Deck 40: Psychological Care of Patients with Life-Threatening Illness

Question 1

A nurse explained hospice services to a patient with metastatic cancer.In evaluating the teaching,the nurse determines the need for further information when the patient states that one of the services provided in hospice care is:

A) experimental chemotherapy.
B) symptom management.
C) psychosocial support.
D) nutritional counseling.

Answer 1

experimental chemotherapy.

Question 2

A patient has just been diagnosed with an inoperable brain tumor.Which patient statement about concerns should the nurse expect initially?

A) "I wish I knew what I did to cause this to happen."
B) "I'm very concerned about becoming a burden to my family."
C) "If that is the case I would like to look into nursing home placement or hospice care right away."
D) "Well, all of us have to die someday. I'll have to see a lawyer about a will, and I'll need you to tell me more about advance directives."

Answer 2

"I'm very concerned about becoming a burden to my family."

Question 3

A patient underwent surgery for cancer and now needs follow-up chemotherapy.The patient reports anorexia,fatigue,and trouble concentrating and sleeping.A nurse would place highest priority on responding to which statement by the family member?

A) "We are so concerned about him. He hardly eats or sleeps anymore. Can something be done?"
B) "We're not surprised he's depressed after all he is going through, but is there some medicine that can help him right now?"
C) "We're not surprised he's so depressed. It ought to be expected after all that he's been through. He'll be back to normal after the chemotherapy."
D) "We can't wait for the chemotherapy to start. He worries about any remaining cancer starting to grow between the surgery and the chemotherapy."

Answer 3

"We're not surprised he's so depressed. It ought to be expected after all that he's been through. He'll be back to normal after the chemotherapy."

Question 4

A patient with metastasized cancer says to the nurse,"I've been reading about some of the cancer research,and I am still hoping for a cure in the next few months." In formulating a response to the patient,which should the nurse consider first?

A) The patient's religion and/or faith-based beliefs
B) The need for a consultation with a professional grief counselor
C) The purpose that would be served in confronting the patient's denial
D) The patient's ability to understand the meaning of this particular research

Question 5

When a terminally ill patient is attempting to make the decision to withhold further treatment,the nurse would indicate that which medication would no longer be prescribed if treatment were to be withheld?

A) Antibiotics
B) Antiemetics
C) Opioid analgesics
D) Nonopioid analgesics

Question 6

The adult child of a critically ill patient has been keeping vigil,remaining at the bedside constantly for 3 days.Which communication from the nurse would be most appropriate when the child becomes demanding and impatient with the staff providing the parent's care?

A) "I can see that you are feeling short-tempered, which is not unusual under the circumstances. Still, it is not good for your parent to hear you complaining."
B) "It must be difficult for you to be here day after day. What other family members can stay so that you can get a good night's sleep at home?"
C) "It would be best for you to go home for a few days and get some sleep and proper nutrition. Do you have the number here so you can call if you feel the need to?"
D) "You have had little sleep in the last few days. Perhaps you should go home for some rest. You can't be of much help if you are so tired you can't think properly."

Question 7

When the parents of a terminally ill teenager whose death is imminent are approached and counseled regarding the possibility of organ donation,the parents refuse.The nurse is concerned that they may not have fully considered the positive effect organ donation has on both the surviving family members as well as organ recipients.Which nursing action will have the greatest therapeutic effect regarding the parents' decision?

A) Ask the chaplain to address the issue with the parents after giving them time to reconsider.
B) Gently share with the parents that they could be making a mistake they will later regret.
C) Say nothing, and support the parents in their decision to the fullest extent possible.
D) Refer the matter to the hospital's organ procurement agent.

Question 8

A nurse is caring for a patient awaiting test results that will indicate whether the patient has cancer.Which communication would be most helpful initially to facilitate a therapeutic nurse-patient relationship?

A) "I'm sure this must be a difficult time. It may be most helpful for you to focus on the development of new drugs and other therapies."
B) "How sad and frightened you must feel right now. Do you have any family or friends that are good support systems for you that I might call?"
C) "I am trying to imagine how you feel. If you spend this time making sure all your affairs are in order, it will give you more of a sense of control over the situation."
D) "This is a time of uncertainty for you and your family. I sense that you are quite anxious and in disbelief. I'd like to talk to you about how you're feeling."

Question 9

A nurse is working with the family of a terminally ill child with leukemia.The nurse shares with the parents that which sibling will likely have a more factual than emotional response to the sibling's death?

A) 16-year-old
B) 12-year-old
C) 8-year-old
D) 3-year-old

Question 10

A nurse advocating for an anxious patient newly diagnosed with a life-threatening illness would ask the health care provider to prescribe which type of medication?

