Deck 11: Care at the End of Life

Question 1

The health status of an older patient with liver disease is rapidly deteriorating. There is no documentation on the medical record regarding the patient's care wishes. What should the nurse do to ensure the patient receives care that is desired at the end of life?
1) Ask social services to provide an advance directive for the patient to complete.
2) Talk with the patient regarding what the patient wants after the hospitalization ends.
3) Call a meeting with the patient, family, and primary care physician to discuss care goals.
4) Discuss the patient's dire situation with the family and find out what their wishes might be.

Answer 1

3

Question 2

The family of an older patient who is terminally ill wants to know if the patient can have a massage to help with the pain. How should the nurse respond to the family? Select all that apply.
1) "It might reduce the patient's anxiety."
2) "It might help reduce the patient's pain."
3) "It might help the patient breathe better."
4) "It could help improve the patient's mood."
5) "It could cause the patient more discomfort."

Answer 2

1, 2, 3, 4

Question 3

The nurse is planning care for an older patient who is dying. Which interventions will assist the patient to die with dignity? Select all that apply.
1) Maintain cleanliness and patient's personal hygiene.
2) Provide pain management and control symptoms.
3) Make decisions for the patient and family.
4) Coordinate goals of treatment with the patient's values.
5) Communicate patient needs to the healthcare team.

Answer 3

1, 2, 4, 5

Question 4

An older patient with terminal cancer is considering hospice care but is concerned that Medicare will stop payments if the care is provided for longer than 6 months. What can the nurse respond to this patient? Select all that apply.
1) Medicare does not limit the hospice benefit.
2) Medicare regulations discourage a longer use of the benefit.
3) Hospice costs more than traditional hospital or long-term care.
4) Patient may enroll when the life expectancy is 6 months or less.
5) Hospice supports the family for 6 months after the patient's death.

Question 5

The hospice nurse has provided a presentation to student nurses on barriers to effective end-of-life care. Which statement made by a student indicates that additional teaching is needed?
1) "Most patients have good pain management and are comfortable when they die."
2) "Referrals to hospice or palliative care often aren't made when appropriate."
3) "When a patient is dying, there can be disagreements about the goal of their care."
4) "Healthcare professionals often have difficulty in being honest with patients when a prognosis is poor."

Question 6

An older patient dying from a terminal illness reports that the last dose of pain medication provided barely reduced the level of pain. What should the nurse do to help this patient?
1) Give the patient pain medication every hour.
2) Contact the physician for an adjustment in pain medication.
3) Provide the pain medication at the next scheduled dose time.
4) Give the patient another dose of the medication even though it is before the scheduled time.

Question 7

The nurse administers a narcotic for pain to a terminal patient with end-stage pulmonary disease and dementia. After one hour, the patient exhibits facial grimacing and restlessness. How should the nurse interpret these assessment findings?
1) The patient has continuing pain.
2) The patient is experiencing a sleep disorder.
3) The patient requires comfort measures.
4) The patient assessment is is within normal limits.

Question 8

An older patient with terminal cancer asks the nurse to explain palliative care. How should the nurse respond to this patient? Select all that apply.
1) "It is the same as hospice care."
2) "It is always provided in the home."
3) "It can be provided along with life-prolonging care."
4) "It is helpful for chronic health problems for which there is no cure."
5) "It improves the quality of life while facing a life-threatening illness."

Question 9

The nurse is caring for an older patient who is terminally ill and in the end stages of life. Which actions by the patient would the nurse anticipate? Select all that apply.
1) Asking an estranged brother to make a hospital visit.
2) Assigning a family member as executor of their estate.
3) Discussing pain management with their physician.
4) Voicing concerns of leaving behind loved ones after death.
5) Increasing the hours for private duty aid to assist with personal care needs.

Question 10

The family of an older patient dying of liver cancer is concerned that the patient will not eat or drink. The patient is alert and oriented, and expresses no desire to eat. What nursing action would be best?
1) Request an order from the physician for a feeding tube.
2) Obtain a dietary consult for feeding supplements.
3) Encourage the family to bring in home-cooked food.
4) Comply with the patient's wishes despite the family's concern.

Question 11

The nurse is planning oral hygiene for an older patient with a terminal illness who has an intact swallowing reflex. Which interventions would be appropriate for this patient? Select all that apply.
1) Offer ice chips frequently.
2) Provide care with soft swabs.
3) Apply petroleum jelly to the lips.
4) Brush the teeth three times a day.
5) Avoid using alcohol-based solutions.

