Deck 4: End-Of-Life Care in the Critical Care Unit

Question 1

A statement that provides a legally recognized description of an individual's desires regarding care at the end of life is a (an):

A) advance directive.
B) guardianship ad litem.
C) healthcare proxy.
D) power of attorney.

Answer 1

advance directive.

Question 2

All of the patient's children are distressed by the possibility of removing life-support treatments from their mother.The child who is most upset tells the nurse,"This is the same as killing her! I thought you were supposed to help her!" The nurse explains to the family,

A) "This is a process of allowing your mother to die naturally after the injuries that she sustained in a serious accident."
B) "The hospital would never allow us to do that kind of thing."
C) "Let's talk about this calmly, and I will explain why assisted suicide is appropriate in this case."
D) "She's lived a long and productive life."

Answer 2

"This is a process of allowing your mother to die naturally after the injuries that she sustained in a serious accident."

Question 3

The patient's husband,experiencing anticipatory grieving,tells the nurse that he doesn't see any point in continuing to visit at the bedside,because the patient is unresponsive.The best response for the nurse supports him by saying,

A) "You're right, she is not aware of anything going on around her now."
B) "Although she is not responding, she may be able to hear you and benefit from your presence."
C) "I'll call you if she starts responding again."
D) "Why don't you check to see if any other family member would like to visit her?"

Answer 3

"Although she is not responding, she may be able to hear you and benefit from your presence."

Question 4

Which statement is consistent with societal views of dying in the United States?

A) Dying is viewed as a failure on the part of the system and providers.
B) Most Americans would prefer to die in a hospital to spare loved ones the burden of care.
C) People die of indistinct, complex illness for which a cure is always possible.
D) The purpose of the healthcare system is to prevent disease and treat symptoms.

Question 5

Designated healthcare surrogates should base healthcare decisions on:

A) personal beliefs and values.
B) recommendations of family members and friends.
C) recommendations of the physician and healthcare team.
D) wishes previously expressed by the patient.

Question 6

Which statement is true regarding the impact of culture on end-of-life decision making?

A) African-Americans prefer more conservative, less invasive care options during the end of life.
B) Caucasians prefer aggressive and more invasive care options during the end of life.
C) Culture and religious beliefs may affect end-of-life decision making.
D) Perspectives regarding end-of-life care are similar between and within religious groups.

Question 7

The most critical element of effective early end-of-life decision making is:

A) control of distressing symptoms such as nausea, anxiety, and pain.
B) effective communication between the patient, family, and healthcare team throughout the course of the illness.
C) organizational support of palliative care principles.
D) relocation the dying patient from the critical care unit to a lower level of care.

Question 8

What were the findings of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)?

A) Clear communication is typical in the relationships between most patients and healthcare providers.
B) Critical care units often meet the needs of dying patients and their families.
C) Disparities exist between patients' care preferences and actual care provided.
D) Pain and suffering of patients at end of life is well controlled in the hospital.

Question 9

The patient's husband is very upset because his wife,who is near death,has dyspnea and restlessness.The nurse explains to him that there are some ways to decrease her discomfort,including:

A) respiratory therapy treatments.
B) opioid medications given as needed.
C) incentive spirometry.
D) increased hydration.

Question 10

The family is considering withdrawing life-sustaining measures from the patient.The nurse knows that ethical principles for withholding or withdrawing life-sustaining treatments include which of the following?

A) Any treatment may be withdrawn and withheld, including nutrition, antibiotics, and blood products.
B) Doses of analgesic and anxiolytic medications must be adjusted carefully and should not exceed usual recommended limits.
C) Life-sustaining treatments may be withdrawn while a patient is receiving paralytic agents.
D) The goal of withdrawal and withholding of treatments is to hasten death and thus relieve suffering.

Question 11

A 75-year-old patient,who suffered a massive stroke 3 weeks ago,has been unresponsive and has required ventilatory support since the time of the stroke.The physician has approached the spouse regarding placement of a permanent feeding tube.The spouse states that the patient never wanted to be kept alive by tubes and personally didn't want what was being done.After holding a family conference with the spouse,the medical team concurs and the feeding tube is not placed.This situation is an example of:

A) euthanasia.
B) palliative care.
C) withdrawal of life support.
D) withholding of life support.

Question 12

Which statement is true regarding the effects of caring for dying patients on nurses?

A) Attendance at funerals is inappropriate and will only create additional stress in nurses who are already at risk for burnout.
B) Caring for dying patients is an expected part of nursing and will not affect the emotional health of the nurse if he or she maintains a professional approach with each patient and family.
C) Most nurses who work with dying patients are able to balance care needs of patients with personal emotional needs.
D) Provision of aggressive care to patients for whom they believe it is futile may result in personal ethical conflicts and burnout for nurses.

Question 13

In which of the following situations would a healthcare surrogate or proxy assume the end-of-life decision-making role for a patient?

