Chapter 11 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 11

Question 1

Type: MCMA

An older patient with terminal cancer is considering hospice care but is concerned that Medicare will stop payments if the care is provided for longer than 6 months. What can the nurse respond to this patient?

Standard Text: Select all that apply.

1. Medicare does not limit the hospice benefit.

2. Medicare regulations discourage a longer use of the benefit.

3. Hospice costs more than traditional hospital or long-term care.

4. Patient may enroll when the life expectancy is 6 months or less.

5. Hospice supports the family for 6 months after the patients death.

Correct Answer: 1,2,4

Rationale 1: Medicare law does not limit the hospice benefit.
Reference: Page 255

Rationale 2: Medicare regulations often discourage a patient from using hospice for longer than 6 months.
Reference: Page 255

Rationale 3: Hospice costs less than traditional hospital or long-term care.
Reference: Page 255

Rationale 4: Patients may enroll when their physician judges their life expectancy to be 6 months or less.
Reference: Page 255

Rationale 5: Hospice supports all family members during the illness and supports the family for 1 year after the death.
Reference: Page 255

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Discuss the diverse settings for end-of-life care and the role of the nurse in each setting.

Question 2

Type: MCMA

During an assessment the nurse determines that an older patient dying from a terminal illness is experiencing common fears. What fears did this nurse assess in the patient?

Standard Text: Select all that apply.

1. Dying alone

2. Loss of consciousness

3. Loss of bladder control

4. Leaving loved ones behind

5. Becoming a burden to others

Correct Answer: 1,2,3,5

Rationale 1: Common fears and concerns of the dying include dying alone.
Reference: Page 257

Rationale 2: Common fears and concerns of the dying include loss of consciousness.
Reference: Page 257

Rationale 3: Common fears and concerns of the dying include loss of bladder control.
Reference: Page 257

Rationale 4: Common fears and concerns of the dying do not include leaving loved ones behind.
Reference: Page 257

Rationale 5: Common fears and concerns of the dying include becoming a burden to others.
Reference: Page 257

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Describe the role of the nurse in providing quality end-of-life care for older adults and their families.

Question 3

Type: MCSA

An older patient dying of end-stage pulmonary disease and dementia receives narcotic medication for chronic pain. Currently the patient is restless and grimacing. How should the nurse interpret these assessment findings?

1. The patient is in pain.

2. The patient has an undiagnosed personality disorder.

3. The patient needs nonpharmacological pain management approaches.

4. The patient is not experiencing any difference in pain level and no adjustments are needed.

Correct Answer: 1

Rationale 1: When an older adult is unable to speak or self-report the level of pain, the nurse should carefully observe the patient for behavioral symptoms of pain that may include restlessness and grimacing.
Reference: Page 259

Rationale 2: Personality disorders with the presence of dementia are difficult to identify and to differentiate the source of the behavior.
Reference: Page 259

Rationale 3: Nonpharmacological pain management approaches can augment medication for pain; however, this patient is demonstrating signs of acute pain.
Reference: Page 259

Rationale 4: The patient is restless and grimacing, which are behavioral symptoms of pain that need to be addressed.
Reference: Page 259

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 4

Type: MCSA

An older patient dying from a terminal illness reports that the last dose of pain medication provided barely reduced the level of pain. What should the nurse do to help this patient?

1. Give the patient pain medication every hour.

2. Contact the physician for an adjustment in pain medication.

3. Provide the pain medication at the next scheduled dose time.

4. Give the patient another dose of the medication even though it is before the scheduled time.

Correct Answer: 2

Rationale 1: The nurse cannot prescribe the dose or frequency of pain medication and cannot give the patient pain medication every hour if it is not prescribed at this frequency.
Reference: Page 262

Rationale 2: Dying patients may need more pain medication than the normal range for the prescribed drug. Organic changes are occurring rapidly within the body and systems are shutting down, decreasing the absorption levels of drugs.
Reference: Page 262

Rationale 3: Delaying medication would cause unnecessary suffering for the patient.
Reference: Page 262

Rationale 4: Altering the administration schedule is outside of the scope of the professional practice role of nursing.
Reference: Page 262

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 5

Type: MCMA

The nurse is planning oral hygiene for an older patient with a terminal illness who has an intact swallowing reflex. Which interventions would be appropriate for this patient?

