Question 1

The nurse is scheduling a hospice team to meet with the family of a dying patient.Which individuals will most likely participate in this meeting? (Select all that apply.)

Accepted Answer

The hospice team is multidisciplinary and includes the nurse,social worker,chaplain,and bereavement counselor in addition to the physician and home health aide.D.Because the hospice philosophy is one of support and symptom management,physical therapy designed to restore function would not be involved.F.CPR would not be appropriate for a hospice patient.

Question 2

A patient with lung cancer who expected to die within a few days is being given a blood transfusion.Family members,who realize death is imminent,ask,"Why are you giving a blood transfusion when we all know death is just around the corner?" What should the nurse respond to the family?

Accepted Answer

Blood transfusions may be given to improve oxygenation and reduce dyspnea and are not intended to prolong life but to promote comfort.A.It is not necessary for the family to wait for an answer from the physician.Teaching is a nursing role.B.It is not the nurse's duty to provide life-prolonging treatments until the patient dies.Nurses often administer comfort care at the end of life.C.Comfort is the goal at the end of life,not increased energy.

Question 3

The nurse is identifying approaches so that a terminally ill patient experiences a "good death." Which strategies should the nurse select to meet this goal? (Select all that apply.)

Accepted Answer

Characteristics of a good death include avoiding unnecessary life-sustaining treatment and prolonging the dying process,adequate pain and symptom management,reducing the emotional and financial burden on their families,and using the remaining time to strengthen relationships with loved ones.C.Death is not a conclusion to relationships with loved ones.D.A good death means that the patient has the ability to make their own decisions.

Question 4

A patient is very restless and agitated near the end of life,and the physician orders haloperidol (Haldol)by mouth.However,the patient coughs and chokes every time foods or fluids are offered.Which action should the nurse take?

Accepted Answer

The patient will benefit from sedation,and the Haldol can be effectively administered by injection.A D.Crushing the medication,mixing it with applesauce,or dissolving the medication in water and providing it through a syringe will not prevent aspiration.B.Withholding the medication will not help the patient's restlessness.

Question 5

A patient asks what a do not resuscitate order means.What should the nurse explain to the patient?

Accepted Answer

DNR simply means do not resuscitate if a patient's heart stops.A.B.C.A DNR order does not direct care prior to death-type and extent of treatment prior to death is still determined by the patient.

Question 6

The nurse is preparing to provide cardiopulmonary resuscitation (CPR)to a patient found unresponsive and not breathing.What should the nurse keep in mind regarding the survival rate of patients who receive CPR in the hospital?

Accepted Answer

Only 10% to 15% of patients who receive CPR in a hospital survive.One reason for the low survival rate is that CPR must begin within 3 to 5 minutes of collapse.The most successful cases are ones in which CPR plus an automatic external defibrillator (AED)is used within 3 to 5 minutes of collapse.Patients who are not in a hospital and who survive after CPR have a 5% chance of living for one year.Success of CPR in a hospital setting depends greatly on the patient's age.The best rate of CPR success is 10% in the age 40-to-59-year group.In patients over the age of 80 years,the CPR success rate declines to 3%.In patients over the age of 90 years,it declines further to 1%.

Question 7

The family of a dying patient is sitting at the bedside,silently watching the patient slip into a coma.What should the nurse suggest to the family at this time?

Accepted Answer

The nurse should suggest that the family talk to the patient because hearing is the last sense to leave a person.A.It would be inappropriate to ask the family to count the patient's respirations in order to predict death.C.The patient is slipping into a coma and most likely will not be aroused or able to participate in conversation.D.The nurse has no way to predict the patient's time of death.Sending the family home at this crucial time would be inappropriate.

Question 8

The nurse is providing care to a patient with a terminal illness.What should be the nurse's priorities when providing care to this patient? (Select all that apply.)

Accepted Answer

The role of the nurse with patients nearing the end of life include helping to identify patients with life-limiting illnesses early,so they and their families have the opportunity to re-define their goals of care,help patients communicate their wishes to HCPs,both orally and in writing,to ensure that their wishes are understood,and give patients support and validation as they move through the series of losses leading to a good death.B.Preparing the family for life after the patient has died is not a priority at this time.C.Encouraging the patient to have hope for a full recovery would be unrealistic and not fair to the patient.

Question 9

The nurse is reviewing a terminally ill patient's advance directive.In which part of this directive should the nurse find the patient's instructions to the physician concerning the care wanted as death nears?

Accepted Answer

Living wills are documents instructing physicians as to the patients' preferences for withholding or withdrawing life-sustaining procedures for patients who are unable to communicate,found to be permanently unconscious,or have been declared "terminal." A.D.The Patient Self-Determination Act and Health Insurance Portability and Accountability Act (HIPAA)are pieces of legislation and not parts of an advance directive.C.A durable power of attorney document specifies who will speak for the patient when he or she cannot speak for himself or herself.

Question 10

The nurse observes a terminal patient making a gurgling sound when breathing.Which nursing diagnosis should the nurse use to guide interventions for this patient?

Accepted Answer

Saliva that the patient is now unable to swallow may collect in the back of the throat,causing a sound sometimes called a "death rattle." A.Impaired gas exchange would occur deeper in the lungs.B.Breathing pattern refers to breathing rhythm or rate,not airway patency.D.Mucous membranes are not necessarily involved.