A) Selective serotonin reuptake inhibitor
B) Monoamine oxidase inhibitor
C) Tricyclic antidepressant
D) Benzodiazepine

Question 11

A patient with end-stage renal disease does not want further aggressive treatment but is reluctant to withdraw life-sustaining treatment.The nurse would help the patient to understand that life-sustaining treatment includes maintaining:

A) full code status.
B) comfort measures only.
C) nutrition, hydration, and dialysis.
D) nutrition and hydration but removal of dialysis.

Question 12

A patient undergoing chemotherapy is experiencing anxiety-induced anticipatory nausea and vomiting.A nurse could assist this patient by requesting a prescription for which preferred medication?

A) Lorazepam (Ativan)
B) Hydroxyzine (Vistaril)
C) Promethazine (Phenergan)
D) Chlorpromazine (Thorazine)

Question 13

A nurse should use which measure initially to reduce dyspnea in a patient with end-stage chronic obstructive pulmonary disease?

A) Administer a dose of an ordered prn bronchodilator.
B) Encourage the patient to use an incentive spirometer.
C) Assist the patient to cough and deep breathe.
D) Elevate the head of the bed.

Question 14

A patient receiving palliative care is treated with large doses of narcotic analgesics to control pain.To minimize side effects of this medication the nurse should ensure that there is a prn prescription for which type of medication?

A) Antiemetic
B) Stool softener
C) Bronchodilator
D) Nonopioid analgesic

Question 15

A nurse enters the room of a patient newly diagnosed with multiple sclerosis and notes that the patient is crying quietly while lying in bed.Which communication by the nurse would be most appropriate?

A) "You are crying. What are you feeling that's making you so sad?"
B) "Do you want me to call the health care provider to order some antidepressant medication for you?"
C) "I can understand why you would cry. I imagine most people would feel sad after being given your diagnosis."
D) "Crying is a normal response to a diagnosis such as yours. You'll feel better after your plan of care has been fully developed."

Question 16

An older adult patient diagnosed with Parkinson-induced dementia becomes critically ill with severe pneumonia.No family is available.After repeated failed attempts to contact the patient's agent designated by the Health Care Power of Attorney,which standard should the health care team use as the best method for decision making in planning care for this patient?

A) Informed consent
B) Best interests standard
C) Patient's Bill of Rights
D) Substituted judgment standard

Question 17

A nurse working in the pediatric intensive care unit is assigned to pediatric patients who are experiencing pain.The nurse would select the Wong FACES Pain Rating Scale for use in which child?

A) A 6-month-old patient with failure to thrive
B) A 12-month-old patient with a burn injury
C) A 24-month-old patient with injuries after a fall
D) A 38-month-old patient with sickle cell disease

Question 18

A patient diagnosed with amyotrophic lateral sclerosis says to the nurse,"I've been looking on the Internet to get more information about this disease.Which of the sites has the most reliable information?" Which site would the nurse recommend?

A) National Institutes of Health (NIH)
B) Food and Drug Administration (FDA)
C) Centers for Disease Control and Prevention (CDC)
D) Occupational Safety and Health Administration (OSHA)

Question 19

A patient with liver failure rings the call bell and tells the nurse,"The lunch is cold,and my sheets are wrinkled.You never seem to have enough help to give me the care I need." Which intervention should the nurse implement initially?

A) Listen quietly but attentively until the patient has finished speaking.
B) Attempt to correct each problem the patient has identified immediately.
C) Say to the patient, "I'm sorry but please know that the staff is really doing the best they can."
D) Promise the patient to share all of the concerns with the unit's nurse manager on day shift.

Question 20

The adult child of a terminally ill patient tells a nurse,"The doctor recommended considering end-of-life care." The nurse interprets that this most likely means that the patient will not live more than _____ month(s).

A) 1
B) 3
C) 6
D) 24

Question 21

A patient who is terminally ill expresses a wish to "hurry up and end it all." In exploring reasons for this wish,which should the nurse assess first?

A) Guilt and fatigue
B) Pain and depression
C) Self-esteem and hope
D) Competency and pain

Question 22

Palliative care includes: (Select all that apply.)

A) comfort measures.
B) fluid-volume replacement.
C) range-of-motion exercises.
D) nasogastric tube feedings.
E) pain medication therapies.

Question 23

A 22-year-old nurse is working with a seriously ill 23-year-old patient who is recovering from a motor vehicle accident.The nurse recognizes having difficulty maintaining professional boundaries based on their similar ages.Which action should the nurse take initially?

A) Seek guidance from another experienced nurse or the unit manager.
B) Provide excellent care, but keep conversation and contact to a minimum.
C) Arrange to have ancillary staff complete as much care as possible within their scope of practice.
D) Discuss with the nursing supervisor the possibility of having another nurse assume this patient assignment.