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

Question 1

The nurse is explaining exactly what a do not resuscitate (DNR) order is to a patient. Which of the following is the best explanation?

A)"A DNR order means you will not be resuscitated if your heart stops, and that all therapeutic support will be withdrawn."
B)"A DNR order means you will not be resuscitated if your heart stops; you can specify whether you still want treatment to prolong your life, or only care that keeps you comfortable."
C)"A DNR order means that you will not be placed on a ventilator if your heart stops and you require CPR."
D)"A DNR order means that you will receive everything you need to remain comfortable, but you will not receive treatment that will prolong life."

Answer 1

"A DNR order means you will not be resuscitated if your heart stops; you can specify whether you still want treatment to prolong your life, or only care that keeps you comfortable."

Question 2

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

A)Suction secretions.
B)Encourage oral fluids.
C)Place a dehumidifier in the room.
D)Place the patient in Fowler's or semi-Fowler's position.
E)Administer scopolamine as ordered.
F)Increase oxygen to 3 L per nasal cannula.

Answer 2

Suction secretions.
Place the patient in Fowler's or semi-Fowler's position.
Administer scopolamine as ordered.

Question 3

Which individuals should be included in a hospice team? (Select all that apply.?

A)Physical therapist working to regain patient ability to walk
B)Nurse to manage symptoms of pain and nausea
C)Social worker to assist with community resources
D)Bereavement counselor to provide assistance to family and loved ones
E)Chaplain to provide spiritual and emotional support
F)Hospitalist to direct an emergency response team and provide cardiopulmonary resuscitation (CPR)

Answer 3

Nurse to manage symptoms of pain and nausea
Social worker to assist with community resources
Bereavement counselor to provide assistance to family and loved ones
Chaplain to provide spiritual and emotional support

Question 4

For CPR to be successful, when must it begin?

A)Within 1 to 2 minutes of patient discovery
B)Within 1 to 2 minutes of asystole
C)Within 3 to 5 minutes of collapse
D)Within 8 to 10 minutes of patient symptoms
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 5

In which of the following patients would a feeding tube most likely be beneficial? (Select all that apply.?

A)A 65-year-old patient recovering from pneumonia
B)An 80-year-old patent with dementia
C)A 55-year-old patient receiving chemotherapy and experiencing loss of appetite
D)A 90-year-old patient with diabetes and heart failure
E)A 76-year-old patient with terminal cancer
F)A 55-year-old with esophageal cancer who is receiving radiation therapy

Question 6

A terminal patient has a gurgling sound, sometimes called a "death rattle." Which nursing diagnosis should guide interventions?

A)Impaired Gas Exchange
B)Ineffective Airway Clearance
C)Impaired Oral Mucous Membranes
D)Ineffective Breathing Pattern

Question 7

What is the survival rate after CPR for all patients in a hospital?

A)2%
B)5%
C)10% to 15%
D)25%

Question 8

A patient is very restless and agitated near the end of life, and the physician orders haloperidol (Haldol) PO. The patient coughs and chokes every time foods or fluids are offered. Which nursing action is most appropriate?

A)Crush the medication, and mix it with applesauce.
B)Dissolve the medication in a small amount of water, and administer it with an oral syringe.
C)Ask the physician for an order to administer the Haldol intramuscularly.
D)Hold the medication until the patient is more alert and able to swallow.

Question 9

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?

A)"The less the patient drinks, the less urination will be necessary, and urination can be uncomfortable at this point in the dying process."
B)"As your family member becomes dehydrated from not eating or drinking, natural endorphins will be released, which increase comfort near the end of life."
C)"The starvation process at the end of life is quite natural; a side benefit is that lower doses of medications are needed to keep the patient comfortable."
D)"The best way to feed the patient is with a syringe and small amounts of water or liquid feeding."

Question 10

A "good death," according to a focus group of terminally ill patients, included which of the following? (Select all that apply.?

A)Adequate pain and symptom management
B)Allowing loved ones to make end-of-life decisions
C)Dying that is not prolonged
D)A conclusion to relationships with loved ones
E)Minimal financial and emotional burdens on family members
F)Using remaining time to strengthen relationships with loved ones

Question 11

Which of the following are appropriate actions by the nurse during the immediate postmortem period? (Select all that apply.?

A)Remove all tubes, medical supplies, and equipment from the bedside.
B)Provide the family a place away from the patient's room to talk and grieve.
C)Bathe and dress the patient.
D)Ask the family if they want the patient's face covered or uncovered.
E)Recommend that the family donate the patient's organs as a way to find meaning from the death.
F)Notify the physician with the patient's time of death per institutional policy.

Question 12

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 is the nurse's best response?

A)"It is my duty as a nurse to continue to administer life-prolonging treatments until the patient dies."
B)"The transfusion will help increase the patient's oxygen levels. It will not prolong life but will increase comfort."
C)"That question is best answered by the physician during rounds."
D)"The blood will raise the hemoglobin level, which will increase energy level and sense of well-being."

Question 13

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

A)Encourage the patient to bathe daily.
B)Position the patient upright in a recliner with pillows.
C)Provide low-dose morphine.
D)Teach family members how to perform deep tracheal suctioning.
E)Place a fan at the patient's bedside.
F)Administer diuretic therapy as ordered.Completion
Complete each statement.

Question 14

Which of the following factors account for the low survival rate among patients who receive cardiopulmonary resuscitation (CPR)? (Select all that apply.?

A)Presence of one or more medical conditions
B)Presence of a terminal illness
C)Administration of CPR in combination with automated external defibrillator (AED)
D)Living in a skilled nursing facility
E)Being in a hospital for an acute condition after living independently

Question 15

In which part of an advance medical directive does the patient provide instructions to the physician concerning the care wanted as death nears, such as withholding life-sustaining procedures?

A)Durable power of attorney
B)Living will
C)Patient Self-Determination Act
D)HIPAA

Question 16

As a patient approaches death, the sense of ________________is the final sense that is lost.

Question 17

Which of the following indicate a prognosis of 6 months or less? (Select all that apply.?

A)Weight loss of 10% or more
B)Increased agitation
C)Frequent hospitalizations
D)Incontinence
E)Recurrent infections
F)Functional decline

Question 18

In the United States, about ____________________% of people die suddenly.