Question 1

The nurse would expect to assess which metabolic condition in the client at the end of life who is vomiting?

Accepted Answer

A)   Metabolic alkalosis
B)   Metabolic acidosis
C)   Respiratory alkalosis
D)   Respiratory acidosis A

Question 2

What suggestions should the nurse give the family of a client with end-stage cancer who is experiencing nausea and vomiting?

Accepted Answer

A)   Do not feed the client.
B)   Encourage ingestion of foods that appeal to the client.
C)   Serve seasoned foods.
D)   Serve food very hot. B

Question 3

The nurse is assessing a hospice client who has had changes in cognition due to delirium. Using the Confusion Assessment Method, what would the nurse expect to find?

Accepted Answer

A)   A gradual change in mental status
B)   Fluctuations in severity of mental status throughout the day
C)   Enhanced ability to focus
D)   Able to reorient to person and place B

Question 4

What action should the nurse take when a home hospice client exhibits Cheyne-Stokes breathing?

Accepted Answer

A)   Tell the family that this type of breathing indicates improvement
B)   Ask the family to leave the room
C)   Prepare the family for imminent death
D)   Begin postmortem care

Question 5

A client at the end of life has an antimuscarinic medication ordered for secretion management. When is the ideal time for the nurse administer this medication?

Accepted Answer

A)   At the first sign of the death rattle
B)   When the death rattle can be heard from several feet away
C)   Before the death rattle occurs
D)   If the death rattle upsets the family

Question 6

Which action by the spouse of a hospice client indicates understanding of the nurse's teaching plan for reducing dyspnea?

Accepted Answer

A)   Closing a window near the client
B)   Keeping the room warm
C)   Using a fan near the client's face
D)   Reducing the humidity level of the room

Question 7

Which is the best way for the nurse to assess pain in the neonate?

Accepted Answer

A)   Using the CRIES scale to assess for behavioral and physiologic indicators of pain
B)   Using the Oucher Scale with faces showing mild to severe pain
C)   Using the nurse's experience in caring for neonates as a guide
D)   Using the Children's Fatigue Scale

Question 8

An alert and oriented female client in early hospice care is experiencing urinary incontinence. Which is the most appropriate initial intervention for this client?

Accepted Answer

A)   Teach pelvic floor muscle strengthening exercises
B)   Establish a voiding schedule
C)   Limit all fluid intake
D)   Place diapers on the client

Question 9

When starting a terminal client on an opioid for pain control, which action should be included in the plan of care?

Accepted Answer

A)   Administer a daily laxative
B)   Reduce fiber in the diet
C)   Limit fluid intake
D)   Administer a daily enema

Question 10

What is the best way for the nurse to determine if a client is experiencing dyspnea?

Accepted Answer

A)   Observe the client's breathing without the client's knowledge
B)   Evaluate pulmonary function test results
C)   Send an arterial blood gas sample to the laboratory
D)   Obtain subjective data from the client

Question 11

How should the nurse respond when the son of an end-stage cancer patient tells the nurse that his "dad is refusing to eat" and he fears that his father has "given up hope"?

Accepted Answer

A)   Make suggestions of foods that his father might find palatable.
B)   Have the son complete a 24-hour food diary of what his father eats.
C)   Explain that this is normal and that his father is comfortable.
D)   Call the physician and request a nutrition consult.

Question 12

Which nursing intervention would be a priority in managing dyspnea in the hospice client?

Accepted Answer

A)   Providing an inhaled bronchodilator
B)   Administering opioid medication
C)   Raising the head of the bed
D)   Administering supplemental oxygen

Question 13

The daughter of a client, who is at the end of life, is concerned that the gurgling sound she hears is her father drowning in his own secretions. What is the best initial response by the nurse?

Accepted Answer

A)   "This must be very upsetting to watch, but he isn't suffering."
B)   "It might be best if you leave the room."
C)   "You may not be giving him enough fluid."
D)   "I'll suction him now."

Question 14

At the time of death, which finding is the nurse most likely to assess?

Accepted Answer

A)   Lack of heartbeat
B)   Body temperature same as room temperature
C)   Rigor mortis
D)   Livor mortis

Question 15

The plan of care for a client in hospice care should include:

Accepted Answer

A)   curative treatments.
B)   control of symptoms.
C)   postponing death.
D)   laboratory tests.

Question 16

A client in the terminal phase of dying reports feeling very tired and no longer wants to get out of bed and engage with family. What is the best response for the nurse to make to the family?

Accepted Answer

A)   "Assist your family member to get out of bed at least twice a day."
B)   "Encourage your family member to be a part of family events as much as possible."
C)   "Encourage your family member to be awake during the day."
D)   "Be present for your loved one and do not pressure him to be more involved."

Question 17

The nursing care plan for a client in hospice who is experiencing daytime coughing due to excessive accumulated secretions should include:

Accepted Answer

A)   chest physiotherapy.
B)   antitussive medication.
C)   bronchodilators.
D)   reducing fluid intake.

Question 18

Which of the following pain medication orders for a client with ovarian cancer would be most appropriate for the nurse to use to control a client's chronic pain?

Accepted Answer

A)   Administer short-acting pain medication as needed.
B)   Administer short-acting pain medication around the clock.
C)   Administer long-acting pain medication when the client reports severe pain.
D)   Administer long-acting pain medication around the clock.

Question 19

The nurse is using the Karnofsky Performance Scale to determine the performance status of a client in palliative care with end-stage lung cancer. With a score of 50, what activity level should the nurse anticipate?

Accepted Answer

A)   Performs activities of daily living independently
B)   Requires occasional assistance with activities of daily living
C)   Requires considerable assistance with activities of daily living
D)   Needs total assistance

Question 20

The nurse is caring for a client in palliative care who is alert and oriented to person, place, and time. Which assessment data would be most appropriate in determining the client's need for pain medication?

Accepted Answer

A)   Ask the client to rate his pain.
B)   Observe the client's face for signs of pain.
C)   Evaluate the client's heart rate, blood pressure, and pulse rate.
D)   Ask the client's spouse if the client is in pain.

Exam 53: Pathophysiology at the End of Life