Deck 17: Nursing Care of Patients at the End of Life

Question 1

The nurse is reviewing the chart of a patient to determine if he is appropriate for hospice. Which qualification supports hospice care?

A)Patient unresponsive
B)Need for 24-hour care
C)Prognosis of 6 months or less
D)Diagnosis of cancer

Answer 1

Prognosis of 6 months or less

Question 2

A patient asks what a do not resuscitate (DNR) order means. What should the nurse explain to the patient?

A)"A DNR order means that you will not be placed on a ventilator if your heart stops and you require CPR."
B)"A DNR order means you will not be resuscitated if your heart stops and that all therapeutic support will be withdrawn."
C)"A DNR order means that you will receive everything you need to remain comfortable, but you will not receive treatment that will prolong life."
D)"A DNR order means you will not be resuscitated if your heart stops; you can specify whether you still want treatment to prolong your life or only care that keeps you comfortable."

Answer 2

"A DNR order means you will not be resuscitated if your heart stops; you can specify whether you still want treatment to prolong your life or only care that keeps you comfortable."

Question 3

The adult daughter of a terminally ill patient is upset because the patient is confused and is talking to people who are not in the room. What should the nurse do to help the patient and daughter? (Select all that apply.)

A)Encourage the patient to continue to talk.
B)Make sure that a dim light is on in the patient's room.
C)Suggest the daughter provide the patient with sips of fluids.
D)Explain to the daughter that confusion is common and expected.
E)Encourage the daughter to provide tactile stimulation to the patient.

Answer 3

Encourage the patient to continue to talk.
Make sure that a dim light is on in the patient's room.
Explain to the daughter that confusion is common and expected.

Question 4

The nurse is providing hospice care for a patient in the terminal phase of lung cancer. Which nursing actions would be appropriate? (Select all that apply.)

A)Provide low-dose morphine.
B)Place a fan at the patient's bedside.
C)Encourage the patient to bathe daily.
D)Administer diuretic therapy as ordered.
E)Position the patient upright in a recliner with pillows. 6.Teach family members how to perform deep tracheal suctioning.

Question 5

A terminally ill patient who is not able to talk is demonstrating restlessness. What actions can the nurse take to help this patient achieve comfort? (Select all that apply.)

A)Medicate for pain.
B)Elevate the head of the bed.
C)Measure oxygen saturation.
D)Reposition the patient in bed.
E)Ensure incontinence pad is clean and dry.

Question 6

A dying patient is experiencing copious secretions, difficulty in swallowing, and labored breathing. Which interventions should the nurse perform? (Select all that apply.)

A)Suction secretions.
B)Encourage oral fluids.
C)Place a dehumidifier in the room.
D)Administer scopolamine as ordered.
E)Increase oxygen to 3 L per nasal cannula.
F)Place the patient in Fowler or semi-Fowler position.

Question 7

A patient with lung cancer who is expected to die within a few days is being given a blood transfusion. Family members, who realize death is imminent, ask, "Why are you giving a blood transfusion when we all know death is just around the corner?" Which response by the nurse to the family is most appropriate?

A)"That question is best answered by the physician during rounds."
B)"It is my duty as a nurse to continue to administer life-prolonging treatments until the patient dies."
C)"The blood will raise the hemoglobin level, which will increase energy level and sense of well-being."
D)"The transfusion will help increase the patient's oxygen levels. It will not prolong life, but will increase comfort."

Question 8

The nurse is reviewing the nutritional status for a group of patients. In which patients would a feeding tube most likely be beneficial? (Select all that apply.)

A)An 80-year-old patent with dementia
B)A 76-year-old patient with terminal cancer
C)A 65-year-old patient recovering from pneumonia
D)A 90-year-old patient with diabetes and heart failure
E)A 55-year-old with esophageal cancer who is receiving radiation therapy
F)A 55-year-old patient receiving chemotherapy and experiencing loss of appetite

Question 9

The nurse is scheduling a hospice team to meet with the family of a dying patient. Which individuals will most likely participate in this meeting? (Select all that apply.)

