Deck 24: Nutritional Care of the Terminally Ill

Question 1

A nurse is caring for a dying client. The client's family has become alarmed because they have begun to hear a loud, hoarse, bubbling sound. Which explanation by the nurse is accurate?
1)The client has decreased pulmonary secretions.
2)The client's dehydration has worsened these symptoms.
3)The client is not experiencing any pain.
4)The client's humidifier is worsening these symptoms.

Answer 1

3

Question 2

A nurse is caring for a dying client who is still alert and able to make his or her own decisions. The client refuses any IV or parenteral fluids. The family members disagree, and ask the nurse to administer IV fluids. Which action by the nurse is most appropriate?
1)Follow the client's wishes.
2)Explain to the family that because the client has decision-making capability, their wishes will be followed.
3)Explain to the family that because the client has decision-making capability, you will follow their wishes. Then, report immediately to the supervisor and medical director, as they may need to involve the ethics committee.
4)Follow the family's wishes.

Answer 2

3

Question 3

A nurse is caring for a client who is experiencing constipation. Which of the following would the nurse expect to be eliminated from the client's nutritional care plan?
1)Whole grains
2)Prune juice
3)Legumes
4)Cheese

Answer 3

4

Question 4

Which is considered by many health-care workers to be the most useful indicator that the end of life is approaching?
1)Decreased mental alertness
2)Oliguria
3)Decreased temperature
4)Discoloration of skin

Question 5

Which of the following interventions can be implemented to decrease the thirst sensation that could occur under fluid restriction? Select all that apply.
1)Provide ice chips if the client is alert.
2)Lubricate client's lips with a moistened gauze or water-soluble product.
3)Allow family to feed the client comfort foods.
4)Encourage the client to drink a large glass of water or juice when desired.
5)Give small amounts of water or food if the client is able to swallow.

Question 6

An experienced hospice nurse is educating a nursing student on the changes in vital signs that occur during the later stages of the dying process. Which statement by the nurse is accurate?
1)The client's blood pressure will increase.
2)The client's body temperature will decrease.
3)The client's pulse rate will constantly decrease.
4)The client's respirations will increase.

Question 7

A nurse is caring for the client with dysphagia. Which intervention may the nurse take to prevent aspiration?
1)Position client at a 90-degree angle with feet flat on the floor when eating.
2)Have client eat while watching television.
3)Encourage the client to swallow water between bites of food.
4)Teach the client to breathe while swallowing.

Question 8

A nurse is caring for a client who has been receiving parenteral nutrition through a feeding tube. The client is now approaching end-of-life, and is unable to verbalize their wishes. The family wants the feedings to stop immediately. Which approach should the nurse take?
1)Follow the family wishes and discontinue the feeding.
2)Initially stop the feeding and initiate a discussion between the family, the care team, and the medical power of attorney to determine the best approach.
3)Review the client's advance directives and then decide whether feedings can be discontinued.
4)Explain to the family that feeding should continue until the family, care team, and medical power of attorney can discuss and determine the best approach.

Question 9

A hospice nurse is caring for a client who is experiencing dyspnea. Which nutritional interventions may be appropriate? Select all that apply.
1)Encourage consumption of coffee
2)Recommend consuming hot foods
3)Encourage intake of soft foods
4)Discourage consumption of chocolate
5)Discourage eating three hours prior to bedtime

Question 10

Which of the following statements about the hospice philosophy are true? Select all that apply.
1)Death is a natural process of life.
2)At end-of-life, the best place to be is a health-care setting.
3)Clients have the right to die in the setting they choose.
4)A client has the right to be as comfortable as possible.
5)Providing further treatments to the client for curative measures are encouraged.

Question 11

A nurse is educating the client's family on palliative care. Which statement made by the nurse is accurate?
1)The goal of palliative care is to cure disease.
2)When providing palliative care, the focus is on slowing disease processes.
3)Palliative care is meant to improve a client's life expectancy.
4)Providing spiritual and psychological support is part of palliative care.

Question 12

A nurse is caring for a client who is beginning to refuse food and drink. The client's wife is concerned. Which is an appropriate action for the nurse to take?
1)Discuss strategies to encourage the client to eat and drink more.
2)Counsel the wife about changes in oral intake near the end-of-life.
3)Request an order to administer tube feedings.
4)Request an order to administer IV fluids.

Question 13

Ethical disagreements may occur between a health-care provider and a client's family during end-of-life care due to the provision of:
1)Spiritual counseling.
2)Medications.
3)Nutrition.
4)Pain relief.

Question 14

A nurse is teaching a client's family about legal and ethical issues surrounding end-of-life care. Which statement made by the nurse is true?
1)The federal government determines whether to expand individual rights.
2)Providing treatment that the client does not want is usually okay.
3)Clients have the right to refuse artificial feeding.
4)Treatment for incompetent clients is based on family desires and needs.

Question 15

At what time is it appropriate for the health-care team to assess nutritional needs and status of a client?
1)As soon as the client is admitted to service
2)During the RN case manager's first visit with client
3)When questions arise from the family and client about feeding
4)When the client begins to exhibit symptoms

Question 16

A nurse is caring for a client who is in the final days and hours of life who has stopped eating and drinking. Which of the following actions should the nurse take to reduce thirst sensations?
1)Encourage client to eat and drink normally.
2)Administer IV fluids.
3)Request an order for parenteral nutrition.
4)Offer the client ice chips, if alert.

Question 17

Which are appropriate nutritional assessment questions to ask a client who is dying and receiving tube feedings? Select all that apply.
1)Do you feel your symptoms could be decreased or controlled through dietary change?
2)Have your feedings created or increased discomfort, diarrhea, distension, other?
3)How much milk do you consume?
4)Do you feel diet or nutritional supplement would benefit you or your disease process?
5)Do you find eating enhances comfort?

Question 18

A nurse is caring for a client who has begun to have terminal respiratory secretions. Which intervention is appropriate to help reduce these symptoms?
1)Positioning client on his or her side with frequent turning
2)Suctioning secretions
3)Decreasing elevation of the client's bed
4)Administer IV fluids

Question 19

A person's ability to choose the way in which they want to live or die and their right to make those decisions on their own without outside influence is called:
1)Self-actualization.
2)Self-determination.
3)Self-sufficiency.
4)Self-dependency.

Question 20

A nurse is educating the family of a client about why it may be appropriate to withhold and minimize hydration in the dying client. Which statement made by the nurse is accurate?
1)Minimizing hydration can help decrease oral secretions.
2)Withholding hydration will make it easier for the client to eat.
3)Minimizing hydration helps decrease pain for the client.
4)Withholding hydration helps decrease edema.