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):

Accepted Answer

Legally recognized documents that provide guidance on an individual's end-of-life choices are advance directives.Advance directives include living wills,durable power of attorney for health care,and healthcare surrogate designations.A guardianship ad litem is a parent who files legal action on the behalf of a child.A healthcare proxy is an individual who is legally designated through statute to make decisions for an incapacitated person.A power of attorney is an individual who is,through filing of legal papers,authorized to act on the behalf of an incapacitated person in legal matters.

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,

Accepted Answer

Forgoing life-sustaining treatments is not the same as active euthanasia or assisted suicide.Killing is an action causing another's death,whereas allowing dying is avoiding any intervention that interferes with a natural death following illness or trauma.

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,

Accepted Answer

The patient may still be able to hear despite appearing to be nonresponsive.

Question 4

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

Accepted Answer

Death is viewed as a failure by society and healthcare providers that results in aggressive management of disease,even in unfavorable situations.Research has indicated that most Americans would prefer to die at home.There is a commonly held belief that people die of distinct diseases,implying that a cure is possible.There is a commonly held belief that the healthcare system exists to treat illness,disease,and injury and to "save" lives.

Question 5

Designated healthcare surrogates should base healthcare decisions on:

Accepted Answer

Healthcare surrogates attempt to have decisions match the wishes of the patient.Although suggestions of family and friends may provide insight into patient desires,actual decisions should be based upon known patient wishes.The physician and healthcare team may provide recommendations,but decisions should be based upon the patient's wishes.

Question 6

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

Accepted Answer

Religious doctrines and cultural beliefs have profound impact on end-of-life decisions.
African-Americans prefer more aggressive and invasive end-of-life care options.Caucasians prefer less aggressive care options at the end of life.Perspectives on end-of-life care vary within and between religious groups.

Question 7

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

Accepted Answer

The failure of clinicians,family members,and patients to openly discuss prognoses,end-of-life wishes,and preferences contributes to care conflicts such as in the Schiavo case.Early discussion of end-of-life wishes is required to promote positive outcomes for the patient and family,and actually should predate illness.Even though symptom control is a significant dimension of palliative care,it is not involved in initial end-of-life decision making.Adequate staffing and facility policies that support the dying patient are critical but should not impact family decision making.The patient should be cared for in an environment that best supports the needs of the patient and family.Even though organizational support of palliative principles is important,it should not drive individual decision making.

Question 8

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

Accepted Answer

Disparities and lack of communication are common in the relationships between patients and healthcare providers.Critical care units are often poorly equipped to meet the needs of dying patients.The SUPPORT study demonstrated that pain and suffering is widespread in hospitals.

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:

Accepted Answer

Dyspnea is best managed with close evaluation of the patient and the use of opioids,sedatives,and nonpharmacologic interventions (oxygen,positioning,and increased ambient air flow).

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?

Accepted Answer

Any treatment that is used to sustain life,including nutrition,fluids,antibiotics,blood products,and respiratory support,may be withdrawn in consultation with the patient and/or surrogate provided that the patient has been deemed terminal or persistently vegetative.Any dose of anxiolytics or analgesics may be used to relieve suffering,although these may have the potential to hasten death.Life-sustaining treatment should not be withdrawn while the patient is receiving paralytic treatments.Death occurs as a consequence of the underlying disease,and the goal of care is to relieve suffering,not hasten death.

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:

Accepted Answer

Because the tube feeding had not been placed in the care of this patient,this scenario is an example of withholding of life support.Withholding of life support does not constitute euthanasia.Withdrawal of life support involves discontinuation of previously established therapies in a terminally ill patient.

Question 12

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

Accepted Answer

Burnout may occur when nurses must provide aggressive care to patients for whom they believe it is futile or when care choices made by patients and/or surrogates differ from those of clinicians.Attendance at funerals may relieve emotional strain in some situations.Meeting the emotional needs of patients and families often requires that the nurse invest emotionally while providing care.Maintaining a professional,healthy distance and being human when working with the dying is a difficult task that requires a great deal of balancing.

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?

Accepted Answer

A patient who requires heavy sedation,such as IV infusions of pain medications or anxiolytic medications,would not be competent to make healthcare decisions.A healthcare proxy or surrogate would be required in this situation.A patient who is deemed competent by the medical team may be responsible for healthcare decisions even if these are not consistent with family beliefs.A surrogate would not assume decision-making responsibilities in this situation.A healthcare team member who cannot support decisions would be responsible for finding an alternative care provider who could support the patient's wishes.

Question 14

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

Accepted Answer

The purpose of palliative care is to relieve negative symptoms that affect the quality of life of a patient.Palliative care is an integral part of every injured or ill patient's care.Basic nursing care,including repositioning,skin care,and provision of a peaceful environment,promote comfort.These conditions all commonly require palliative care techniques.

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?

Accepted Answer

Medical futility is a situation in which therapy or interventions will not provide a foreseeable possibility of improvement in the patient's health status.Palliative care focuses on symptom relief and is not limited to the dying.Terminal weaning refers to withdrawal of artificial ventilation interventions.Withdrawal of treatment refers to removal of established therapies in a terminally ill patient.

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?

Accepted Answer

Lorazepam (Ativan)1 mg IV is an appropriate loading dose for a patient who is benzodiazepine naïve and experiencing agitation during withdrawal of life support.Fentanyl treats pain and morphine controls pain.Paralytic agents are not warranted.

Question 17

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

Accepted Answer

DNR orders should be written before withdrawal of life support; this will prevent any unfortunate errors in unwanted resuscitation during the time period between initiation of withdrawal and the actual death.

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,

Accepted Answer

The goal of withdrawal of life-sustaining treatments is to remove treatments that are not beneficial and may be uncomfortable.

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?

Accepted Answer

Active involvement of family is a critical dimension of end-of-life care.Family members should have access to the patient and inclusion in care to the degree they desire.Limitation of visitors is not consistent with effective end-of-life care practices.
Control of distressing symptoms is a dimension of end-of-life care.Family education and anticipatory guidance are critical elements of end-of-life care.Meeting the emotional and psychological needs of the patient and family through provision of spiritual resources and bereavement care is a critical element of end-of-life care.

Question 20

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

Accepted Answer

Morphine is an excellent agent to control the symptom of dyspnea.A 5-mg IV bolus and initiation of a morphine drip is an appropriate initial intervention to control dyspnea.Initial dosing of midazolam should be 2 to 4 mg,and more is indicated for anxiety.The morphine dose should be titrated incrementally by 50% dose increases.Midazolam is indicated for management of dyspnea and is titrated incrementally by 50% dose increases.

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

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