Chapter 17. Nursing Care of Patients at the End of Life My Nursing Test Banks

Chapter 17. Nursing Care of Patients at the End of Life

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse observes a terminal patient making a gurgling sound when breathing. Which nursing diagnosis should the nurse use to guide interventions for this patient?
a. Impaired Gas Exchange
b. Ineffective Breathing Pattern
c. Ineffective Airway Clearance
d. Impaired Oral Mucous Membranes
____ 2. The nurse is preparing to provide cardiopulmonary resuscitation (CPR) to a patient found unresponsive and not breathing. What should the nurse keep in mind regarding the survival rate of patients who receive CPR in the hospital?
a. Most patients survive after receiving CPR in the hospital.
b. About 5% of patients survive who receive CPR in the hospital.
c. Less than 1% of patients survive who receive CPR in the hospital.
d. Between 10% to 15% of patients survive who receive CPR in the hospital.
____ 3. A family member is concerned that a patient near the end of life is not eating or drinking and asks the nurse how the family can help the patient increase oral intake. Which response by the nurse is most appropriate?
a. The best way to feed the patient is with a syringe and small amounts of water or liquid feeding.
b. The less the patient drinks, the less urination will be necessary and urination can be uncomfortable at this point in the dying process.
c. The starvation process at the end of life is quite natural; a side benefit is that lower doses of medications are needed to keep the patient comfortable.
d. As your family member becomes dehydrated from not eating or drinking, natural endorphins will be released, which increase comfort near the end of life.
____ 4. A patient is very restless and agitated near the end of life, and the physician orders haloperidol (Haldol) by mouth. However, the patient coughs and chokes every time foods or fluids are offered. Which action should the nurse take?
a. Crush the medication, and mix it with applesauce.
b. Hold the medication until the patient is more alert and able to swallow.
c. Ask the physician for an order to administer the Haldol intramuscularly.
d. Dissolve the medication in a small amount of water, and administer it with an oral syringe.
____ 5. A patient with lung cancer who expected to die within a few days is being given a blood transfusion. Family members, who realize death is imminent, ask, Why are you giving a blood transfusion when we all know death is just around the corner? What should the nurse respond to the family?
a. That question is best answered by the physician during rounds.
b. It is my duty as a nurse to continue to administer life-prolonging treatments until the patient dies.
c. The blood will raise the hemoglobin level, which will increase energy level and sense of well-being.
d. The transfusion will help increase the patients oxygen levels. It will not prolong life but will increase comfort.
____ 6. The nurse is reviewing a terminally ill patients advance directive. In which part of this directive should the nurse find the patients instructions to the physician concerning the care wanted as death nears?
a. HIPAA
b. Living will
c. Durable power of attorney
d. Patient Self-Determination Act
____ 7. A patient asks what a do not resuscitate order means. What should the nurse explain to the patient?
a. A DNR order means that you will not be placed on a ventilator if your heart stops and you require CPR.
b. A DNR order means you will not be resuscitated if your heart stops, and that all therapeutic support will be withdrawn.
c. A DNR order means that you will receive everything you need to remain comfortable, but you will not receive treatment that will prolong life.
d. A DNR order means you will not be resuscitated if your heart stops; you can specify whether you still want treatment to prolong your life, or only care that keeps you comfortable.
____ 8. The nurse finds a patient unresponsive and not breathing. While beginning CPR, the nurse realizes that the best outcome for this patient would be if CPR was started at which time?
a. Within 1 to 2 minutes of asystole
b. Within 3 to 5 minutes of collapse
c. Within 1 to 2 minutes of patient discovery
d. Within 8 to 10 minutes of patient symptoms
____ 9. The spouse of a patient with end-stage renal disease sits quietly at the patients bedside, staring at the patient as the patient slips into a coma. What should the nurse do at this time?
a. Ask the spouse what plans have been made for the patient once death occurs.
b. Remind the spouse to use the call light if the patient wakes up wanting something.
c. Sit down with the spouse and engage in conversation about the patients care needs.
d. Suggest the spouse return home, as the patient is unaware of the spouse being there.
____ 10. During the last vital signs assessment, a patient with end-stage heart failure has a body temperature of 102F. Which action should the nurse take at this time?
a. Provide additional blankets
b. Assist to a side-lying position
c. Encourage increased oral fluid intake
d. Administer acetaminophen as prescribed
____ 11. The spouse of a patient who died from a terminal illness expresses guilt for not encouraging the patient to seek medical attention sooner. The nurse realizes that the spouse is experiencing which stage of the grief process?
a. Reintegration
b. Shock and disbelief
c. Experiencing the loss
d. Denial and resistance
