Deck 59: End-Of-Life Care

Question 1

A nurse is providing end-of-life care for an 89-year-old diabetic client diagnosed with acute renal failure. Which nursing consideration should the nurse employ when addressing the basic needs of the client and family members?

A) Try to convince the client and family members to agree to organ or tissue donation.
B) Provide nursing care to the client, without regard to the nurse's own feelings.
C) Discourage the client from talking to family members about his death.
D) Offer to secure spiritual counseling, if requested, for the client and family members.

Answer 1

Offer to secure spiritual counseling, if requested, for the client and family members.

Question 2

A client's family keeps repeating over and over "why is this happening to my father?" What stage of dying is being expressed by the client's family?

A) Denial and isolation
B) Anger and rage
C) Bargaining and developing awareness
D) Detachment

Answer 2

Anger and rage

Question 3

A client diagnosed with a terminal illness says to family members "I don't care anymore about living. This is not living to me." What stage of dying is being expressed by the client?

A) Denial and isolation
B) Anger and rage
C) Bargaining and developing awareness
D) Depression

Answer 3

Depression

Question 4

What are the most common advance directives? Select all that apply.

A) Living will
B) Durable power of attorney for healthcare
C) Do Not Resuscitate
D) Do Not Intubate
E) Health Surrogate

Question 5

The nurse documents that the client has a written living will. What statement describes the function of a living will?

A) Document in which the client states the types of treatment desired to receive or not to receive if a terminal situation arises
B) Document which designates a person of the client's choice to make healthcare decisions should the client become incompetent
C) Document in which healthcare personnel are informed that if the person experiences cardiopulmonary arrest, that a "code blue" should not be called
D) Document in which healthcare personnel are informed not to start tube feeding and to keep the client as comfortable as possible

Question 6

Which statement accurately describes the function of a durable power of attorney for healthcare?

A) Document in which the client states the types of treatment desired to receive or not to receive if a terminal situation arises
B) Document which designates a person of the client's choice to make healthcare decisions should the client become incompetent
C) Document that informs healthcare personnel that if the person experiences cardiopulmonary arrest, a "code blue" should not be called
D) Document in which healthcare personnel are informed not to start tube feeding and to keep the client as comfortable as possible

Question 7

An older adult client is admitted to the healthcare facility with acute respiratory distress. The client's health record has a DNR. Which statement will direct nursing care when the client suddenly develops cardiopulmonary arrest?

A) A full code is initiated immediately.
B) The client is allowed to die naturally.
C) Cardiopulmonary resuscitation without medications is initiated.
D) The code team is called with intervention delayed until the physician arrives.

Question 8

An older adult client at an assisted living facility is in acute respiratory distress. The client's health record has a DNH order. What is the best description for a DNH order?

A) The individual will be allowed to die naturally without mechanical or chemical intervention.
B) The individual will have a tube feeding initiated as soon as possible.
C) Client does not wish to be hospitalized or resuscitated if the individual's condition becomes critical.
D) The ambulance is to be called immediately in the event of cardiopulmonary arrest, even though natural death is imminent.

Question 9

A nurse is caring for a 69-year-old client in the advanced stage of breast cancer. Which nursing considerations should the nurse perform to facilitate emotional support to the client and family members? Select all that apply.

A) Provide no false hopes about the client's condition.
B) Encourage family members to talk about how their own lives are going to be impacted.
C) Encourage family members to stay with the client, especially at night.
D) Ask the family members not to express their sorrow in front of the client.
E) Support the client and family in the expression of their spirit and/or religious practices.

Question 10

A 90-year-old client with carcinoma of the prostate reports severe, excruciating pain in the lower limbs and hips. The attending physician has prescribed heavy doses of narcotics to relieve the pain. Which statement accurately describes client issues regarding this medication therapy?

A) Client may have an increased concern of drug abuse and dependency.
B) The client's pain may suddenly increase, indicating impending death.
C) Client may be allowed to self-administer narcotics, if he is capable of doing so.
D) Alternative therapies, such as homeopathy and herbal remedies, are avoided.

Question 11

An 84-year-old client diagnosed with a terminal brain tumor is admitted to the healthcare facility following an epileptic seizure. Which nursing consideration should the nurse implement when providing end-of-life care for the client?

A) Avoid placing the client in a low Fowler's or orthopneic position.
B) Ensure that the client's head is not elevated when placing on the back.
C) Encourage the client to assume a position other than supine.
D) Avoid disturbing the client with frequent changes in position.