Standard Text: Select all that apply.

1. Offer ice chips frequently.

2. Provide care with soft swabs.

3. Apply petroleum jelly to the lips.

4. Brush the teeth three times a day.

5. Avoid using alcohol-based solutions.

Correct Answer: 1,2,3,5

Rationale 1: Ice chips to relieve the feeling of dryness may be offered as long as the swallowing reflex is present.
Reference: Page 262

Rationale 2: Oral care with soft swabs should be provided several times a day and whenever the mouth has a foul odor or appears uncomfortable for the patient.
Reference: Page 262

Rationale 3: Soothing ointments or petroleum jelly may be applied to the lips to prevent painful cracking or drying.
Reference: Page 262

Rationale 4: The patients oral hygiene should be provided with soft oral swabs or moistened cloths. A toothbrush would be too harsh for the patients delicate oral tissues.
Reference: Page 262

Rationale 5: Alcohol-based products can be irritating and drying and their use is discouraged.
Reference: Page 262

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 6

Type: MCSA

The family of an older patient dying of liver cancer is concerned that the patient will not eat or drink. The patient is alert and oriented, and expresses no desire to eat. What action would the nurse take?

1. Force fluids.

2. Consult the dietician for feeding supplements.

3. Contact the physician for an order for tube feedings.

4. Comply with the patients wishes despite the familys concern.

Correct Answer: 4

Rationale 1: The patients wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263

Rationale 2: The patients wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263

Rationale 3: The patients wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263

Rationale 4: Anorexia and dehydration are common and normal with the patient with a terminal illness. The patients wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 7

Type: MCSA

An older patient with end-stage renal and heart failure is experiencing odd dreams and is talking with people who are not present in the room. What does this finding indicate to the nurse?

1. Pending death

2. Ineffective pain medication

3. Overdose of narcotic medication

4. Normal visual and auditory hallucinations at the end of life

Correct Answer: 4

Rationale 1: Respiratory, neurological, and cardiac changes are more likely to indicate impending death.
Reference: Page 263

Rationale 2: Odd dreams and hallucinations in the terminally ill patient do not indicate ineffective pain medication. Grimacing and complaining of pain would indicate ineffective pain medication management.
Reference: Page 263

Rationale 3: Odd dreams and hallucinations in the terminally ill patient do not occur because of an overdose of narcotic medication. A change in respiratory status would indicate an overdose of narcotic medication.
Reference: Page 263

Rationale 4: Terminal delirium presents as confusion, restlessness, and/or agitation, with or without daynight reversal. Visual, auditory, and olfactory hallucinations may occur during this time. It is important for the nurse to understand that this condition is often irreversible, and that the patients experience of the delirium may be very different from what is witnessed by caregivers.
Reference: Page 263

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6. Identify the signs of approaching death.

Question 8

Type: MCSA

While providing postmortem care to a patient who has died the patient elicits a respiratory sound when turned. What should the nurse do?

1. Check for a pulse.

2. Reposition the airway.

3. Continue with the postmortem care.

4. Report to the physician the patient is still breathing.

Correct Answer: 3

Rationale 1: Checking for a pulse is not necessary in a deceased patient.
Reference: Page 266

Rationale 2: Repositioning the airway is not necessary in a deceased patient.
Reference: Page 266

Rationale 3: When the body is moved or the extremities repositioned, the body may produce respiratory-type sounds or the chest may appear to rise and fall. This can be alarming, but is only the sound of air leaving the lungs.
Reference: Page 266

Rationale 4: Contacting the physician is not necessary because the sound is a normal finding.
Reference: Page 266

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. Describe postmortem care.