____ 12. The family of a dying patient is sitting at the bedside, silently watching the patient slip into a coma. What should the nurse suggest to the family at this time?
a. Count the patients respirations to know when death is near.
b. Talk to the patient because hearing is the last sense to leave the patient.
c. Stimulate the patient so that the patient is able to engage in conversation.
d. Return home to get some rest because it will be awhile before the patient dies.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 13. The nurse is providing care to a patient with a terminal illness. What should be the nurses priorities when providing care to this patient? (Select all that apply.)
a. Helping the patient define goals of care
b. Preparing the family for life after the patient has died
c. Encouraging the patient to have hope for a full recovery
d. Supporting the patient through losses leading to a good death
e. Helping the patient communicate care wishes to health care providers (HCPs)
____ 14. The nurse is identifying approaches so that a terminally ill patient experiences a good death. Which strategies should the nurse select to meet this goal? (Select all that apply.)
a. Dying that is not prolonged
b. Adequate pain and symptom management
c. A conclusion to relationships with loved ones
d. Allowing loved ones to make end-of-life decisions
e. Minimal financial and emotional burdens on family members
f. Using remaining time to strengthen relationships with loved ones
____ 15. The nurse is reviewing the nutritional status for a group of patients. In which patients would a feeding tube most likely be beneficial? (Select all that apply.)
a. An 80-year-old patent with dementia
b. A 76-year-old patient with terminal cancer
c. A 65-year-old patient recovering from pneumonia
d. A 90-year-old patient with diabetes and heart failure
e. A 55-year-old with esophageal cancer who is receiving radiation therapy
f. A 55-year-old patient receiving chemotherapy and experiencing loss of appetite
____ 16. A patient with terminal cancer has just died. Which actions should the nurse take during the immediate postmortem period? (Select all that apply.)
a. Bathe and dress the patient.
b. Ask the family if they want the patients face covered or uncovered.
c. Remove all tubes, medical supplies, and equipment from the bedside.
d. Provide the family a place away from the patients room to talk and grieve.
e. Notify the physician with the patients time of death per institutional policy.
f. Recommend that the family donate the patients organs as a way to find meaning from the death.
____ 17. A dying patient is experiencing copious secretions, difficulty in swallowing, and labored breathing. Which interventions should the nurse carry out? (Select all that apply.)
a. Suction secretions.
b. Encourage oral fluids.
c. Place a dehumidifier in the room.
d. Administer scopolamine as ordered.
e. Increase oxygen to 3 L per nasal cannula.
f. Place the patient in Fowlers or semi-Fowlers position.
____ 18. The nurse is concerned that a patient has a short time left to live. Which criterion is the nurse using that indicates a prognosis of 6 months or less to live? (Select all that apply.)
a. Incontinence
b. Functional decline
c. Increased agitation
d. Recurrent infections
e. Frequent hospitalizations
f. Weight loss of 10% or more
____ 19. The nurse is scheduling a hospice team to meet with the family of a dying patient. Which individuals will most likely participate in this meeting? (Select all that apply.)
a. Nurse to manage symptoms of pain and nausea
b. Social worker to assist with community resources
c. Chaplain to provide spiritual and emotional support
d. Physical therapist working to regain patient ability to walk
e. Bereavement counselor to provide assistance to family and loved ones
f. Hospitalist to direct an emergency response team and provide CPR
____ 20. The nurse is providing hospice care for a patient in the terminal phase of lung cancer. Which nursing actions would be appropriate? (Select all that apply.)
a. Provide low-dose morphine.
b. Place a fan at the patients bedside.
c. Encourage the patient to bathe daily.
d. Administer diuretic therapy as ordered.
e. Position the patient upright in a recliner with pillows.
f. Teach family members how to perform deep tracheal suctioning.
____ 21. A terminally ill patient is experiencing mouth discomfort. Which actions should the nurse take to help this patient? (Select all that apply.)
a. Offer ice chips.
b. Offer sips of water.
c. Apply lanolin to the lips.
d. Provide an alcohol-based mouthwash.
e. Use sponge-tipped Toothettes for mouth care.
____ 22. A terminally ill patient who is not able to talk is demonstrating restlessness. What actions can the nurse take to help this patient achieve comfort? (Select all that apply.)
a. Medicate for pain.
b. Elevate the head of the bed.
c. Measure oxygen saturation.
d. Reposition the patient in bed.
e. Ensure incontinence pad is clean and dry.
____ 23. The adult daughter of a terminally ill patient is upset because the patient is confused and is talking to people who are not in the room. What should the nurse do to help the patient and daughter? (Select all that apply.)
a. Encourage the patient to continue to talk.
b. Make sure that a dim light is on in the patients room.
c. Suggest the daughter provide the patient with sips of fluids.
d. Explain to the daughter that confusion is common and expected.
e. Encourage the daughter to provide tactile stimulation to the patient.