Question 12

A client involved in a motor vehicle accident is rushed to the healthcare facility in an unconscious state. The healthcare provider has diagnosed the situation as critical with little hope of survival. The unconscious client suddenly regains consciousness and becomes alert. Which nursing measure must the nurse employ when caring for the dying
Client's family members?

A) Inform the family that the client may soon be out of danger.
B) Request the family members not to talk about death to the client.
C) Immediately call the family members to bid farewell to the client.
D) Provide respite care to the client's family members.

Question 13

A client involved in a motor vehicle accident is rushed to the healthcare facility in an unconscious state. The nurse frequently changes the client's position. Why does the nurse change positions frequently? Select all that apply.

A) Promote comfort
B) Prevent skin breakdown
C) Ease breathing
D) Kept client clean and dry
E) Provide visual stimulation

Question 14

What nursing measure should the nurse implement to provide support to the dying client and the family members?

A) Provide detailed explanations of what is done and what is expected.
B) Support the client and family and avoid being judgmental.
C) Assume all responsibility for the planning of care.
D) Discourage family members from leaving the client.

Question 15

A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a healthcare facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What nursing measures must the nurse implement to provide care and support for the dying client and family members? Select all that apply.

A) Establish a supportive and trusting relationship with the client and family.
B) Explain the client's condition and treatment to the client and family.
C) Express warmth, care, and concern when interacting with the client and family.
D) Ensure that the client's higher-level needs are met.
E) Pray with the family to demonstrate religious support

Question 16

A 90-year-old client diagnosed with intestinal carcinoma is in the final stages of the death process. What nursing measures must the nurse ensure to implement care and support the dying client and family members? Select all that apply.

A) Maintain open communication among all concerned.
B) Provide appropriate pain relief.
C) Talk often with the nonresponsive or comatose client.
D) Arrange for spiritual counseling, if requested.
E) Encourage the client to both eat and drink sufficient amounts

Question 17

A 90-year-old client diagnosed with intestinal carcinoma is in the final stages of the dying process. What measures should the nurse implement for both the client and the family to prepare and plan for the inevitable death? Select all that apply.

A) Encourage them to express their needs, fears, and emotions.
B) Work together to identify preferences concerning death.
C) Discuss positive methods of coping with dying.
D) Encourage the client to participate in self-care.
E) Discourage family from providing direct physical care to the client.

Question 18

Which signs of approaching death will the nurse observe in the client in the final stage of the dying process? Select all that apply.

A) Urinary incontinence is observed
B) Arms and legs are cold to touch
C) Client appears peaceful
D) Breathing becomes noisy
E) Secretions accumulate in the mouth

Question 19

An older adult client who was admitted with a severe head injury passes away at the healthcare facility. Which nursing intervention should the nurse consider when caring for the client's body and family members? Select all that apply.

A) Place a clean sheet over the client's body.
B) Remove all visible medical accessories from the client's body.
C) Allow the family members to see the body immediately.
D) Allow family members to stay in the room as long as they wish.
E) Remove all medical equipment from the client's room.

Question 20

Which nursing measures are part of postmortem care of the body? Select all that apply.

A) Pronounce the client dead and sign the death certificate.
B) Position the client's body immediately following death.
C) Transfer the client's body as "coroner's case" for an autopsy.
D) Pad and tie the client's wrists and ankles together.
E) Apply a chin strap or place a rolled towel under the client's chin.

Question 21

What is the correct sequence of steps that occurs during the last stage of life and indicates approaching death?
1) The client's sense of hearing is slowly lost.
2) The client experiences sweating.
3) The client's extremities feel colder to touch.
4) The client's sense of touch is gradually diminished.

A) 1, 2, 3, 4
B) 2, 3, 4, 1
C) 3, 4, 1, 2
D) 4, 1, 2, 3

Question 22

A family member has heard about the rule of threes and asks the nurse what it means. How should the nurse describe the rule of threes?

A) A person can live 3 minutes without oxygen.
B) A person can live 3 hours without water.
C) A person can live 3 days without food.
D) A person can live 3 weeks without warmth.

Question 23

Various breathing patterns may be seen in the client who is dying. What statement accurately describes Kussmaul breathing? Select all that apply.

A) Respiratory rate greater than 20 breaths/minute
B) Respirations are shallow
C) Breathing is labored
D) Often occurs if a person experiences alkalosis
E) Periods of apnea are noted