Deck 11: Caring for the Patient at End of Life

Question 1

A terminal patient with a fulminating leg wound needs surgery, yet it is unlikely the patient will survive the procedure. The nurse could ethically support which action by the health care team?

A) Explaining that the surgery is needed and every effort will be done to keep the patient alive
B) Deciding not to conduct the surgery and determining if there are other treatment approaches
C) Telling the patient that offering surgery was an error and that treatment will be done with medications and therapy
D) Conducting the surgery without telling the patient that survival is unlikely.

Answer 1

Deciding not to conduct the surgery and determining if there are other treatment approaches

Question 2

The health care team has just given the family of a terminally ill patient an update on the patient's status. Thirty minutes later the patient's sibling says, "The family does not understand the last update the physician gave us." Which nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Repeat the information the physician provided.
B) Have the physician paged to talk to the family again.
C) Explain the information in a different way.
D) Offer to call the physician's answering service to leave a message for the family.
E) Have the unit supervisor talk with the family.

Answer 2

Repeat the information the physician provided.
Explain the information in a different way.

Question 3

The nurse is preparing an analgesic infusion for a cancer patient who is in pain and is nearing the end of life. What should the nurse do to ensure this patient's comfort?

A) Titrate the medication to help with pain relief and not hasten the dying process.
B) Use meperidine in the infusion.
C) Limit the amount of medication infused.
D) Contact the pharmacy for the correct dose to provide the patient.

Answer 3

Titrate the medication to help with pain relief and not hasten the dying process.

Question 4

A competent elderly patient has a living will that specifies avoiding resuscitation and heroic life support measures. The family members are not supportive of this directive. Which action by the nurse is most appropriate?

A) Consider the document valid and document its existence in the medical record.
B) Contact the Social Services department.
C) Notify the hospital attorney.
D) Explain to the patient that the conflict could invalidate the document.

Question 5

A terminally ill patient is unconscious. Which nursing assessment findings would the nurse evaluate as possible pain responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The patient's breathing pattern changes.
B) The patient becomes diaphoretic.
C) It is unlikely that the unconscious patient will experience pain.
D) Agitation will begin or will increase.
E) Facial grimacing will occur with movement.

Question 6

A terminally ill patient is receiving palliative care. How would the nurse explain the purpose of this type of care to the family?

A) "Palliative care is designed to alleviate suffering and promote quality of life."
B) "Palliative care reduces pain and prevents medical complications."
C) "Palliative care's purpose is to control the side effects of illness while postponing death."
D) "Palliative care involves withdrawing all medical care to allow natural death."

Question 7

While preparing for the discharge of an elderly, terminally ill patient, the family asks for information concerning the most appropriate time to become involved with a hospice agency. Which action by the nurse is most appropriate?

A) Assist the family in making contact with a hospice agency at this time.
B) Estimate the patient's life expectancy to gauge when contact with hospice should be made.
C) Encourage the family to "hold off" making the contact until death is very close.
D) Determine what expectations the family has of the hospice agency.

Question 8

The family of an incapacitated patient desires one course of treatment that contradicts the decisions of the person with durable power of attorney. The disagreement is affecting the patient's nursing care. What should the nurse do?

A) Tell the person with durable power of attorney that he has to get the family's consent.
B) Follow the family's desires.
C) Provide care according to the decisions of the person with durable power of attorney.
D) Ask the physician to talk with the family and the person with durable power of attorney.

Question 9

The medical team has proposed a new therapy for a patient who is terminally ill. The nurse should ensure that the patient and family understand which aspects of the therapy before they make a decision about its implementation? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The goals of the treatment
B) The likelihood that the goals of therapy will be met
C) The treatment burden
D) Predicted quality of life after the treatment
E) Implications for the health care community

Question 10

A terminally ill patient has been transferred from acute care to palliative care. The health care team should review former orders for which characteristics? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Does the order comply with the patient's wishes?
B) Does this treatment provide symptom relief?
C) Does the treatment make the best use of resources?
D) Does the intervention support the patient's emotional health?
E) Does the intervention support the patient's spiritual health?

Question 11

A patient is prescribed an intravenous midazolam drip at a rate of 1-5 mg/hr, titrated to symptom relief. The nurse would start this drip at ______ mg/hr.

Question 12

A patient with a chronic illness who is receiving palliative care asks the nurse if a newly prescribed medication will cure the disease. What is the nurse's best response?

A) "It will help you be more comfortable. I don't think it's going to cure the disease."
B) "Of course it's going to cure the disease."
C) "If you believe it will cure the disease, then it will."
D) "I don't think it's going to help or hurt at this time."

Question 13

Which nursing intervention follows the principles of palliative care?

A) Encouraging physical therapy to restore prior level of functioning
B) Talking to the patient about plans for funeral arrangements
C) Talking to the patient about possibly becoming an organ donor
D) Facilitating a consult to promote weight gain

Question 14

A woman is acting as primary caregiver for her husband, who is on hospice care. The wife needs to keep her own physician's appointment. What advice should the nurse give?

A) "Your husband should be okay for a couple of hours on his own."
B) "Can your daughter take off from work to stay with your husband?"
C) "Hospice can provide a caregiver to be with your husband while you are at your appointment."
D) "Maybe you can delay your appointment until someone can stay with your husband."

Question 15

A patient is experiencing delirium. Which group of medications should the nurse consider administering to help reduce delirium?

A) Neuroleptics
B) Benzodiazapines
C) NSAIDs nonsteroidal anti-inflammatory drugs)
D) Opioids

Question 16

The nurse is planning palliative care for a patient with severe atherosclerotic disease. What is the highest priority for this patient?

A) Tolerance of physical activity
B) Use of available financial resources
C) Redesigning the patient's home to support assistive devices
D) Pain and symptom management

Question 17

Several visitors are in the room of a terminally ill patient. The nurse enters the room to discuss the plan of care for the patient. Which actions should be taken?

A) Stand at the foot of the patient's bed and tell all present the best course of action.
B) Ask the patient which individuals he or she would like to have stay in the room.
C) Ask the other patient in the room to raise the volume of the television.
D) Sit down next to the patient and discuss the plan.

Question 18

A patient asks the nurse what it means to have hospice care at home. What is the most accurate response to this patient?

A) "Hospice makes sure that you are comfortable at home."
B) "Hospice care helps cure your illness."
C) "Hospice care is for patients who will be sick for longer than a year."
D) "Hospice care means all your needs will be met."

Question 19

A terminally ill patient is experiencing dyspnea. What should the nurse do to help the patient feel more comfortable?

A) Raise the head of the bed.
B) Gently massage the patient.
C) Replace the oxygen cannula with a face mask.
D) Provide oral care.

Question 20

A patient is very near the end of life. Which nursing interventions are indicated to assist the family during their grieving process? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Teach the family about the normal events that occur just prior to death.
B) Remove as much monitoring equipment from the patient and the room as is possible.
C) Support the family's use of cultural and religious customs.
D) Avoid using harsh terms such as "death" or "dying" when describing the situation.
E) Limit the number of people at the bedside to no more than two or three.