Deck 9: End-Of-Life Care

Question 1

The nurse is caring for a dying client who becomes very agitated.What is the nurse's best response?

A) Use music therapy to promote relaxation.
B) Increase the dose of intravenous opioids.
C) Provide a second antipsychotic medication.
D) Assess the client for urinary retention.

Answer 1

Assess the client for urinary retention.

Question 2

The health care provider suggests inpatient hospice for a client.The family members are concerned that their loved one will receive only custodial care.What is the nurse's best response?

A) "The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left."
B) "Palliative care will release you from the burden of having to care for someone in the home. It does not mean that curative treatment will stop."
C) "A palliative care facility is like a nursing home and costs less than a hospital because only pain medications are given."
D) "Your relative is unaware of her surroundings and will not notice the difference between her home and a palliative care facility."

Answer 2

"The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left."

Question 3

The terminally ill client is prescribed morphine to help cope with increasing discomfort.A family member expresses concern that the client is on "too much morphine." What is the nurse's best response?

A) "What has the physician told you about your family member's illness?"
B) "Don't worry about that. We're following the physician's plan of care."
C) "Tell me more about what you mean by too much morphine."
D) "You should talk with your physician about this when he makes rounds."

Answer 3

"Tell me more about what you mean by too much morphine."

Question 4

A dying client's family members are spending time with the client.What instruction is best to give to family members regarding noise in the client's room?

A) "Remember that she cannot hear you."
B) "Try to get her to talk or respond to you."
C) "Avoid making any noise when you are with her."
D) "Talk in your normal speaking voice."

Question 5

An experienced hospice nurse is training a new nurse in the practices of palliative care.What statement by the new nurse indicates understanding about drug therapy for end-of-life care?

A) "I can administer as much pain medication as I want because the client is dying."
B) "The administration of these medications will hasten the client's death."
C) "I can administer medication per the protocol to relieve the client's symptoms."
D) "The purpose of palliative sedation is to relieve family members' distress."

Question 6

A client who is near death appears to be having difficulty breathing.What is the nurse's highest-priority intervention?

A) Teach the family how to perform nasotracheal suctioning.
B) Request that the physician order morphine sulfate.
C) Document the finding in the client's chart.
D) Call a respiratory therapist to intubate the client.

Question 7

The wife is concerned because her terminally ill husband does not want to eat.What is the nurse's best response?

A) "Let him know that food is available if he wants it, but do not insist that he eat."
B) "A feeding tube can be placed in the nose to provide important nutrients."
C) "Force him to eat even if he does not feel hungry, or he will die sooner."
D) "He is getting all the nutrients he needs through his intravenous catheter."

Question 8

The nurse is discussing advance directives with a client.Which statement by the client indicates good understanding of the purpose of an advance directive?

A) "An advance directive will keep my children from selling my home when I'm old."
B) "An advance directive will be completed as soon as I'm incapacitated and can't think for myself."
C) "An advance directive will specify what I want done when I can no longer make decisions about health care."
D) "An advance directive will allow me to keep my money out of the reach of my family."

Question 9

The spouse of a dying client states that she is concerned that her husband is choking to death.What is the nurse's best response?

A) "Do not worry. The choking sound is normal during the dying process."
B) "I will administer more morphine to keep your husband comfortable."
C) "I can ask the respiratory therapist to suction secretions out through his nose."
D) "I will have another nurse assist me to turn your husband on his side."

Question 10

The family members of a client with a terminal illness tell a nurse that the client keeps asking if she is dying.What is the nurse's best response?

A) "Whenever she asks about dying, change the subject."
B) "Tell her the truth in as gentle a way as possible."
C) "Tell her that she will get better eventually."
D) "Ask her if she is afraid to die."

Question 11

A hospitalized American Indian client is approaching death.Family members who are standing vigil in the client's room begin to divide up his possessions among themselves as his symptoms progress.What is the nurse's most important intervention?

A) Ask the family members to step outside the room so the client cannot hear them.
B) Tell the family that they are being insensitive and their behavior is inappropriate.
C) Recognize that this is a culturally appropriate activity and document it in the chart.
D) Report these activities to the client's physician and the nursing supervisor.

Question 12

The client's family members are concerned that the client should have a urinary catheter placed because of her decreasing urinary output.What is the hospice nurse's best response?

A) "A Foley catheter is inserted only if she is taking medications that affect output."
B) "I will insert a Foley catheter if her urinary output drops below 500 mL/day."
C) "A Foley catheter will be inserted if her bladder becomes distended."
D) "I will insert a Foley catheter if she becomes incontinent of urine."