Question 9

Type: MCSA

An older patient is not breathing well and has cold, mottled skin. The patient has a living will and requests comfort measures only. What should the nurse do to care for this patient?

1. Ask the family what they want to be done for the patient.

2. Contact the physician for orders to control the patients breathing.

3. Provide personal hygiene and skin care as outlined in the care plan.

4. Withhold pain medication, hygiene, and nutrition until the patient dies.

Correct Answer: 3

Rationale 1: Asking the family what they want to be done for the patient will go against the patients written wishes and is inappropriate.
Reference: Page 267

Rationale 2: Contacting the physician to intervene to control respiration is considered adding extraordinary measures and is inappropriate, as is going against the patients written wishes when a living will is present and in force.
Reference: Page 267

Rationale 3: Comfort measures only indicate that the patient does not want extraordinary measures to sustain life. This does not mean that nursing care ceases but that nursing care to provide patient comfort is intensified and maintained through the end stages of the patients life.
Reference: Page 267

Rationale 4: Comfort measures only indicate that the patient does not want extraordinary measures to sustain life. This does not mean that nursing care ceases but that nursing care to provide patient comfort is intensified and maintained through the end stages of the patients life.
Reference: Page 267

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 10

Type: MCSA

The family of an older patient with a terminal illness has been aware of the patients pending death and is present when the patient dies. The familys reaction to the patients death was very emotional and demonstrated a state of disbelief. How should the nurse interpret this familys behavior?

1. Irrational behavior

2. Expression of anger

3. Maladaptive coping of the family

4. Normal shock when experiencing the loss of a loved one

Correct Answer: 4

Rationale 1: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. This is not irrational behavior.
Reference: Page 265

Rationale 2: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. This is not an expression of anger.
Reference: Page 265

Rationale 3: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. This is not maladaptive coping of the family.
Reference: Page 265

Rationale 4: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. There is disbelief that death has occurred and may be marked by shock, emotional dullness, and restless behavior that may include stupor and withdrawal. It may include physical characteristics such as nausea or insomnia.
Reference: Page 265

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9. Discuss family support during the grief and bereavement period.

Question 11

Type: MCMA

The nurse is planning care for an older patient who is dying. Which interventions will ensure the patient dies with dignity?

Standard Text: Select all that apply.

1. Relieving suffering

2. Controlling pain and symptoms

3. Making decisions for the patient and family

4. Clarifying goals of treatment and the patients values

5. Communicating patient needs between healthcare providers

Correct Answer: 1,2,4,5

Rationale 1: The nurse who helps the patient die comfortably and with dignity will relieve suffering for the patient.
Reference: Page 252

Rationale 2: The nurse who helps the patient die comfortably and with dignity will control pain and symptoms.
Reference: Page 252

Rationale 3: Making decisions for the patient and family will not help the patient die comfortably and with dignity. The nurse must implement the decisions of the patient and family to ensure a comfortably death with dignity.
Reference: Page 252

Rationale 4: The nurse who helps the patient die comfortably and with dignity will clarify the goals of treatment and the patients values.
Reference: Page 252

Rationale 5: The nurse who helps the patient die comfortably and with dignity will communicate the patients needs between the healthcare providers.
Reference: Page 252

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 12

Type: MCSA

The nurse, caring for an older patient who is nearing death, has never taken care of a dying patient before. What is the first thing that the nurse must do prior to caring for this patient?

