Exam View - CH0009 Harding 11e TB Lewis

Med Surg (Baton Rouge Community College)

Chapter 09: Palliative and End-of-Life Care

MULTIPLE CHOICE

1. 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.
   • ANS: C
2. 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 any longer.”
   • 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.”
   • ANS: B
3. 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 would be accurate for the nurse to make to the patient’s family?
   • a. “These vital signs will continue to increase until death finally occurs.”
   • b. “These vital signs demonstrate the body’s ability to compensate and heal.”
   • c. “These vital signs are an expected response now but will slow down later.”
   • d. “These vital signs may indicate an improvement in the patient’s condition.”
   • ANS: C
4. 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 uncertain prognosis
   • ANS: B
5. 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 issue would the nurse identify as a concern in working with the patient’s spouse?
   • a. Fear
   • b. Anxiety
   • c. Hopelessness
   • d. Difficulty coping
   • ANS: D
6. 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.
   • ANS: D
7. 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 by the nurse would show respect for the patient?
   • 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.
   • ANS: B
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 prescribed 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.
   • ANS: A
9. 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.
   • ANS: C
10. 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.
    • ANS: B
11. A middle-aged patient tells the nurse, “My mother died 2 months ago. I have been thinking about all the good times we shared together every day.” What type of grief is the patient describing?
    • a. Adaptive grieving
    • b. Anticipatory grief
    • c. Dysfunctional reactions
    • d. Prolonged grief disorder
    • ANS: A
12. The son of a dying patient tells the nurse, “Mother doesn’t 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.”
    • ANS: B
13. Which patient should the nurse refer for hospice care?
    • a. A 40-year-old patient with AIDS-related dementia who needs pain management
    • b. A 70-year-old patient with lymphoma who is unable to discuss issues related to dying
    • c. A 60-year-old patient with chronic severe pain because of spinal arthritis and vertebral collapse
    • d. A 50-year-old patient with advanced liver failure whose family can no longer provide care at home
    • ANS: A
14. The nurse admits a terminally ill patient to the hospital. What is the first action that the nurse should plan to complete?
    • a. Determine the patient’s wishes about end-of-life care.
    • b. Discuss the normal grief process with the patient and family.
    • c. Emphasize the importance of addressing any family concerns.
    • d. Encourage the patient to talk about fears or unresolved issues.
    • ANS: A
15. Which action should the nurse take first 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 may want to have them at the bedside.
    • ANS: B

MULTIPLE RESPONSE

1. Which nursing actions for the care of a dying patient can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? (Select all that apply.)
   • a. Provide postmortem care to the patient.
   • b. Teach family members about common signs of approaching death.
   • c. Administer prescribed morphine sulfate sublingual for pain control.
   • d. Encourage the family members to talk with and reassure the patient.
   • e. Determine how often physical assessments are needed for the patient.
   • ANS: A, C, D