A) When a dying patient requires extensive heavy sedation, such as benzodiazepines and narcotics, to control distressing symptoms
B) When a dying patient who is competent requests to withdraw treatment against the wishes of the family
C) When a dying patient who is competent requests to continue treatment against the recommendations of the healthcare team
D) When a dying patient who is competent is receiving prn treatment for pain and anxiety

Question 14

Which statement made by a staff nurse identifying guidelines for palliative care would need corrected?

A) Basic nursing care is a critical element in palliative care management.
B) Common conditions that require palliative management are nausea, agitation, and sleep disturbance.
C) Palliative care practices are reserved for the dying client.
D) Palliative care practices relieve symptoms that negatively affect the quality of life of a patient.

Question 15

A 65-year-old patient with a history of metastatic lung carcinoma has been unresponsive to chemotherapy.The medical team has determined that there are no additional treatments available that will prolong life or improve the quality of life in any meaningful way.Despite the poor prognosis,the patient continues to receive chemotherapy and full nutrition support.This is an example of what end-of-life concept?

A) Medical futility
B) Palliative care
C) Terminal weaning
D) Withdrawal of treatment

Question 16

A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated.The patient is on a continuous morphine infusion and has an additional order for lorazepam ( Ativan )1 to 2 mg IV as needed ( prn ).The patient has received no lorazepam (Ativan)during this course of illness.What is the most appropriate nursing intervention to control agitation?

A) Administer fentanyl ( Duragesic ) 25 mg IV bolus.
B) Administer lorazepam ( Ativan ) 1 mg IV now.
C) Increase the rate of the morphine infusion by 50%.
D) Request an order for a paralytic agent.

Question 17

To prevent any unwanted resuscitation after life-sustaining treatments have been withdrawn,the nurse should ensure that:

A) do-not-resuscitate (DNR) orders are written before discontinuation of the treatments.
B) the family is not allowed to visit until the death occurs.
C) DNR orders are written as soon as possible after the discontinuation of the treatments.
D) the change-of-shift report includes the information that the patient is not to be resuscitated.

Question 18

The patient's husband is terrified by the prospect of removing life-sustaining treatments from the patient.He asks why anyone would do that.The nurse explains,

A) "It is to save you money so you won't have such a large financial burden."
B) "It will preserve limited resources for the hospital so other patients may benefit from them."
C) "It is to discontinue treatments that are not helping your wife and may be very uncomfortable for her."
D) "We have done all we can for your wife and any more treatment would be futile."

Question 19

Which nursing intervention would need to be corrected on a care plan for a patient in order to be consistent with the principles of effective end-of-life care?

A) Control of distressing symptoms such as dyspnea, nausea, and pain through use of pharmacological and nonpharmacological interventions
B) Limitation of visitation to reduce the emotional distress experienced by family members
C) Patient and family education on anticipated patient responses to withdrawal of therapy
D) Provision of spiritual care resources as desired by the patient and family

Question 20

A patient with end-stage heart failure is experiencing considerable dyspnea.Appropriate pharmacological management of this symptom includes:

A) administration of 6 mg of midazolam ( Versed ) and initiation of a continuous midazolam infusion.
B) administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion.
C) hourly increases of the midazolam ( Versed ) infusion by 100% dose increments.
D) hourly increases of the morphine infusion by 100% dose increments.

Question 21

Palliation may include: (Select all that apply.)

A) relieving pain.
B) relieving nausea.
C) psychological support.
D) withdrawing life-support interventions.
E) withholding tube feedings.

Question 22

Which interventions can the nurse use to facilitate communication with patients and families who are in the process of making decisions regarding end-of- life care options? (Select all that apply.)

A) Communication of uniform messages from all healthcare team members
B) An integrated plan of care that is developed collaboratively by the patient, family, and healthcare team
C) Facilitation of continuity of care through accurate shift-to-shift and transfer reports
D) Limitation of time for families to express feelings in order to control family grief
E) Reassuring the patient and family that they will not be abandoned as the goals of care shift from aggressive treatment to comfort care

Question 23

Which of the following statements about comfort care is accurate?

A) Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal community.
B) Each procedure should be evaluated for its effect on the patient's comfort before being implemented.
C) Only the patient can determine what constitutes comfort care for him or her.
D) Withdrawing life-sustaining treatments is considered euthanasia in most states.

Question 24

Select interventions that may be included during "terminal weaning" include which of the following? (Select all that apply.)

A) Complete extubation following ventilator withdrawal
B) Discontinuation of artificial ventilation but maintenance of the artificial airway
C) Discontinuation of anxiolytic and pain medications
D) Titration of ventilator support based upon blood gas determinations
E) Titration of ventilator support to minimal levels based upon patient assessment of comfort

Question 25

When providing palliative care,the nurse must keep in mind that the family may include which of the following? (Select all that apply.)

A) Unmarried life partners of same sex
B) Unmarried life partners of opposite sex
C) Roommates
D) Close friends
E) Parents

Question 26

Which therapeutic interventions may be withdrawn or withheld from the terminally ill client? (Select all that apply.)

A) Antibiotics
B) Dialysis
C) Nutrition
D) Pain medications
E) Simple nursing interventions such as repositioning and hygiene