Question 13

The nurse is providing care for a hospice client who is in the last stages of the dying process.The client develops a pressure ulcer on her sacrum,and family members tell the nurse that they would like a specialist consulted to treat the ulcer.When the nurse discusses this with the client,the client states that the ulcer does not bother her,that it is not causing her pain,and that she'd rather not have additional caregivers at this time.What should the hospice nurse do next?

A) Tell the family the wound care specialist will be consulted and treatment will begin.
B) Ask the social worker and the chaplain to talk with family members about the dying process.
C) Explain the client's desires to the family, emphasizing that the client will be made as comfortable as possible.
D) Ask the agency mental health nurse to speak with the client about refusing treatment.

Question 14

The nurse is being trained in hospice care.Which intervention by the nurse is most compatible with the goals of end-of-life care for the client?

A) Administer influenza and pneumococcal vaccinations.
B) Prevent the client with chronic obstructive pulmonary disease from smoking.
C) Perform passive range-of-motion exercises to prevent contractures.
D) Permit the client with diabetes mellitus to have a serving of ice cream.

Question 15

A terminally ill client has just died in a hospital setting with family members at the bedside.The health care provider is also present.What should be the nurse's priority intervention as postmortem care begins?

A) Call for emergency assistance so that resuscitation procedures can begin.
B) Ask the family members if they would like to spend time alone with the client.
C) Ensure that a death certificate has been completed by the physician.
D) Request family members to prepare the client's body for the funeral home.

Question 16

The client tells the nurse that even though it has been 4 months since her sister's death,she frequently finds herself crying uncontrollably.The client is afraid that she is "losing her mind." What is the nurse's best response?

A) "Most people move on within a few months. You should see a grief counselor."
B) "Whenever you start to cry, distract yourself from thoughts of your sister."
C) "You should try not to cry. I'm sure your sister is in a better place now."
D) "Your feelings are completely normal and may continue for a long time."

Question 17

The nurse is caring for a client who is considering being admitted to hospice.What is the nurse's best response?

A) "Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge."
B) "Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms."
C) "Hospice care will not help with your symptoms of depression. I will refer you to the facility's counseling services instead."
D) "You seem to be experiencing some difficulty with this stage of the grieving process. Let's talk about your feelings."

Question 18

An older client was admitted to hospice owing to impending death in approximately 6 weeks.After 2 months,the family remains at the bedside but is becoming increasingly impatient and irritable.What is the best nursing intervention?

A) Ask the family to leave and not return until they are calmer.
B) Sit with the family and listen to their concerns and fears.
C) Tell the family members not to worry, the client will die soon.
D) Consult the chaplain to come and pray with the client's family.

Question 19

The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client's anxiety and restlessness.Which statement by the family member indicates understanding of the nurse's teaching?

A) "Maybe we should just hire a round-the-clock sitter to stay with Grandmother."
B) "I have some of her favorite hymns on a CD that I could bring for music therapy."
C) "I don't think that she'll need pain medication along with her herbal treatments."
D) "I will burn therapeutic incense in the room so we can stop the anxiety pills."

Question 20

The nurse is assessing the dying client.Which manifestations of a dying client should the nurse assess to determine whether the client is near death?

A) Level of consciousness
B) Respiratory rate
C) Bowel sounds
D) Pain level on a 0 to 10 scale

Question 21

The nurse is providing care for a dying client.The nurse would place highest priority on treating which symptoms?

A) Anorexia
B) Weight loss
C) Pain
D) Agitation
E) Nausea
F) Hair loss
G) Dyspnea

Question 22

An intensive care nurse is discussing withdrawal of care with a client's family.The family expresses concerns related to discontinuation of therapy.What is the nurse's best response?

A) "I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia."
B) "You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support."
C) "I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death."
D) "There is no need to worry. Most religious organizations support the client's decision to stop medical treatment."

Question 23

The hospice nurse is caring for a dying client and her family members.What nursing interventions are appropriate to use?

A) Teach family members about physical signs of impending death.
B) Encourage the management of adverse symptoms.
C) Assist family members by offering an explanation for their loss.
D) Encourage reminiscence by both client and family members.
E) Avoid spirituality because the client's and the nurse's beliefs may not be congruent.
F) Do not encourage hope for the terminally ill client.

Question 24

The nurse is admitting a new client to the hospital and needs to determine the plan of care.What criterion is required for the client to make his own medical decisions?

A) Can communicate his treatment preferences
B) Is able to read and write at an 8th grade level
C) Is oriented enough to received information
D) Can evaluate and deliberate information
E) Has completed an advance directive