1. Confirm the patients code status.

2. Review the facilitys policy on postmortem care.

3. Confront personal feelings and fears about death.

4. Confirm that the family has made funeral arrangements.

Correct Answer: 3

Rationale 1: The nurse does need to be aware of the patients code status but this is not the first thing that the nurse needs to do prior to caring for the patient.
Reference: Page 252

Rationale 2: The nurse does need to be aware of the facilitys policy on postmortem care but this is not the first thing that the nurse needs to do prior to caring for the patient.
Reference: Page 252

Rationale 3: Nurses must be confident in their clinical skills when caring for the dying, and aware of the ethical, spiritual, and legal issues they may confront while providing end-of-life care. Many feel that the first step in the process is confronting their own personal fears about death and dying. By addressing their own fears, nurses are better able to help patients and families when they are confronted by impending death. The nurse may then be more objective in recognizing and respecting the patients and familys values and choices that guide their decisions at the end of life.
Reference: Page 252

Rationale 4: Funeral arrangements do not need to be made prior to the patients death.
Reference: Page 252

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1. Describe the role of the nurse in providing quality end-of-life care for older adults and their families.

Question 13

Type: MCSA

The health status of an older patient with liver disease is rapidly deteriorating. There is no documentation on the medical record regarding the patients care wishes. What should the nurse do to ensure the patient receives care that is desired at the end of life?

1. Ask social services to provide an advance directive for the patient to complete.

2. Talk with the patient regarding what the patient wants after the hospitalization ends.

3. Call a meeting with the patient, family, and primary care physician to discuss care goals.

4. Discuss the patients dire situation with the family and find out what their wishes might be.

Correct Answer: 3

Rationale 1: If unsure of a patients wishes for care at the end of life, a team meeting with the key decision makers such as the patient, family, and primary care physician should be held. The nurse should not ask for an advance directive unless the patient desires to complete one.
Reference: Page 254

Rationale 2: If unsure of a patients wishes for care at the end of life, a team meeting with the key decision makers such as the patient, family, and primary care physician should be held. Talking with the patient about what the patient wants after the hospitalization ends may or may not address the issue that the patient is dying.
Reference: Page 254

Rationale 3: If unsure of a patients wishes for care at the end of life, a team meeting with the key decision makers such as the patient, family, and primary care physician should be held. This ongoing open discussion about goals of care will help the patient and the family receive the best possible care at the end of life.
Reference: Page 254

Rationale 4: If unsure of a patients wishes for care at the end of life, a team meeting with the key decision makers such as the patient, family, and primary care physician should be held. Discussing the patients dire situation with the family should be conducted by the physician. Care needs should be focused on the patient and not want the family desires.
Reference: Page 254

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1. Describe the role of the nurse in providing quality end-of-life care for older adults and their families.

Question 14

Type: MCSA

An older patient who is terminally ill is receiving hospice care at home. What suggestion should the hospice nurse make in preparation for the patients death?

1. Discuss being admitted to a hospital.

2. Suggest transferring to a long-term care facility.

3. Recommend admission to an inpatient hospice setting.

4. Find out what the patient needs to be comfortable at home.

Correct Answer: 4

Rationale 1: Most Americans express a preference to die in their own homes. The hospice nurse should not discuss that the patient be admitted to a hospital.
Reference: Page 254

Rationale 2: Most Americans express a preference to die in their own homes. The hospice nurse should not suggest that the patient be transferred to a long-term care facility.
Reference: Page 254

Rationale 3: Most Americans express a preference to die in their own homes. The hospice nurse should not suggest that the patient be admitted to an inpatient hospice setting.
Reference: Page 254

Rationale 4: Most Americans express a preference to die in their own homes. The hospice nurse should find out what the patient needs to be comfortable at home during death.
Reference: Page 254

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1. Describe the role of the nurse in providing quality end-of-life care for older adults and their families.

Question 15

Type: MCSA

The hospice nurse has provided a presentation to long-term care nurses on barriers to excellent end-of-life care. Which statement made by a participating nurse indicates that additional teaching is needed?

