Deck 11: End Of Life and Palliative Care

Question 1

A patient in a hospice program is experiencing continuous, increasing amounts of pain. The nurse caring for the patient plans the scheduling of opioid pain medications to provide

A) prn doses of medication whenever the patient requests.
B) around-the-clock routine administration of analgesics.
C) enough pain medication to keep the patient sedated and unaware of stimuli.
D) analgesic doses that provide pain control without decreasing respiratory rate.

Answer 1

around-the-clock routine administration of analgesics.

Question 2

A patient who has been diagnosed with metastatic malignant melanoma and has a poor prognosis plans an extensive trip around the country "to finally see some of the places I've always wanted to visit and to see some family I haven't seen in years." The nurse recognizes that the patient is manifesting the psychosocial response of

A) restlessness.
B) saying goodbye.
C) unfinished business.
D) altered decision making.

Answer 2

unfinished business.

Question 3

A hospice nurse who has become very close to a terminally ill patient and family is present in the home when the patient dies. The family members are crying softly, and the nurse also feels like crying. The nurse recognizes that

A) it is acceptable and healthy to cry with the family during this phase of the grief process.
B) personal expression of sorrow and loss is appropriate to share with peers rather than burdening the patient's family.
C) it would be unprofessional to cry at this time when the family's feelings need to be addressed.
D) the family should be allowed to grieve together at this time and the nurse's presence will be felt as invasive to the family.

Answer 3

it is acceptable and healthy to cry with the family during this phase of the grief process.

Question 4

When caring for a patient with lung cancer in a home hospice program, it is important for the nurse to

A) accomplish a thorough head-to-toe assessment at least weekly.
B) educate the patient about the purpose of chemotherapy and radiation.
C) complete a detailed intake assessment, including cancer risk factors.
D) encourage the patient to discuss past life events and their meaning.

Question 5

The family member of a dying patient tells the nurse, "I think mother needs an antidepressant. She has always been so outgoing, but now she seems really withdrawn and disinterested in life." Which response by the nurse is most appropriate?

A) "It is likely that she is depressed, so I will ask the doctor for an antidepressant order."
B) "Withdrawal may sometimes be a normal response when preparing to leave life."
C) "It will be important for you to stimulate your mother as she gets closer to dying."
D) "Your mother is becoming tired, and you may need to cut back your visits for now."

Question 6

As the nurse admits a patient with AIDS who has cryptococcal meningitis, the patient tells the nurse, "If my heart or breathing stop, I do not want to be resuscitated." The nurse should

A) document the request in the patient's record and place a DNR notation in the care plan.
B) ask the patient if these wishes have been discussed with the admitting health care provider.
C) inform the patient that a notarized advance directive must be included in the record or resuscitation must be performed.
D) advise the patient to designate a person to make health care decisions when the patient is not able to make them independently.

Question 7

A nursing student who is caring for a dying patient asks the nurse, "How will we know when the patient has died?" The nurse explains that the patient will be considered legally dead when

A) the patient is flaccid and unresponsive.
B) respiratory efforts cease and no apical pulse is audible.
C) the patient is comatose, apneic, and without brainstem reflexes.
D) CPR is ineffective in restoring heartbeat.

Question 8

A family member of a patient who is being admitted with nausea tells the nurse that the patient was diagnosed 2 months ago with pancreatic cancer but has not kept appointments with the doctor and has continued daily activities unchanged from before the diagnosis. When assessing the patient, the nurse will expect that the patient

A) will be very angry about the cancer diagnosis.
B) will not mention anything about pancreatic cancer.
C) may express despair about the cancer diagnosis.
D) may ask about options for treatment of the cancer.

Question 9

Which of these patients is most appropriate for the nurse to refer to hospice care?

A) A 28-year-old with AIDS-related dementia who needs palliative care and pain management
B) A 56-year-old with advanced liver failure whose family members can no longer care for him or her at home
C) 60-year-old with lymphoma whose children are unable to discuss issues related to dying
D) A 72-year-old with chronic severe pain as a result of spinal arthritis and vertebral collapse

Question 10

A patient who is very close to death is very restless and repeats, "I am not ready to die." The most appropriate intervention by the nurse is to

A) call the hospital chaplain to come and visit or pray with the patient.
B) sit at the bedside and ask if there is anything the patient needs.
C) inform the patient that everything possible is being done to delay death.
D) ask the patient what can be done to assist with the acceptance of death.

Question 11

The wife of a patient with terminal lung cancer visits daily and cheerfully talks with the patient about vacation plans for the next year. When asked by the nurse how she is feeling, she says, "I'm busy at work, but otherwise things are fine." An appropriate nursing diagnosis for the wife is

A) caregiver role strain related to feeling overwhelmed.
B) disabled family coping related to lack of grieving.
C) anxiety related to complicated grieving process.
D) hopelessness related to knowledge deficit about cancer.

Question 12

A patient near death is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28. The nurse explains to the family that these symptoms

A) will continue to increase until death finally occurs.
B) are a normal response before these functions decrease.
C) may be associated with an improvement in the patient's condition.
D) indicate a reflex response to the slowing of other body systems.

Question 13

The nurse is caring for a patient who has 20-second periods of apnea followed by periods of deep and rapid breathing. The nurse documents this finding as

A) death-rattle respirations.
B) agonal breathing.
C) apneustic breathing.
D) Cheyne-Stokes respiration.

Question 14

A patient who has a regularly scheduled annual physical examination tells the nurse, "My mother died 6 months ago and I just can't seem to get over it. I still think about her every day." Which nursing diagnosis is most appropriate for this patient?

A) Complicated grieving related to unresolved issues
B) Chronic sorrow related to ongoing distress about loss of mother
C) Risk-prone health behavior related to inability to resolve grief
D) Anxiety related to lack of knowledge about normal grieving