Question 1

What is the most common complaint heard from families of dying patients?
A) Poor nursing care
B) Inadequate communication
C) Lack of consistent plan of care
D) Confusion among health care team members

Accepted Answer

Communication seems to be the most common source of complaints in families across studies and should be at the center of efforts to improve end-of-life care.Families have commonly complained about infrequent physician communication,unmet communication needs in the shift from aggressive to end-of-life care,and lacking or inadequate communication.

Question 2

Recommendations for creating a supportive atmosphere during end-of-life discussions include which intervention?
A) Telling the family when and where the procedure will occur
B) Beginning the conversation by inquiring about the emotional state of the family
C) Ending the conversation by inquiring about the emotional state of the family
D) Recommendations that the family not be present when the procedure occurs

Accepted Answer

Recommendations for creating a supportive atmosphere during withdrawal discussions include taking a moment at the beginning of the conversation to inquire about the family's emotional state.During the family meeting in which a decision to withdraw life support is made,a time to initiate withdrawal is usually established.

Question 3

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.After a family conference,the practitioner orders a do-not-resuscitate (DNR)order,and palliative care is begun.How does this affect the patient's treatment?
A) The patient will continue to receive the same aggressive treatment short of resuscitation if he has another cardiac arrest.
B) All treatment will be stopped, and the patient will be allowed to die.
C) All attempts will be made to keep the patient comfortable without prolonging his life.
D) The patient will be immediately transferred to hospice.

Accepted Answer

When palliative care is begun,the primary goal is to keep the patient comfortable by continuing assessments and managing symptoms that might cause pain,anxiety,or distress.

Question 4

Which statement regarding organ donation is accurate?
A) Organ donation is a choice only the patient can make for him- or herself.
B) Hospitals must have written protocols for the identification of potential organ donors.
C) Organ donation must be requested by the nurse caring for the dying patient.
D) Individual institutional policies govern how organ donation requests are made.

Accepted Answer

The Social Security Act Section 1138 requires that hospitals have written protocols for the identification of potential organ donors.The Joint Commission has a standard on organ donation.The nurse must notify the organ procurement official to approach the family with a donation request.

Question 5

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation.The patient continues to grimace and fight the ventilator.What nursing intervention would be appropriate?
A) Increase the morphine dosage until no signs of pain or discomfort are present.
B) Increase the morphine drip, but if the patient's respiratory rate drops below 10 breaths/min, return to the original dosage.
C) Gradually decrease the morphine and switch to Versed to avoid respiratory depression.
D) Ask the family to leave the room because their presence is causing undue stress to the patient.

Accepted Answer

Even though opiates can cause respiratory depression,the goal in palliative care is to alleviate pain and suffering.A bolus dose of morphine (2-10 mg IV)and a continuous morphine infusion at 50% of the bolus dose per hour is recommended.Because many critical care patients are not conscious,assessment of pain and other symptoms becomes more difficult.Gélinas and colleagues recommended using signs of body movements,neuromuscular signs,facial expressions,or responses to physical examination for pain assessment in patients with altered consciousness.

Question 6

A patient was admitted to the critical care unit after having a cerebrovascular accident (CVA)and myocardial infarction (MI).The patient has poor activity tolerance,falls in and out of consciousness,and has poor verbal skills.The patient has been resuscitated four times in the past 6 hours.The patient does not have advance directives.Family members are at the bedside.Who should the practitioner approach to discuss decisions of care and possible do-not-resuscitate (DNR)status?
A) Patient
B) Family
C) Hospital legal system
D) Hospital ethics committee

Accepted Answer

Patients' capacity for decision making is limited by illness severity; they are too sick or are hampered by the therapies or medications used to treat them.When decision making is required,the patient is the first person to be approached.

Question 7

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient does not have an advance directive.Which statement would be the best way to approach the family regarding his ongoing care?
A) "I will refer this case to the hospital ethics committee, and they will contact you when they have a decision."
B) "What do you want to do about the patient's care at this point?"
C) "Dr. Smith believes that there is no hope at this point and recommends do-not-resuscitate status."
D) "What would the patient want if he knew he were in this situation?"

Accepted Answer

Approaching the family and asking what they know about the patient's wishes and preferences is the best way to begin this discussion.Emotional support for the patient and the family is important as they discuss advance care planning in the critical care setting.

Question 8

In caring for a patient receiving palliative care,antiemetics are used in the treatment of what problem?
A) Dyspnea
B) Nausea and vomiting
C) Anxiety
D) Edema

Accepted Answer

Nausea and vomiting are common and should be treated with antiemetics.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).Benzodiazepines,especially midazolam with its rapid onset and short half-life,are frequently used to treat anxiety.

Question 9

Haloperidol are traditionally been used to managed which symptom?
A) Anxiety
B) Dyspnea
C) Delirium
D) Pain

Accepted Answer

Delirium is commonly observed in critically ill patients and in those approaching death.Haloperidol and benzodiazepines (such as midazolam,lorazepam)have traditionally been used to manage delirium but have side effects that can be problematic.More recently,atypical antipsychotics have proven equally effective without troubling side effects of other drug classes.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).Benzodiazepines,especially midazolam with its rapid onset and short half-life,are frequently used to treat anxiety.Morphine is the most common drug used for pain management.

Question 10

Hospice care is an option that should be considered,especially in end-stage illness.Hospice care can help families with which issue(s)?
A) Organ and tissue donations
B) Symptom management and family support
C) Procurement of advance directives and living wills
D) Legal and voluntary euthanasia

Accepted Answer

Health professionals can assist patients and families by providing information about the hospice benefit,particularly regarding the aggressive symptom management and family support.Organ donations must follow Social Security Act Section 1138 regarding written protocols for identification of potential organ donors and notification of organ recovery agencies.Advance directives can be taken care of at the hospital or legal firm.Euthanasia generally not offered through hospice.