1. Most patients have good pain control when they die.

2. Referrals to hospice or palliative care often arent made.

3. When a client is dying, there can be disagreements about the goal of care.

4. In general, healthcare professionals have difficulty in being honest with patients when discussing a poor prognosis.

Correct Answer: 1

Rationale 1: Although not all deaths involve pain and suffering, there are deficiencies in the way end-of-life care is currently provided in the U.S. healthcare system. Barriers include lack of knowledge regarding pain and symptom control.
Reference: Page 254

Rationale 2: Referrals to hospice or palliative care are often not made when appropriate for end-of-life care.
Reference: Page 254

Rationale 3: There are often disagreements about the goal of care when providing end-of-life care.
Reference: Page 254

Rationale 4: Healthcare professionals do have difficulty being honest with patients when discussing a poor prognosis.
Reference: Page 254

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1. Describe the role of the nurse in providing quality end-of-life care for older adults and their families.

Question 16

Type: MCMA

An older patient with terminal cancer asks the nurse to explain palliative care. How should the nurse respond to this patient?

Standard Text: Select all that apply.

1. It is the same as hospice care.

2. It is always provided in the home.

3. It can be provided along with life-prolonging care.

4. It is helpful for chronic health problems for which there is no cure.

5. It improves the quality of life while facing a life-threatening illness.

Correct Answer: 3,4,5

Rationale 1: Palliative care is not the same as hospice care. Palliative care is focused on the relief of suffering in an attempt to achieve the best possible quality of life for patients with serious illness and their families. Hospice care is focused on support and care for the patient in the last phase of an incurable disease so that the patient may live life as fully and comfortably as possible.
Reference: Page 256

Rationale 2: Palliative care can take place across all care settings.
Reference: Page 256

Rationale 3: Regardless of the stage of the disease or the need for curative therapies, palliative care is appropriate for patients with life-limiting, serious illness. It can be delivered concurrently with life-prolonging care or as the main focus of care.
Reference: Page 256

Rationale 4: Although palliative care can be delivered to patients of any age, it is especially appropriate when provided to older people who have progressive chronic illnesses.
Reference: Page 256

Rationale 5: Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illnesses.
Reference: Page 256

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Discuss the diverse settings for end-of-life care and the role of the nurse in each setting.

Question 17

Type: MCSA

The home care nurse is planning a visit to an older patient whose daughter died 6 months ago and the spouse died last month. For which potential health problem should the nurse assess the patient during the visit?

1. Normal grief

2. Complicated grief

3. Anticipatory grief

4. Uncompleted grief

Correct Answer: 2

Rationale 1: Normal grief is an experience of sadness and loss with reactions may include pain, distress, and physical and emotional suffering. Normal grieving may take years to complete.
Reference: Page 273

Rationale 2: Complicated grief extends beyond the normal grieving process. The survivor may feel hopeless and depressed, and the grief may affect a persons ability to care for him- or herself or others. Factors that may contribute to complicated grief in older adults include multiple, concurrent losses.
Reference: Page 273

Rationale 3: Anticipatory grief occurs before a loss associated with a diagnosis, illness, or death and is experienced by the patient, family, and caregivers.
Reference: Page 273

Rationale 4: Uncompleted grief is not an identified type of grief.
Reference: Page 273

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9. Discuss family support during the grief and bereavement period.

Question 18

Type: MCMA

The family of an older patient who is terminally ill wants to know if the patient can have a massage to help with the pain. How should the nurse respond to the family?

Standard Text: Select all that apply.

1. It might reduce the patients anxiety.

2. It might help reduce the patients pain.

3. It might help the patient breathe better.

4. It could help improve the patients mood.

5. It could cause the patient more discomfort.

Correct Answer: 1,2,3,4

Rationale 1: The use of complementary and alternative medicine at the end of life is associated with reduction in anxiety.
Reference: Page 263

Rationale 2: The use of complementary and alternative medicine at the end of life is associated with reduction in pain.
Reference: Page 263

Rationale 3: The use of complementary and alternative medicine at the end of life is associated with reduction in breathlessness.
Reference: Page 263

Rationale 4: The use of complementary and alternative medicine at the end of life is associated with an improvement in mood.
Reference: Page 263

Rationale 5: The use of complementary and alternative medicine at the end of life is not associated with more discomfort but rather has been known to reduce pain.
Reference: Page 263

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 19

Type: MCSA

An older patient who is dying starts yelling,I cant believe this. I am a good person. Why is this happening to me? The nurse identifies that the patient is in which stage of dying?

