Deck 9: Palliative Care at End of Life

Question 1

A patient with terminal cancer is being admitted to a family-centered inpatient hospice. The patient's spouse 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 provisional nursing diagnosis is appropriate for the patient's spouse?

A)Ineffective coping related to lack of grieving
B)Anxiety related to complicated grieving process
C)Hopelessness related to knowledge deficit about cancer
D)Caregiver role strain related to spouse's complex care needs

Answer 1

Ineffective coping related to lack of grieving

Question 2

A middle-aged patient tells the nurse,"My mother died 4 months ago,and I just can't 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

Answer 2

Anxiety related to lack of knowledge about normal grieving

Question 3

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.

Answer 3

Provide postmortem care to the patient.
Encourage the family members to talk with and reassure the patient.
Administer the prescribed morphine sulfate sublingual as necessary for pain control.

Question 4

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

A)Let the family decide how to tell the patient about the terminal diagnosis.
B)Ask the patient and family about their preferences for care during this time.
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 5

The nurse is caring for an adolescent patient who is dying. The patient's parents are interested in organ donation and ask the nurse how the health care providers determine brain death. Which response by the nurse accurately describes brain death determination?

A)"If CPR does not restore a heartbeat, the brain cannot function."
B)"Brain death has occurred if there is not any breathing or brainstem reflexes."
C)"Brain death has occurred if a person has flaccid muscles and does not awaken."
D)"If respiratory efforts cease and no apical pulse is audible, brain death is present."

Question 6

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 7

The nurse is caring for an unresponsive 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 appropriate?

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

Question 8

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

A)Plan around-the-clock routine administration of analgesics.
B)Provide PRN doses of medication whenever the patient requests them.
C)Suggest small analgesic doses to avoid decreasing the respiratory rate.
D)Offer enough pain medication to keep the patient sedated and unaware of stimuli.

Question 9

Which patient should the nurse refer for hospice care?

A)A 70-yr-old patient with lymphoma whose children are unable to discuss issues related to dying
B)A 60-yr-old patient with chronic severe pain as a result of spinal arthritis and vertebral collapse
C)A 40-yr-old patient with AIDS-related dementia who needs palliative care and pain management
D)A 50-yr-old patient with advanced liver failure whose family members can no longer provide care in the home

Question 10

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

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

Question 11

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

A)Place a "Do Not Resuscitate" (DNR) notation in the patient's care plan.
B)Invite the patient to add a notarized advance directive in the health record.
C)Advise the patient to designate a person to make future health care decisions.
D)Ask if the decision has been discussed with the patient's health care provider.

Question 12

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)"Cut back your visits for now to avoid overtiring your mother."
B)"Withdrawal can be a normal response in the process of dying."
C)"Most dying patients don't know what is going on around them."
D)"It is important to stimulate your mother so she can't retreat from you."

Question 13

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 14

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 family members." The nurse recognizes that the patient is manifesting which psychosocial response to death?

A)Protesting the unfairness of death
B)Anxiety about unfinished business
C)Fear of having lived a meaningless life
D)Restlessness about the uncertainty of prognosis

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 quickly to allow the family to grieve privately.
D)Consider leaving hospice work because patient losses are common.

Question 16

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

A)"These vital signs will continue to increase until death finally occurs."
B)"These vital signs are an expected response now but will slow down later."
C)"These vital signs may indicate an improvement in the patient's condition."
D)"These vital signs are a helpful response to the slowing of other body systems."