Question 12

A patient with terminal cancer is experiencing the denial phase of grieving. Which statement by the patient best reflects this stage?
1) "I look at myself in the mirror and I look healthy. How can I be dying?"
2) "If I start exercising every day and taking my vitamins, I know that God will cure me."
3) "I can't stop crying. I'm sad for myself and my children."
4) "I've lived a good life and tried to be a good person."

Question 13

Hospice care has been ordered in the home for an older patient who is terminally ill. What is the hospice nurse's priority assessment?
1) Assess the patient's need to be admitted to the hospital.
2) Assess the patient's financial ability to pay for hospice service.
3) Assess the patient's funeral and burial arrangements.
4) Assess the patient's needs to be comfortable at home.

Question 14

A new nurse is caring for an older patient who is nearing death. What is the nurse's best action before caring for this patient?
1) Confirm the patient's Do Not Resuscitate status.
2) Review the facility's policy on post-mortem care.
3) Reflect and examine personal feelings and fears about death.
4) Contact the funeral home to notify of impending death.

Question 15

While providing postmortem care to a patient who has died the patient elicits a respiratory sound when turned. What should the nurse do?
1) Check for a pulse.
2) Reposition the airway.
3) Continue with the postmortem care.
4) Report to the physician the patient is still breathing.

Question 16

The nurse is caring for a patient who is terminally ill and can no longer speak. Which best indicates that this patient is in pain?
1) Skin is cool and moist to touch.
2) Facial grimacing with moaning when turned
3) Cyanotic feet and lower legs
4) Cheyne-Stokes respiratory pattern

Question 17

An older patient with heart and end-stage renal failure is hearing things and seeing things that others do not. How does the nurse best describe this finding?
1) Deteriorating sense of vision and hearing
2) Late-onset mental illness
3) Overdose of narcotic medication
4) Visual and auditory hallucinations at the end of life

Question 18

The home care nurse is performing wound care on a newly widowed patient whose adult daughter died six months ago. Which statement by the patient is most concerning to the nurse?
1) "I've been so lonely. At least you come to visit me."
2) "I pass the time by writing my life's story in a journal."
3) "I have no regrets. I've lived a good, long life."
4) "I don't know why God took both my wife and daughter from me so soon."

Question 19

The family of an older patient with a terminal illness has been aware of the patient's pending death and is present when the patient dies. The family's reaction to the patient's death was very emotional and demonstrated a state of disbelief. How should the nurse interpret this family's behavior?
1) Irrational behavior
2) Expression of anger
3) Maladaptive coping of the family
4) Normal shock when experiencing the loss of a loved one

Question 20

An older patient is not breathing well and has cold, mottled skin. The patient has a living will and requests comfort measures only. What should the nurse do to care for this patient?
1) Ask the family what they want to be done for the patient.
2) Contact the physician for orders to control the patient's breathing.
3) Provide personal hygiene and skin care as outlined in the care plan.
4) Withhold pain medication, hygiene, and nutrition until the patient dies.

Question 21

An older patient experiencing cancer pain is prescribed intravenous pain medication. What actions will the nurse take when administering this medication? Select all that apply.
1) Assess the effectiveness of the pain medication after each administration.
2) Use the appropriate fluid delivery system when administering intravenously.
3) Offer oral medications for breakthrough pain management.
4) Withhold pain medication until the pain becomes intolerable.
5) Ensure the intravenous site does not become infected or infiltrated.

Question 22

The hospice nurse is discussing the addition of adjuvant medication to help an older patient with cancer pain. Which types of medications would the considered as adjuvant for this type of pain? Select all that apply.
1) Antiemetics
2) Corticosteroids
3) Antidepressants
4) Anticonvulsants
5) Muscle relaxants

Question 23

An older patient who is dying has complained of ongoing pain for several days. What is the best way for this patient's pain to be treated at the end of life?
1) Give immediate-release medications routinely.
2) Refrain from administering pain medication at end of life.
3) Administer maximum doses of long and short-acting pain medication routinely.
4) Give long-acting medications routinely and immediate-release doses with breakthrough pain.

Question 24

A newly licensed nurse is preparing to provide postmortem care for the first time and asks for help. What is the staff nurse's best response?
1) "Postmortem care is something that a nurse must learn to do. Take out all tubes and clean the body."
2) "Family members rarely ask to see the body so just clean the deceased from the shoulders and up."
3) "You can delegate this to the nursing assistant since it is within their scope of care."
4) "Providing postmortem care shows respect and dignity to the patient. But I can understand that you are nervous."

Question 25

An older patient who is dying is unable to fully close the eyes. What can the nurse do to protect the patient's eyes from irritation?
1) Apply eye guards.
2) Apply artificial tears.
3) Tape the eyes closed.
4) Reduce the room lighting.