Deck 10: Palliative Care at End of Life

Question 1

The nurse cares for an adolescent patient who is dying.The patient's parents are interested in organ donation and ask the nurse how the decision about brain death is made.Which response by the nurse is most appropriate?

A) "Brain death occurs if a person is flaccid and unresponsive."
B) "If CPR is ineffective in restoring a heartbeat, the brain cannot function."
C) "Brain death has occurred if there is no breathing and certain reflexes are absent."
D) "If respiratory efforts cease and no apical pulse is audible, brain death is present."

Answer 1

"Brain death has occurred if there is no breathing and certain reflexes are absent."

Question 2

The son of a dying patient tells the nurse,"Mother doesn't really respond any more when I visit.I don't think she knows that I am here." Which response by the nurse is appropriate?

A) "You may need to cut back your visits for now to avoid overtiring your mother."
B) "Withdrawal may sometimes be a normal response when preparing to leave life."
C) "It will be important for you to stimulate your mother as she gets closer to dying."
D) "Many patients don't really know what is going on around them at the end of life."

Answer 2

"Withdrawal may sometimes be a normal response when preparing to leave life."

Question 3

The nurse cares for a terminally ill patient who is experiencing pain that is continuous and severe.How should the nurse schedule the administration of opioid pain medications?

A) Give around-the-clock routine administration of analgesics.
B) Provide PRN doses of medication whenever the patient requests.
C) Offer enough pain medication to keep the patient sedated and unaware of stimuli.
D) Suggest analgesic doses that provide pain control without decreasing respiratory rate.

Answer 3

Give around-the-clock routine administration of analgesics.

Question 4

As the nurse admits a patient in end-stage kidney disease to the hospital,the patient tells the nurse,"If my heart or breathing stop,I do not want to be resuscitated." Which action is best for the nurse to take?

A) Ask if these wishes have been discussed with the health care provider.
B) Place a "Do Not Resuscitate" (DNR) notation in the patient's care plan.
C) Inform the patient that a notarized advance directive must be included in the record or resuscitation must be performed.
D) Advise the patient to designate a person to make health care decisions when the patient is not able to make them independently.

Question 5

The nurse admits a terminally ill patient to the hospital.What is the first action that the nurse should complete when planning this patient's care?

A) Determine the patient's wishes regarding end-of-life care.
B) Emphasize the importance of addressing any family issues.
C) Discuss the normal grief process with the patient and family.
D) Encourage the patient to talk about any fears or unresolved issues.

Question 6

Which patient should the nurse refer for hospice care?

A) 60-year-old with lymphoma whose children are unable to discuss issues related to dying
B) 72-year-old with chronic severe pain as a result of spinal arthritis and vertebral collapse
C) 28-year-old with AIDS-related dementia who needs palliative care and pain management
D) 56-year-old with advanced liver failure whose family members can no longer provide care in the home

Question 7

The spouse of a patient with terminal cancer visits daily and cheerfully talks with the patient about wedding anniversary plans for the next year.When the nurse asks about any concerns,the spouse says,"I'm busy at work,but otherwise things are fine." Which nursing diagnosis is most appropriate?

A) Ineffective coping related to lack of grieving
B) Anxiety related to complicated grieving process
C) Caregiver role strain related to feeling overwhelmed
D) Hopelessness related to knowledge deficit about cancer

Question 8

Which nursing actions for the care of a dying patient can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

A) Provide postmortem care to the patient.
B) Encourage the family members to talk with and reassure the patient.
C) Determine how frequently physical assessments are needed for the patient.
D) Teach family members about commonly occurring signs of approaching death.
E) Administer the prescribed morphine sulfate sublingual as necessary for pain control.

Question 9

The nurse cares for a terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing.Which action by the nurse would be most appropriate?

A) Suction the patient.
B) Administer oxygen via face mask.
C) Place the patient in high Fowler's position.
D) Document the respirations as Cheyne-Stokes.

Question 10

The nurse cares for a patient with lung cancer in a home hospice program.Which action by the nurse is most appropriate?

A) Discuss cancer risk factors and appropriate lifestyle modifications.
B) Encourage the patient to discuss past life events and their meaning.
C) Teach the patient about the purpose of chemotherapy and radiation.
D) Accomplish a thorough head-to-toe assessment several times a week.

Question 11

Which action is best for the nurse to take to ensure culturally competent care for an alert,terminally ill Filipino patient?

A) Ask the patient and family about their preferences for care during this time.
B) Let the family decide whether to tell the patient about the terminal diagnosis.
C) Obtain information from Filipino staff members about possible cultural needs.
D) Remind family members that dying patients prefer to have someone at the bedside.

Question 12

A middle-aged patient tells the nurse,"My mother died 4 months ago,and I just can't seem to get over it.I'm not sure it is normal to still think about her every day." Which nursing diagnosis is most appropriate?

A) Hopelessness related to inability to resolve grief
B) Complicated grieving related to unresolved issues
C) Anxiety related to lack of knowledge about normal grieving
D) Chronic sorrow related to ongoing distress about loss of mother

Question 13

A patient who has been diagnosed with inoperable lung cancer and has a poor prognosis plans a trip across the country "to settle some issues with sisters and brothers." The nurse recognizes that the patient is manifesting which psychosocial response to death?

A) Restlessness
B) Yearning and protest
C) Anxiety about unfinished business
D) Fear of the meaninglessness of one's life

Question 14

A young adult patient with metastatic cancer,who is very close to death,appears restless.The patient keeps repeating,"I am not ready to die." Which action is best for the nurse to take?

A) Remind the patient that no one feels ready for death.
B) Sit at the bedside and ask if there is anything the patient needs.
C) Insist that family members remain at the bedside with the patient.
D) Tell the patient that everything possible is being done to delay death.

Question 15

A hospice nurse who has become close to a terminally ill patient is present in the home when the patient dies and feels saddened and tearful as the family members begin to cry.Which action should the nurse take at this time?

A) Contact a grief counselor as soon as possible.
B) Cry along with the patient's family members.
C) Leave the home as soon as possible to allow the family to grieve privately.
D) Consider whether working in hospice is desirable because patient losses are common.

Question 16

A hospice patient is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28.Which statement,if made by the nurse to the patient's family member,is most appropriate?

A) "These symptoms will continue to increase until death finally occurs."
B) "These symptoms are a normal response before these functions decrease."
C) "These symptoms indicate a reflex response to the slowing of other body systems."
D) "These symptoms may be associated with an improvement in the patient's condition."