Question 11

The spouse of a patient with end-stage renal disease sits quietly at the patient's bedside,staring at the patient as the patient slips into a coma.What should the nurse do at this time?

Accepted Answer

When a patient is dying,the family is in crisis.The nurse needs to sit with patients and families in crisis,sustain eye contact,and support them in their process.A.Asking the spouse about plans once the patient dies is inappropriate.B.Reminding the spouse to use the call light is harsh and does not support the patient or family's needs at this time.D.Suggesting the spouse return home may interrupt the time that the spouse has left to spend with the patient.

Question 12

A family member is concerned that a patient near the end of life is not eating or drinking and asks the nurse how the family can help the patient increase oral intake.Which response by the nurse is most appropriate?

Accepted Answer

Benefits in withholding artificial feeding and hydration in the final weeks of life in actively dying patients include fewer pharyngeal and lung secretions,which can reduce dyspnea; reduced swelling around tumors,which can reduce associated pain; and less urination,resulting in dryer skin with fewer breakdowns.It has also been theorized that as dehydration occurs,the body produces a form of endorphin,which enhances comfort.A.Feeding may not be the best action.B.Urination is not uncomfortable.C.Use of the word starvation may be distressing to the family.

Question 13

The nurse is providing hospice care for a patient in the terminal phase of lung cancer.Which nursing actions would be appropriate? (Select all that apply.)

Accepted Answer

Activities should be planned to conserve energy.Low-dose morphine reduces pulmonary edema and anxiety.A fan or breeze reduces the feeling of dyspnea.Diuretic therapy may increase comfort and treat dyspnea.An upright position will help alleviate dyspnea.C.Daily bathing is not required.F.Deep tracheal suctioning would be invasive and painful and often irritates tissue rather than aiding with breathing.

Question 14

The nurse finds a patient unresponsive and not breathing.While beginning CPR,the nurse realizes that the best outcome for this patient would be if CPR was started at which time?

Accepted Answer

The best outcomes from CPR occur when it is begun within 3 to 5 minutes of collapse.The most successful cases are ones in which CPR plus AED (automatic external defibrillator)are used within 3 to 5 minutes.A.It will be difficult to determine the length of time of asystole.C.CPR should be started immediately upon patient discovery.D.Waiting 8 to 10 minutes would not ensure a successful outcome when implementing CPR.

Question 15

During the last vital signs assessment,a patient with end-stage heart failure has a body temperature of 102°F.Which action should the nurse take at this time?

Accepted Answer

For the terminally ill patient experiencing a fever,the nurse should provide acetaminophen,an antipyretic,as prescribed.A.Providing additional blankets would be appropriate if the patient's temperature was sub-normal.B.Assisting to a side-lying position has no clinical significance for the client experiencing a fever.C.The client's health status may not support an increase in oral fluids.

Question 16

The nurse is reviewing the nutritional status for a group of patients.In which patients would a feeding tube most likely be beneficial? (Select all that apply.)

Accepted Answer

Patients who are expected to recover from an acute process or are experiencing an intervention that currently complicates oral intake would benefit the most from a feeding tube.This includes the patient recovering from pneumonia,radiation treatment for esophageal cancer,and receiving chemotherapy.B,D,and E.Using a feeding tube for a patient with dementia will not improve quality of life.The patients with terminal cancer,heart failure,and diabetes are not going to survive and tube feeding can increase complications and reduce comfort at the end of life.

Question 17

A dying patient is experiencing copious secretions,difficulty in swallowing,and labored breathing.Which interventions should the nurse carry out? (Select all that apply.)

Accepted Answer

Suctioning and positioning can help reduce aspiration of secretions.Scopolamine helps dry secretions.B.Encouraging oral fluids increases the risk of aspiration.C.A dehumidifier is not helpful and may make the patient less comfortable.E.Increasing oxygen provision will not alter secretions.

Question 18

The spouse of a patient who died from a terminal illness expresses guilt for not encouraging the patient to seek medical attention sooner.The nurse realizes that the spouse is experiencing which stage of the grief process?

Accepted Answer

When experiencing the loss the spouse may feel guilt over not preventing the death or not providing enough care.A.Reintegration is when the spouse finds hope in the future,participates in social events,and feels more energetic.B.With shock and disbelief the spouse has difficulty with feelings of numbness,emotional outbursts,poor daily functioning,and avoidance.D.Denial and resistance is not a stage of the grief process.

Question 19

The nurse is concerned that a patient has a short time left to live.Which criterion is the nurse using that indicates a prognosis of 6 months or less to live? (Select all that apply.)

Accepted Answer

Some indicators of a prognosis of 6 months or less regardless of diagnosis are functional decline,recurrent infections,frequent hospitalizations,and a 10% loss of weight in 6 months.A.C.Agitation and incontinence can occur for many reasons and do not necessarily predict death.

Question 20

A patient with terminal cancer has just died.Which actions should the nurse take during the immediate postmortem period? (Select all that apply.)

Accepted Answer

After death,the nurse will provide postmortem care.First,remove the tubes,medical supplies,and equipment.Bathing and dressing the patient and making him or her look presentable for the family shows respect.D.Allow the family time with the patient; do not remove the body until they are ready.Contacting the physician and funeral home are carried out according to institutional policy.Covering or uncovering the face at removal should be done according to the family's wishes.F.Information about organ donation should be provided according to agency policy,but the nurse should not make recommendations.

Quiz 17: Nursing Care of Patients at the End of Life