Chapter 17. Nursing Care of Patients at the End of Life
Answer Section

MULTIPLE CHOICE

1. ANS: C
Saliva that the patient is now unable to swallow may collect in the back of the throat, causing a sound sometimes called a death rattle. A. Impaired gas exchange would occur deeper in the lungs. B. Breathing pattern refers to breathing rhythm or rate, not airway patency. D. Mucous membranes are not necessarily involved.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

2. ANS: D
Only 10% to 15% of patients who receive CPR in a hospital survive. One reason for the low survival rate is that CPR must begin within 3 to 5 minutes of collapse. The most successful cases are ones in which CPR plus an automatic external defibrillator (AED) is used within 3 to 5 minutes of collapse. Patients who are not in a hospital and who survive after CPR have a 5% chance of living for one year. Success of CPR in a hospital setting depends greatly on the patients age. The best rate of CPR success is 10% in the age 40-to-59-year group. In patients over the age of 80 years, the CPR success rate declines to 3%. In patients over the age of 90 years, it declines further to 1%.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

3. ANS: D
Benefits in withholding artificial feeding and hydration in the final weeks of life in actively dying patients include fewer pharyngeal and lung secretions, which can reduce dyspnea; reduced swelling around tumors, which can reduce associated pain; and less urination, resulting in dryer skin with fewer breakdowns. It has also been theorized that as dehydration occurs, the body produces a form of endorphin, which enhances comfort. A. Feeding may not be the best action. B. Urination is not uncomfortable. C. Use of the word starvation may be distressing to the family.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

4. ANS: C
The patient will benefit from sedation, and the Haldol can be effectively administered by injection. A D. Crushing the medication, mixing it with applesauce, or dissolving the medication in water and providing it through a syringe will not prevent aspiration. B. Withholding the medication will not help the patients restlessness.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

5. ANS: D
Blood transfusions may be given to improve oxygenation and reduce dyspnea and are not intended to prolong life but to promote comfort. A. It is not necessary for the family to wait for an answer from the physician. Teaching is a nursing role. B. It is not the nurses duty to provide life-prolonging treatments until the patient dies. Nurses often administer comfort care at the end of life. C. Comfort is the goal at the end of life, not increased energy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

6. ANS: B
Living wills are documents instructing physicians as to the patients preferences for withholding or withdrawing life-sustaining procedures for patients who are unable to communicate, found to be permanently unconscious, or have been declared terminal. A. D. The Patient Self-Determination Act and Health Insurance Portability and Accountability Act (HIPAA) are pieces of legislation and not parts of an advance directive. C. A durable power of attorney document specifies who will speak for the patient when he or she cannot speak for himself or herself.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Application

7. ANS: D
DNR simply means do not resuscitate if a patients heart stops. A. B. C. A DNR order does not direct care prior to deathtype and extent of treatment prior to death is still determined by the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

8. ANS: B
The best outcomes from CPR occur when it is begun within 3 to 5 minutes of collapse. The most successful cases are ones in which CPR plus AED (automatic external defibrillator) are used within 3 to 5 minutes. A. It will be difficult to determine the length of time of asystole. C. CPR should be started immediately upon patient discovery. D. Waiting 8 to 10 minutes would not ensure a successful outcome when implementing CPR.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

9. ANS: C
When a patient is dying, the family is in crisis. The nurse needs to sit with patients and families in crisis, sustain eye contact, and support them in their process. A. Asking the spouse about plans once the patient dies is inappropriate. B. Reminding the spouse to use the call light is harsh and does not support the patient or familys needs at this time. D. Suggesting the spouse return home may interrupt the time that the spouse has left to spend with the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

10. ANS: D
For the terminally ill patient experiencing a fever, the nurse should provide acetaminophen, an antipyretic, as prescribed. A. Providing additional blankets would be appropriate if the patients temperature was sub-normal. B. Assisting to a side-lying position has no clinical significance for the client experiencing a fever. C. The clients health status may not support an increase in oral fluids.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort| Cognitive Level: Application

11. ANS: C
When experiencing the loss the spouse may feel guilt over not preventing the death or not providing enough care. A. Reintegration is when the spouse finds hope in the future, participates in social events, and feels more energetic. B. With shock and disbelief the spouse has difficulty with feelings of numbness, emotional outbursts, poor daily functioning, and avoidance. D. Denial and resistance is not a stage of the grief process.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Analysis

