Deck 15: End-of-Life Care

Question 1

The totally competent 76-year-old female with terminal cancer is fatigued and tearful about the ineffectiveness of her treatment. She tells the nurse that she wishes she had never started it but now feels obligated to continue. What would be the most appropriate explanation by the nurse regarding the treatment?

A) Once treatment has begun, the doctor should decide about any changes.
B) She may change her mind about treatment at any time.
C) Decisions about treatment should be made by the person who is her medical power of attorney.
D) Cessation of treatment will shorten her life.

Answer 1

She may change her mind about treatment at any time.

Question 2

What are the benefits of an advance directive? (Select all that apply.)

A) It is legally binding.
B) It remains in effect until the family changes it.
C) It prevents last-minute confusion about the wishes of the patient.
D) It prevents violation of end-of-life choices.
E) It clarifies end-of-life issues for the family.

Answer 2

It is legally binding.
It prevents last-minute confusion about the wishes of the patient.
It prevents violation of end-of-life choices.
It clarifies end-of-life issues for the family.

Question 3

The nurse becomes tearful at the death of a patient. What would be the most appropriate response of the nurse?

A) Leave the room so that the family will not witness the unprofessional behavior.
B) Touch the hand of the daughter and say, "We'll miss your dad."
C) Become occupied with rearranging a floral bouquet until emotions are under control.
D) Ask family members to leave the room so the post mortem care can be provided.

Answer 3

Touch the hand of the daughter and say, "We'll miss your dad."

Question 4

A dying patient is receiving 2 mg of morphine sulfate every hour. The patient's daughter is worried about oversedation. What does the nurse explain that this small dose of morphine controls?

A) Dyspnea
B) Pain
C) Hallucinations
D) Fatigue

Question 5

What should be done with copies of a signed advance directive? (Select all that apply.)

A) Given to the person who has been named as power of attorney for medical decisions
B) Posted in the home for emergency personnel
C) Placed in the medical record in the physician's office
D) Filed with the hospital
E) Given to the neighbor

Question 6

What is the average fluid intake necessary for safe administration of a bulk-forming laxative to a dying patient?

A) 1000 mL
B) 1500 mL
C) 2000 mL
D) 2500 mL

Question 7

Why is end-of-life planning often neglected? (Select all that apply.)

A) There is a clear procedure to follow.
B) People are uncomfortable talking about death.
C) Young people do not see the need for end-of-life planning.
D) End-of-life planning is a relatively new concept.
E) Many persons are not really sure what they want to do.

Question 8

Which patient would be a candidate for hospice care?

A) The patient with a life expectancy of only 12 months.
B) The patient who agrees to life support.
C) The patient who agrees to palliative measures.
D) The patient who has a treatable illness.

Question 9

What is a cardiovascular sign of impending death?

A) Cheyne-Stokes respiration
B) Bounding pulse
C) Cyanosis of the extremities
D) Increased blood pressure

Question 10

What is the objective of pain control for the dying patient?

A) Keep the patient unconscious and relaxed to avoid the perception of pain.
B) Delay medication until the patient reports that the pain is intense.
C) Find a control level that reduces pain but allows the patient to interact.
D) Eradicate pain completely.

Question 11

What are the benefits of a holistic caregiver at the end-of-life? (Select all that apply.)

A) The caregiver communicates and responds to the patient's concerns about death.
B) The caregiver embraces the value of palliative care rather than curative care.
C) The caregiver helps the patient and family face loss and grieve in anticipation of loss.
D) The caregiver encourages the patient to focus on wellness and recovery.
E) The caregiver collaborates with other professionals for patient support.

Question 12

What would be the most acceptable intervention for the nurse dealing with a patient with a threat of aspiration?

A) Perform deep tracheal suctioning of the patient every hour.
B) Place the patient in a side-lying position, with the head turned to the side.
C) Slightly elevate the foot of the bed, with the patient in a supine position.
D) Give the patient only thickened fluids.

Question 13

What are a person's perceptions regarding end-of-life care dependent upon? (Select all that apply.)

A) Age
B) Gender
C) Cultural background
D) Caregivers
E) Life experiences

Question 14

The patient with terminal liver cancer says to the nurse, "I'm going to take a long time to die, aren't I? I'm going to get sicker and weaker every day." What would be the best response by the nurse?

A) "You will die in 4 to 6 months."
B) "I don't want to hear this kind of negative talk. Make use of the time you have."
C) "We have many medications that can make you feel better."
D) "What concerns you the most about dying?"