A)Nurse to manage symptoms of pain and nausea
B)Social worker to assist with community resources
C)Chaplain to provide spiritual and emotional support
D)Physical therapist working to regain patient ability to walk
E)Bereavement counselor to provide assistance to family and loved ones 6.Hospitalist to direct an emergency response team and provide cardiopulmonary resuscitation (CPR)

Question 10

A patient with terminal cancer has just died. Which actions should the nurse take during the immediate postmortem period? (Select all that apply.)

A)Bathe and dress the patient.
B)Ask the family if they want the patient's face covered or uncovered.
C)Remove all tubes, medical supplies, and equipment from the bedside.
D)Provide the family a place away from the patient's room to talk and grieve.
E)Notify the physician with the patient's time of death per institutional policy. 6.Recommend that the family donate the patient's organs as a way to find meaning from the death.

Question 11

The nurse is providing care to a patient with a terminal illness. What should be the nurse's priorities when providing care to this patient? (Select all that apply.)

A)Helping the patient define goals of care
B)Preparing the family for life after the patient has died
C)Encouraging the patient to have hope for a full recovery
D)Supporting the patient through losses leading to a good death
E)Helping the patient communicate care wishes to health care providers (HCPs)

Question 12

A patient asks the nurse to explain a durable power of attorney. Which statement by the nurse is most accurate?

A)"A durable power of attorney is a person you choose to speak for you when you cannot make decisions."
B)"It is a document that provides instruction to the health care provider regarding your preferences."
C)"This is a document stating you do not want to be resuscitated if your heart stops."
D)"This gives the nurse power to make any medical decisions on your behalf."

Question 13

During the last vital signs assessment, a patient with end-stage heart failure has a body temperature of 102.6°F. Which action should the nurse take at this time?

A)Provide additional blankets.
B)Assist to a side-lying position.
C)Encourage increased oral fluid intake.
D)Administer acetaminophen as prescribed.

Question 14

The nurse is discussing a terminal diagnosis with a patient. Which is most appropriate for the nurse to include?

A)"Tell me what you know about your diagnosis."
B)"You shouldn't be angry or blame God for this."
C)"The sooner you accept this diagnosis, the better."
D)"There is a good support group you should attend."

Question 15

The nurse is caring for a dying patient under hospice care. Which is an example of nonverbal communication?

A)Make eye contact with the patient.
B)Encourage the patient to reminisce.
C)Ask close-ended questions.
D)Answer any questions the patient may have.

Question 16

A terminally ill patient is experiencing mouth discomfort. Which actions should the nurse take to help this patient? (Select all that apply.)

A)Offer ice chips.
B)Offer sips of water.
C)Apply lanolin to the lips.
D)Provide an alcohol-based mouthwash.
E)Use sponge-tipped toothettes for mouth care.

Question 17

The licensed practical nurse/licensed vocational nurse (LPN/LVN) notifies the registered nurse (RN) that a patient under hospice care is in respiratory distress. Which clinical manifestation supports this finding?

A)Increased oxygen saturation
B)Decreased respiratory rate
C)Increased respiratory effort
D)Respiratory rate of 12 breaths/min

Question 18

The nurse is concerned that a patient has a short time left to live. Which criterion is the nurse using that indicates a prognosis of 6 months or less to live? (Select all that apply.)

A)Incontinence
B)Functional decline
C)Increased agitation
D)Recurrent infections
E)Frequent hospitalizations
F)Weight loss of 10% or more

Question 19

A family member is concerned that a patient near the end of life is not eating or drinking and asks the nurse how the family can help the patient increase oral intake. Which response by the nurse is most appropriate?

A)"The best way to feed the patient is with a syringe and small amounts of water or liquid feeding."
B)"The less the patient drinks, the less urination will be necessary, and urination can be uncomfortable at this point in the dying process."
C)"The starvation process at the end of life is quite natural; a side benefit is that lower doses of medications are needed to keep the patient comfortable."
D)"As your family member becomes dehydrated from not eating or drinking, natural endorphins will be released, which increase comfort near the end of life."

Question 20

The nurse is caring for a patient who is unconscious and begins to make a gurgling sound, or death rattle. Which action should the nurse take?

A)Administer oxygen as ordered.
B)Instruct the patient to cough.
C)Give the patient a sip of water.
D)Suction the patient.