Deck 6: Hydration and Nutrition at the End of Life

Question 1

A terminally ill patient asks his family to leave the room while the nurse provides his "liquid lunch." The nurse realizes that the patient is considering the tube feeding as being:

A) Something that is private and not to be shared with family
B) An event that he wants to enjoy alone
C) As an opportunity to have the family leave him alone
D) A way for the family to realize that he is getting fed

Answer 1

Something that is private and not to be shared with family

Question 2

The wife of a terminally ill patient tells the nurse that she is "sorry" that they started tube feedings since it seems now that he will be dependent on them for the rest of his life. The nurse should respond with which of the following?

A) Someone should have explained that to you before the tube feedings were started
B) The tube feedings can be stopped but it depends upon how well your husband responds and if they are helping or hurting his condition
C) Tube feedings are easy to administer and I can teach you how to do them once your husband is discharged home
D) Tube feedings are actually better than eating right now for your husband and they always help in improving health

Answer 2

The tube feedings can be stopped but it depends upon how well your husband responds and if they are helping or hurting his condition

Question 3

The physician of a terminally ill patient suggests that the time-limited trial of artificial hydration and nutrition be stopped since the patient's status has not improved. Which of the following does this suggest to the nurse?

A) The artificial hydration and nutrition is a treatment that has not worked and should be discontinued
B) The physician is killing the patient
C) The physician is going to starve the patient to death
D) The physician wants the patient to die and removing food and fluids will do it quicker

Answer 3

The artificial hydration and nutrition is a treatment that has not worked and should be discontinued

Question 4

The daughter of a terminally ill patient is upset and asks the nurse "what are you doing for my father, since you aren't even giving him anything to eat or drink?" The nurse realizes that the family member is equating foods and fluids with:

A) Poor care
B) Basic nurturing
C) Encouraging the patient to die
D) The patient is so ill that eating or drinking would be futile

Question 5

A patient diagnosed with cancer is unable to eat because of painful mouth sores. The nurse realizes that which of the following might be helpful for this patient?

A) Keeping the patient on nothing-by-mouth status until the sores heal
B) Beginning natural anorexia
C) Beginning terminal dehydration
D) Artificial hydration and nutrition

Question 6

The healthcare team is planning to meet with the family of a terminally ill patient to discuss continuing or discontinuing hydration and nutrition. Which of the following should be included in this discussion?

A) The patient's physical condition and prognosis
B) The patient's insurance coverage
C) Plans for discharging the patient to home
D) Care the patient will need once discharged to home

Question 7

A patient tells the nurse that since he stopped eating, he does not feel nauseated and can actually breathe better. The nurse realizes the patient is describing:

A) Natural anorexia
B) Delirium
C) Terminal dehydration
D) Xerostomia

Question 8

A terminally ill patient is receiving tube feedings. When the meal tray for the roommate arrives, the patient says "that smells so good. I wish I could eat something." Which of the following should the nurse do?

A) Let the patient know that the hospital meals are not that great and that the tube feeding is better
B) Explain that the patient is getting fed through the tube
C) Tell the patient that the desire to eat normally will pass
D) Ask the patient if he is hungry or thirsty

Question 9

Around-the-clock tube feedings have been discontinued for a terminally ill patient. The family is concerned that death will occur faster without nutrition. Which of the following might be appropriate ways for the nurse to respond to the family?

A) The patient is going to be started on a regular diet so the tube feedings are not necessary
B) The patient is fading fast and providing nutrition just prolongs the agony
C) The patient said that he wasn't hungry anymore so the feedings were stopped
D) The feedings were hurting the patient more than helping and they have been stopped for now

Question 10

A terminally ill patient asks to be provided with artificial nutrition for a few months to see if he can regain his strength. Which of the following should the nurse do to support this patient?

A) Remind the patient that fluids and nutrition can only be provided for one month and then stopped
B) Support the patient's request for artificial hydration and nutrition
C) Remind the patient that once nutrition and fluids are started, they cannot be stopped
D) Suggest that the patient is prolonging the agony and could have a more painful death

Question 11

A patient with a terminal illness is receiving continuous tube feedings through a pump. The nurse assesses that the patient is becoming progressively weaker and suspects which of the following is occurring with the patient?

A) Restricted activity is causing the patient to become weaker
B) The tube feeding is not providing enough calories for the patient
C) The patient's illness is becoming worse
D) The tube feeding should be stopped and the patient permitted to begin natural anorexia

Question 12

A terminally ill patient tells the nurse that though he has no appetite and is fatigued after he eats, the food does give him more energy. The nurse realizes that this patient might consider which of the following?

A) Voluntarily stopping eating and drinking
B) Natural anorexia
C) Terminal dehydration
D) Artificial hydration and nutrition

Question 13

A terminally ill patient receiving tube feedings has developed a productive cough and increasing shortness of breath. Which of the following should the nurse do?

A) Lower the head of the bed and stop the feedings
B) Stop the tube feeding, raise the head of the bed, and report the patient's status
C) Continue the feedings with the head of the bed flat
D) Slow the rate of the feedings

Question 14

A terminally ill patient receiving tube feedings tells the nurse that he "misses" having a cup of coffee. The nurse realizes that the patient is describing which of the following?

A) Coffee provided fluids that the patient is requesting
B) The enjoyment that drinking coffee used to give the patient
C) The flavor of coffee
D) The stimulation that coffee provides through caffeine

Question 15

A terminally ill patient tells the nurse that he has had a good life, would like to die in peace, and does not want any more food or fluids. The nurse realizes that which of the following has occurred with this patient?

A) Fluid volume deficit that needs to be treated with intravenous fluids
B) Lack of oxygen to the brain affecting the patient's normal thinking
C) Voluntarily stopped eating and drinking
D) Hepatic failure clouding the patient's ability to think clearly

Question 16

A terminally ill patient wants to stop all foods and fluids but the family is trying to dissuade him from this decision. Which of the following can be done to help the family and patient?

A) Ensure the family that the patient is most likely not going to stop eating and drinking
B) Tell the family that the patient will continue to receive fluids through an intravenous line even though he wants to stop eating and drinking
C) Talk with the family about the advantages of voluntarily stopping eating and drinking
D) Explain that even though the patient says he wants to stop eating and drinking it will not last and in a day or two, he will start to eat again

Question 17

A terminally ill patient says that he feels better when he does not drink fluids. The nurse realizes that which of the following is occurring with this patient?

A) The patient's edema is reducing his need to drink fluids
B) The patient is experiencing confusion
C) The patient has less pain because of less fluid in the body
D) The patient is waiting to eat foods before drinking fluids

Question 18

The family of a terminally ill patient is upset that the patient is no longer receiving intravenous fluids or tube feedings and believes that the hospital is "trying to kill" the patient. Which of the following should be done to assist this family?

A) Inform them that the lack of food or liquids is short term and the patient will be provided with both in a day or two
B) Remind the family that the patient is terminal and any food or hydration is futile at this time
C) Explain that providing no food or liquids will make it easier to care for the patient
D) Explain the benefits of anorexia and terminal dehydration for the patient

Question 19

The family of a terminally ill patient who has voluntarily stopped eating and drinking asks the nurse how long the patient will survive without food of fluids. Which of the following responses should the nurse give to the family?

A) The patient could live another 1 to 3 weeks although it could be longer
B) The patient will live about 4 more days
C) The patient will live for at least 2 months
D) The patient could live up to 5 months or longer