Question 15

What can caregivers do for a dying patient who suffers from diminished vision?

A) Keep lights bright to increase visual acuity.
B) Stand slightly away from the bed and identify themselves before speaking.
C) Keep all lights on in the room, day and night.
D) Come close to the bed and stand directly in front of the patient.

Question 16

What does an advance directive indicate to the home health nurse?

A) The degree of intervention desired for life support
B) Who is to manage medical decisions in case of debilitating illness
C) Who will manage finances in case of debilitating illness
D) The mortuary to be used in the case of death

Question 17

Why might a professional health care provider neglect to educate patients about end-of-life care?

A) They fear that patients will perceive that they are giving up.
B) They do not want to influence the patient in any decision.
C) They want to keep up the patient's morale.
D) They believe that death is a personal failure on their part.

Question 18

When the dying patient becomes delirious, what should the nurse encourage the family to do?

A) Leave the room and wait outside until the delirium clears.
B) Hold the patient's hand, but say nothing, because hearing stays intact until death.
C) Remain near the bed and speak to the patient in loud tones to stimulate the patient.
D) Touch the patient, call the patient by name, and speak in reassuring tones.

Question 19

The distraught wife of a terminally ill patient complains to the nurse, "My husband has not been shaved, and he has that miserable gown on instead of his own pajamas. Don't you people care about things like that?" What would be the best response of the nurse?

A) "I delayed his morning care because he was sleeping comfortably. I'll complete his care now that he's awake."
B) "We're running late today and I have six other patients to care for. What do you want?"
C) "Of course we care! Someone will come to do his care before lunch."
D) "I'm sorry you feel we're doing such a poor job. I'm doing my best."

Question 20

Why should an 86-year-old man with a terminal illness be encouraged to file an advance directive?

A) To demonstrate understanding of his imminent death
B) To comply with most hospital policies
C) To clarify treatment protocols
D) To spare his family the burden of making end-of-life decisions

Question 21

A resident in the long-term care facility has just expired, and the family is on the way to say their last goodbyes. What should the nurse do prior to the arrival of the family? (Select all that apply.)

A) Remove equipment (e.g., IV poles and tubing, feeding tubes, oxygen equipment).
B) Dress the resident in a clean gown and cover him or her with a clean sheet.
C) Remove dentures.
D) Apply a diaper to catch draining body fluids.
E) Provide privacy by drawing the curtain or moving the other resident to an unoccupied room.

Question 22

What would be appropriate actions of the nurse when dealing with a bereaved family at the time of death? (Select all that apply.)

A) Review the stages of dying with them.
B) Ensure privacy.
C) Observe cultural and spiritual preferences.
D) Legally pronounce the death.
E) Allow the bereaved to express their feelings.

Question 23

Which of the following would be considered palliative care? (Select all that apply.)

A) Treat symptoms of pain, dyspnea, and nausea.
B) Promote acceptance of death.
C) Provide CPR.
D) Monitor mechanical ventilation machines.
E) Enable the patient to have a better quality of life.

Question 24

The hospice nurse explains that dying in peace without pain and with dignity in a supportive care environment is defined as a(n) _________ death.

Question 25

What are benefits of dehydration for a person who is near death? (Select all that apply.)

A) Better gas exchange because of reduction of fluid in the lungs
B) Decreased need to suction because of reduction of respiratory secretions
C) Improved bowel elimination because of reduced bulk in the stool
D) Decreased pain related to release of endorphins
E) Improved drug distribution via the circulating volume

Question 26

The charge nurse on an oncology unit encourages her staff to complete a values clarification exercise. What type of insight is provided by the exercise? (Select all that apply.)

A) The nurses' own values
B) Values that influence care decisions
C) Values that must be abandoned or changed
D) Values that may cause an ethical dilemma
E) Negative values

Question 27

What are appropriate roles of the nurse when working with the bereaved? (Select all that apply.)

A) Guidance
B) Resource
C) Advocacy
D) Support
E) Spiritual counseling

Question 28

How can a nurse encourage communication with a dying patient? (Select all that apply.)

A) Address the patient by name at every opportunity.
B) Use direct questions to inquire about the patient's concerns relative to health and end-of-life issues.
C) Complete care with a minimum of conversation to encourage questions from the patient.
D) Provide empathetic touching during care to show concern.
E) Sit down in the room to converse with the patient.