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

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.)

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

Answer 1

Nurse to manage symptoms of pain and nausea
Bereavement counselor to provide assistance to family and loved ones

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?

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

Answer 2

"The transfusion will help increase the patient's oxygen levels. It will not prolong life but will increase comfort."

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.)

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

Answer 3

Dying that is not prolonged
Adequate pain and symptom management
Minimal financial and emotional burdens on family members
Using remaining time to strengthen relationships with loved ones

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?

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

Question 5

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

A) "A DNR order means that you will not be placed on a ventilator if your heart stops and you require CPR."
B) "A DNR order means you will not be resuscitated if your heart stops, and that all therapeutic support will be withdrawn."
C) "A DNR order means that you will receive everything you need to remain comfortable, but you will not receive treatment that will prolong life."
D) "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 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?

A) Most patients survive after receiving CPR in the hospital.
B) About 5% of patients survive who receive CPR in the hospital.
C) Less than 1% of patients survive who receive CPR in the hospital.
D) Between 10% to 15% of patients survive who receive CPR in the hospital.

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?

A) Count the patient's respirations to know when death is near.
B) Talk to the patient because hearing is the last sense to leave the patient.
C) Stimulate the patient so that the patient is able to engage in conversation.
D) Return home to get some rest because it will be awhile before the patient dies.

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.)

A) Helping the patient define goals of care
B) Preparing the family for life after the patient has died
C) Encouraging the patient to have hope for a full recovery
D) Supporting the patient through losses leading to a good death
E) Helping the patient communicate care wishes to health care providers (HCPs)

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?

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

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?

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

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?

A) Ask the spouse what plans have been made for the patient once death occurs.
B) Remind the spouse to use the call light if the patient wakes up wanting something.
C) Sit down with the spouse and engage in conversation about the patient's care needs.
D) Suggest the spouse return home, as the patient is unaware of the spouse being there.

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?

A) "The best way to feed the patient is with a syringe and small amounts of water or liquid feeding."
B) "The less the patient drinks, the less urination will be necessary and urination can be uncomfortable at this point in the dying process."
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) "As your family member becomes dehydrated from not eating or drinking, natural endorphins will be released, which increase comfort near the end of life."

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.)

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

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?

A) Within 1 to 2 minutes of asystole
B) Within 3 to 5 minutes of collapse
C) Within 1 to 2 minutes of patient discovery
D) Within 8 to 10 minutes of patient symptoms

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?

A) Provide additional blankets
B) Assist to a side-lying position
C) Encourage increased oral fluid intake
D) Administer acetaminophen as prescribed

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.)

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

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.)

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

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?

A) Reintegration
B) Shock and disbelief
C) Experiencing the loss
D) Denial and resistance

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.)

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

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.)

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

Question 21

A terminally ill patient who is not able to talk is demonstrating restlessness.What actions can the nurse take to help this patient achieve comfort? (Select all that apply.)

A) Medicate for pain.
B) Elevate the head of the bed.
C) Measure oxygen saturation.
D) Reposition the patient in bed.
E) Ensure incontinence pad is clean and dry.

Question 22

The adult daughter of a terminally ill patient is upset because the patient is confused and is talking to people who are not in the room.What should the nurse do to help the patient and daughter? (Select all that apply.)

A) Encourage the patient to continue to talk.
B) Make sure that a dim light is on in the patient's room.
C) Suggest the daughter provide the patient with sips of fluids.
D) Explain to the daughter that confusion is common and expected.
E) Encourage the daughter to provide tactile stimulation to the patient.

Question 23

A terminally ill patient is experiencing mouth discomfort.Which actions should the nurse take to help this patient? (Select all that apply.)

A) Offer ice chips.
B) Offer sips of water.
C) Apply lanolin to the lips.
D) Provide an alcohol-based mouthwash.
E) Use sponge-tipped Toothettes for mouth care.