12. ANS: B
The nurse should suggest that the family talk to the patient because hearing is the last sense to leave a person. A. It would be inappropriate to ask the family to count the patients respirations in order to predict death. C. The patient is slipping into a coma and most likely will not be aroused or able to participate in conversation. D. The nurse has no way to predict the patients time of death. Sending the family home at this crucial time would be inappropriate.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

MULTIPLE RESPONSE

13. ANS: A, D, E
The role of the nurse with patients nearing the end of life include helping to identify patients with life-limiting illnesses early, so they and their families have the opportunity to re-define their goals of care, help patients communicate their wishes to HCPs, both orally and in writing, to ensure that their wishes are understood, and give patients support and validation as they move through the series of losses leading to a good death. B. Preparing the family for life after the patient has died is not a priority at this time. C. Encouraging the patient to have hope for a full recovery would be unrealistic and not fair to the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

14. ANS: A, B, E, F
Characteristics of a good death include avoiding unnecessary life-sustaining treatment and prolonging the dying process, adequate pain and symptom management, reducing the emotional and financial burden on their families, and using the remaining time to strengthen relationships with loved ones. C. Death is not a conclusion to relationships with loved ones. D. A good death means that the patient has the ability to make their own decisions.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

15. ANS: C, E, F
Patients who are expected to recover from an acute process or are experiencing an intervention that currently complicates oral intake would benefit the most from a feeding tube. This includes the patient recovering from pneumonia, radiation treatment for esophageal cancer, and receiving chemotherapy. B, D, and E. Using a feeding tube for a patient with dementia will not improve quality of life. The patients with terminal cancer, heart failure, and diabetes are not going to survive and tube feeding can increase complications and reduce comfort at the end of life.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Analysis

16. ANS: A, B, C, E
After death, the nurse will provide postmortem care. First, remove the tubes, medical supplies, and equipment. Bathing and dressing the patient and making him or her look presentable for the family shows respect. D. Allow the family time with the patient; do not remove the body until they are ready. Contacting the physician and funeral home are carried out according to institutional policy. Covering or uncovering the face at removal should be done according to the familys wishes. F. Information about organ donation should be provided according to agency policy, but the nurse should not make recommendations.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

17. ANS: A, D, F
Suctioning and positioning can help reduce aspiration of secretions. Scopolamine helps dry secretions. B. Encouraging oral fluids increases the risk of aspiration. C. A dehumidifier is not helpful and may make the patient less comfortable. E. Increasing oxygen provision will not alter secretions.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

18. ANS: B, D, E, F
Some indicators of a prognosis of 6 months or less regardless of diagnosis are functional decline, recurrent infections, frequent hospitalizations, and a 10% loss of weight in 6 months. A. C. Agitation and incontinence can occur for many reasons and do not necessarily predict death.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Analysis

19. ANS: A, E
The hospice team is multidisciplinary and includes the nurse, social worker, chaplain, and bereavement counselor in addition to the physician and home health aide. D. Because the hospice philosophy is one of support and symptom management, physical therapy designed to restore function would not be involved. F. CPR would not be appropriate for a hospice patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

20. ANS: A, B, D, E
Activities should be planned to conserve energy. Low-dose morphine reduces pulmonary edema and anxiety. A fan or breeze reduces the feeling of dyspnea. Diuretic therapy may increase comfort and treat dyspnea. An upright position will help alleviate dyspnea. C. Daily bathing is not required. F. Deep tracheal suctioning would be invasive and painful and often irritates tissue rather than aiding with breathing.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

21. ANS: A, B, C, E
In the terminally ill patient a dry mouth can be due to lack of oral intake, disease process, or medication. The nurse should offer the patient ice chips or sips of water, apply lanolin to the lips, and use sponge-tipped Toothettes for mouth care. D. An alcohol-based mouthwash can cause the oral tissues to dry further adding to the patients discomfort.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort| Cognitive Level: Application

22. ANS: A, C, D, E
For the terminally ill patient who is unable to verbally communicate needs but is demonstrating restlessness the nurse can medicate for pain, measure oxygen saturation, reposition the patient in bed, and ensure that an incontinence pad is clean and dry. B. Elevating the head of the bed may increase discomfort and is used for the patient who is experiencing dyspnea or other respiratory difficulty.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort| Cognitive Level: Application

23. ANS: A, B, D
The terminally ill patient may demonstrate acute confusion. The family will be better prepared for this confusion if they understand why it is occurring and that confusion is common and expected. The patient should be encouraged to talk. A dim light in the room helps the patient remain oriented. C. Providing the patient with sips of fluid would be helpful if the patient were experiencing a dry mouth. E. Tactile stimulation does not help reduce the patients confusion.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

Leave a Reply