1. Anger

2. Denial

3. Bargaining

4. Depression

Correct Answer: 1

Rationale 1: Anger is the second stage of Kubler-Rosss stages of dying. Anger is exemplified by yelling and asking questions such as why me?
Reference: Page 256

Rationale 2: Denial is the first stage of Kubler-Rosss stages of dying. This is where the patient does not accept the diagnosis of death.
Reference: Page 256

Rationale 3: Bargaining is the third stage of Kubler-Rosss stages of dying. In bargaining, the patient will typically try to make deals so that he or she may live longer.
Reference: Page 256

Rationale 4: Depression is the fourth stage of Kubler-Rosss stages of dying. Depression involves feeling hopeless about the future.
Reference: Page 256

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 20

Type: MCSA

During a home visit an older patient who is terminally ill can no longer talk. What assessment data will the nurse use to determine if the patient is in pain?

1. Cool, dry skin

2. Moaning while being turned

3. Cyanotic feet and lower legs

4. Cheyne-Stokes respiratory pattern

Correct Answer: 2

Rationale 1: Cool dry skin may be present in a dying patient but is not a symptom of unrelieved pain.
Reference: Page 259

Rationale 2: Moaning while being turned may indicate pain.
Reference: Page 259

Rationale 3: Cyanotic feet and lower legs may be present in a dying patient but is not a symptom of unrelieved pain.
Reference: Page 259

Rationale 4: Cheyne-Stokes respiratory pattern may be present in a dying patient but is not a symptom of unrelieved pain.
Reference: Page 259

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Understand how pain and adverse symptoms affect dying.

Question 21

Type: MCMA

The hospice nurse is discussing the addition of adjuvant medication to help an older patient with cancer pain. Which types of medications would the considered as adjuvant for this type of pain?

Standard Text: Select all that apply.

1. Antiemetics

2. Corticosteroids

3. Antidepressants

4. Anticonvulsants

5. Muscle relaxants

Correct Answer: 2,3,4,5

Rationale 1: A wide array of nonopioid medications from several pharmacological classes has been shown to improve pain control when used concomitantly with pain medications. Their use may enhance the effectiveness of other classes of drugs, improving the treatment of pain at lower doses and decreasing the risk of side effects. Medications in this class do not include antiemetics.
Reference: Page 261

Rationale 2: A wide array of nonopioid medications from several pharmacological classes has been shown to improve pain control when used concomitantly with pain medications. Their use may enhance the effectiveness of other classes of drugs, improving the treatment of pain at lower doses and decreasing the risk of side effects. Medications in this class include corticosteroids.
Reference: Page 261

Rationale 3: A wide array of nonopioid medications from several pharmacological classes has been shown to improve pain control when used concomitantly with pain medications. Their use may enhance the effectiveness of other classes of drugs, improving the treatment of pain at lower doses and decreasing the risk of side effects. Medications in this class include antidepressants.
Reference: Page 261

Rationale 4: A wide array of nonopioid medications from several pharmacological classes has been shown to improve pain control when used concomitantly with pain medications. Their use may enhance the effectiveness of other classes of drugs, improving the treatment of pain at lower doses and decreasing the risk of side effects. Medications in this class include anticonvulsants.
Reference: Page 261

Rationale 5: A wide array of nonopioid medications from several pharmacological classes has been shown to improve pain control when used concomitantly with pain medications. Their use may enhance the effectiveness of other classes of drugs, improving the treatment of pain at lower doses and decreasing the risk of side effects. Medications in this class include muscle relaxants.
Reference: Page 261

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 22

Type: MCSA

An older patient who is dying has complained of ongoing pain for several days. What is the best way for this patients pain to be treated at the end of life?