Question 11

Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts?
A) The patient's wishes
B) Experience of the staff
C) The family's need to participate in all aspects of the patient's care
D) State regulatory issues
E) Seeing the resuscitation may confirm the impact of decisions made or delayed

Accepted Answer

The decision to allow family members at the bedside during resuscitative efforts should be made by the family and caregivers and be based on needs and experiences.The family may become more aware of what is involved in decisions if they are present during procedures or resuscitative attempts.Seeing the steps of resuscitation may make clearer the impact of decisions made or delayed.

Question 12

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.

Accepted Answer

The goal of comfort care is to provide only treatments that do not cause pain or other discomfort to the patient.

Question 13

A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes.The patient is sure he will not be here tomorrow because his grandparent is waiting for him.What is the patient exhibiting?
A) Anxiety
B) Delirium
C) Metabolic derangement
D) Near-death awareness

Accepted Answer

The same behaviors may be seen in conscious critical care patients near death.Having an awareness of the phenomenon enables more careful assessment of behaviors that may be interpreted as delirium,acid-base imbalance,or other metabolic derangements.These behaviors include communicating with someone who is not alive,preparing for travel,describing a place the patient can see,or even knowing when death will occur.

Question 14

The patient's condition has deteriorated to the point where she can no longer make decisions about her own care.Which nursing interventions would be most appropriate?
A) Obtain a verbal do-not-resuscitate (DNR) order from the practitioner.
B) Continue caring for the patient as originally ordered because she obviously wanted this.
C) Consult the hospital attorney for recommendations on how to proceed.
D) Discuss with the family what the patient's wishes would be if she could make those decisions herself.

Accepted Answer

If the patient is not able to make end-of-life decisions for herself,her family members should be approached to discuss the next steps because they may have insight into what her wishes would be.

Question 15

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The decision is made to remove the patient from the ventilator.Which of the following statements is most accurate?
A) The cardiac monitor should be left on so everyone will know when the patient has died.
B) Opioids, sedatives, and neuromuscular blocking agents should be discontinued just before removing the ventilator.
C) The family and health care team should decide the best method for removing the ventilator terminal wean versus immediate extubation.
D) If terminal weaning is selected, the family should be sent to the waiting room until the ventilator has actually been removed.

Accepted Answer

The choice of terminal wean as opposed to extubation is based on considerations of access for suctioning,appearance of the patient for the family,how long the patient will survive off the ventilator,and whether the patient has the ability to communicate with loved ones at the bedside.

Question 16

In one study found that greater family satisfaction with withdrawal of life support was associated with which of the following measures?
A) The patient appearing comfortable
B) A chance to voice concerns
C) Discussions were held in the patient's room
D) The process was well explained
E) Adequate privacy during withdrawal of life support

Accepted Answer

After the patient's death,greater family satisfaction with withdrawal of life support was associated with the following measures: the process of withdrawal of life support being well explained; withdrawal of life support proceeding as expected; patient appearing comfortable; family and friends being prepared; appropriate person initiating discussion; adequate privacy during withdrawal of life support; and a chance to voice concerns.

Question 17

What is a powerful influence when the decision-making process is dealing with recovery or a peaceful death?
A) Hope
B) Religion
C) Culture
D) Ethics

Accepted Answer

Hope is a powerful influence on decision making,and a shift from hope for recovery to hope for a peaceful death should be guided by clinicians with exemplary communication skills.Ethics,religion,and culture can influence the decision process regarding care and end-of-life decisions.

Question 18

Disagreement and distress among practitioners,nurse practitioners,and critical care nurses can lead to what issue?
A) Moral indignation
B) Ethical resentment
C) Moral distress
D) Interprofessional anguish

Accepted Answer

Nurses and doctors frequently disagree about the futility of interventions.Sometimes nurses consider withdrawal before practitioners and patients do,and they then believe the care they are giving is unnecessary and possibly harmful.This issue is a serious one for critical care nurses because moral distress can lead to burnout.

Question 19

What are the two basic ethical principles underlying the provision of health care?
A) Beneficence and nonmaleficence
B) Veracity and beneficence
C) Fidelity and nonmaleficence
D) Veracity and fidelity

Accepted Answer

The two basic ethical principles underlying the provision of health care are beneficence and nonmaleficence.

Quiz 10: End-Of-Life Care

What is the most common complaint heard from families of dying patients?

Recommendations for creating a supportive atmosphere during end-of-life discussions include which intervention?

Which statement regarding organ donation is accurate?

In caring for a patient receiving palliative care,antiemetics are used in the treatment of what problem?

Haloperidol are traditionally been used to managed which symptom?

Hospice care is an option that should be considered,especially in end-stage illness.Hospice care can help families with which issue(s) ?

Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts?

Which of the following statements about comfort care is accurate?

A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes.The patient is sure he will not be here tomorrow because his grandparent is waiting for him.What is the patient exhibiting?

The patient's condition has deteriorated to the point where she can no longer make decisions about her own care.Which nursing interventions would be most appropriate?

In one study found that greater family satisfaction with withdrawal of life support was associated with which of the following measures?

What is a powerful influence when the decision-making process is dealing with recovery or a peaceful death?

Disagreement and distress among practitioners,nurse practitioners,and critical care nurses can lead to what issue?

What are the two basic ethical principles underlying the provision of health care?