stay informed
C) To achieve a sense of control
D) To vent emotions
E) To be fed, hydrated, and rested

Question 20

Recommendations for creating a supportive atmosphere during withdrawal discussions include

A) telling the family when and where the procedure will occur.
B) beginning the conversation by inquiring about the emotional state of the family.
C) ending the conversation by inquiring about the emotional state of the family.
D) recommendations that the family not be present when the procedure occurs.