1. Give immediate-release medications routinely.

2. Use long-acting medications that are given routinely.

3. Give immediate-release medications when the patient complains of pain.

4. Give long-acting medications routinely and immediate-release doses with breakthrough pain.

Correct Answer: 4

Rationale 1: Immediate-release agents are excellent PRN medications and should only be used to control breakthrough pain.
Reference: Page 260

Rationale 2: Long-acting drugs or sustained-release formulations are ideal because they provide consistent pain relief; however, they do not address breakthrough pain.
Reference: Page 260

Rationale 3: Immediate-release agents are excellent prn medications and should only be used to control breakthrough pain.
Reference: Page 260

Rationale 4: Long-acting drugs or sustained-release formulations are ideal because they provide consistent pain relief. Immediate-release agents are excellent prn medications and should only be used to control breakthrough pain.
Reference: Page 260

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 23

Type: MCMA

An older patient experiencing cancer pain is prescribed intravenous pain medication. What actions will the nurse take when providing the patient with this medication?

Standard Text: Select all that apply.

1. Use the smallest amount of fluid possible.

2. Use the appropriate fluid delivery system.

3. Offer oral medications for breakthrough pain.

4. Provide pain medication when it is the most severe.

5. Ensure the intravenous site does not become infected.

Correct Answer: 1,2,5

Rationale 1: When administering pain medication using the intravenous route, use the smallest amount of fluid possible to minimize the risk of fluid overload.
Reference: Page 262

Rationale 2: When administering pain medication using the intravenous route, use the appropriate fluid delivery system.
Reference: Page 262

Rationale 3: Oral medications are not used for breakthrough pain. Intravenous medications will most likely be provided for breakthrough pain when the patient is receiving intravenous pain medication. It will take too long for the pain medication to be effective through the oral route.
Reference: Page 262

Rationale 4: Pain medication should be provided to keep the patient comfortable and not have the patient endure unnecessary duress.
Reference: Page 262

Rationale 5: When administering pain medication using the intravenous route, use the nurse needs to ensure that the site does not become infected.
Reference: Page 262

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 24

Type: MCSA

An older patient who is dying is unable to fully close the eyes. What can the nurse do to protect the patients eyes from irritation?

1. Apply eye guards.

2. Apply artificial tears.

3. Tape the eyes closed.

4. Reduce the room lighting.

Correct Answer: 2

Rationale 1: Eye guards are not used to protect the eyes of a dying patient from drying out.
Reference: Page 263

Rationale 2: As death approaches and the patient becomes increasingly sedated, the blink reflex decreases resulting in dry eyes. Opened or half-opened eyelids dry and become irritated. Frequent eye care is provided to promote comfort when this occurs. Artificial tears may be used to prevent drying of the eyes.
Reference: Page 263

Rationale 3: Taping the eyes closed is not an intervention to protect the eyes of a dying patient from drying out.
Reference: Page 263

Rationale 4: Reducing the lighting in the room is not an intervention to protect the eyes of a dying patient from drying out.
Reference: Page 263

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 25

Type: MCSA

A newly licensed nurse is preparing to provide postmortem care for the first time and asks for help. How should the assisting nurse respond to this request?

1. Its just a dead body, it cant hurt you.

2. The families typically dont care about the body once the person is dead.

3. You can delegate this to the nursing assistant. Tell her to clean the body up when she is finished with her other work.

4. It is an important part of care; we need to show the family that the person was valued and respected. I can understand that you are nervous.

Correct Answer: 4

Rationale 1: The assisting nurse should not make an insensitive comment such as the body cannot hurt the other nurse. This does not demonstrate respect for the recently deceased patient.
Reference: Page 265

Rationale 2: Families do care about the body of their deceased loved one. This comment is inappropriate for the assisting nurse to make.
Reference: Page 265

Rationale 3: Postmortem care is not delegated to nursing assistants.
Reference: Page 265

Rationale 4: Postmortem care needs to be done promptly, quietly, efficiently, and with dignity, so that it is communicated to the family that the deceased one was valued and respected.
Reference: Page 265

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. Describe postmortem care.

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