Chapter 40: Psychological Care of Patients with Life-Threatening Illness My Nursing Test Banks

Chapter 40: Psychological Care of Patients with Life-Threatening Illness

Test Bank

MULTIPLE CHOICE

1. A nurse is caring for a patient awaiting test results that will indicate whether the patient has cancer. Which communication would be most helpful initially to facilitate a therapeutic nurse-patient relationship?

a.

Im sure this must be a difficult time. It may be most helpful for you to focus on the development of new drugs and other therapies.

b.

How sad and frightened you must feel right now. Do you have any family or friends that are good support systems for you that I might call?

c.

I am trying to imagine how you feel. If you spend this time making sure all your affairs are in order, it will give you more of a sense of control over the situation.

d.

This is a time of uncertainty for you and your family. I sense that you are quite anxious and in disbelief. Id like to talk to you about how youre feeling.

ANS: D

Between the development of symptoms and a definitive diagnosis, patients and their family members or loved ones have to endure a time of uncertainty. Often the best way to begin the intervention is to tell the person the behavior or emotion that you are observing and give it a name (shock, disbelief, fear, or sadness). It is important to validate and seek the persons agreement with or refinement of this perception. The correct response offers self, a therapeutic communication technique.

DIF: Cognitive Level: Application REF: Text Page: 764

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. A patient has just been diagnosed with an inoperable brain tumor. Which patient statement about concerns should the nurse expect initially?

a.

I wish I knew what I did to cause this to happen.

b.

Im very concerned about becoming a burden to my family.

c.

If that is the case I would like to look into nursing home placement or hospice care right away.

d.

Well, all of us have to die someday. Ill have to see a lawyer about a will, and Ill need you to tell me more about advance directives.

ANS: B

Patients and families have concerns immediately after receiving a diagnosis of terminal illness. Concerns frequently include how long people live after diagnosis, emotional effect or inconvenience to family or friends, being a burden, financial concerns, suffering pain or disfigurement, feelings of loss of control, feelings of still having much to do in life, and dying alone.

DIF: Cognitive Level: Application REF: Text Page: 765

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. A patient with liver failure rings the call bell and tells the nurse, The lunch is cold, and my sheets are wrinkled. You never seem to have enough help to give me the care I need. Which intervention should the nurse implement initially?

a.

Listen quietly but attentively until the patient has finished speaking.

b.

Attempt to correct each problem the patient has identified immediately.

c.

Say to the patient, Im sorry but please know that the staff is really doing the best they can.

d.

Promise the patient to share all of the concerns with the units nurse manager on day shift.

ANS: A

Ways in which the nurse can respond to patient or family concerns include, among others, listening without interrupting or defending, and providing what is requested if possible. For this reason, the nurse should initially listen to the patient before attempting to correct the perceived problems.

DIF: Cognitive Level: Application REF: Text Pages: 762-763

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

4. A patient diagnosed with amyotrophic lateral sclerosis says to the nurse, Ive been looking on the Internet to get more information about this disease. Which of the sites has the most reliable information? Which site would the nurse recommend?

a.

National Institutes of Health (NIH)

b.

Food and Drug Administration (FDA)

c.

Centers for Disease Control and Prevention (CDC)

d.

Occupational Safety and Health Administration (OSHA)

ANS: A

The NIH is a reputable and accurate website for obtaining health-related information. The CDC is appropriate for information about communicable diseases. OSHA oversees workplace safety, and the FDA oversees food and drug standards.

DIF: Cognitive Level: Application REF: Text Page: 764

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. A nurse advocating for an anxious patient newly diagnosed with a life-threatening illness would ask the health care provider to prescribe which type of medication?

a.

Selective serotonin reuptake inhibitor

b.

Monoamine oxidase inhibitor

c.

Tricyclic antidepressant

d.

Benzodiazepine

ANS: D

The patients symptoms of anxiety need not meet the criteria for a formal psychiatric diagnosis in order to be treated. Pharmacological treatment with benzodiazepines is common practice, and nurses should initiate requests for a prescription if the patient does not already have one.

DIF: Cognitive Level: Application REF: Text Page: 764

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient underwent surgery for cancer and now needs follow-up chemotherapy. The patient reports anorexia, fatigue, and trouble concentrating and sleeping. A nurse would place highest priority on responding to which statement by the family member?

a.

We are so concerned about him. He hardly eats or sleeps anymore. Can something be done?

b.

Were not surprised hes depressed after all he is going through, but is there some medicine that can help him right now?

c.

Were not surprised hes so depressed. It ought to be expected after all that hes been through. Hell be back to normal after the chemotherapy.

d.

We cant wait for the chemotherapy to start. He worries about any remaining cancer starting to grow between the surgery and the chemotherapy.

ANS: C

A persistent myth proposes that if a person has a reason to be depressed, no treatment is needed because this functional depression is a normal response. However, this myth denies that the patient has a need for effective treatment. For this reason, the nurse should first follow up on that response.

DIF: Cognitive Level: Analysis REF: Text Page: 764

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

7. A nurse enters the room of a patient newly diagnosed with multiple sclerosis and notes that the patient is crying quietly while lying in bed. Which communication by the nurse would be most appropriate?

a.

You are crying. What are you feeling thats making you so sad?

b.

Do you want me to call the health care provider to order some antidepressant medication for you?

c.

I can understand why you would cry. I imagine most people would feel sad after being given your diagnosis.

d.

Crying is a normal response to a diagnosis such as yours. Youll feel better after your plan of care has been fully developed.

ANS: A

The most appropriate statement is the one that attempts to use therapeutic communication to determine whether the patient is depressed. The correct option is the only one that attempts to elicit more information about the patients feelings. This would be the most effective means of assessing the patients emotional status.

DIF: Cognitive Level: Application REF: Text Pages: 764-765

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. The adult child of a critically ill patient has been keeping vigil, remaining at the bedside constantly for 3 days. Which communication from the nurse would be most appropriate when the child becomes demanding and impatient with the staff providing the parents care?

a.

I can see that you are feeling short-tempered, which is not unusual under the circumstances. Still, it is not good for your parent to hear you complaining.

b.

It must be difficult for you to be here day after day. What other family members can stay so that you can get a good nights sleep at home?

c.

It would be best for you to go home for a few days and get some sleep and proper nutrition. Do you have the number here so you can call if you feel the need to?

d.

You have had little sleep in the last few days. Perhaps you should go home for some rest. You cant be of much help if you are so tired you cant think properly.

ANS: B

The correct response is one that acknowledges the family members situation and then explores an alternative.

DIF: Cognitive Level: Application REF: Text Page: 765

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. A nurse working in the pediatric intensive care unit is assigned to pediatric patients who are experiencing pain. The nurse would select the Wong FACES Pain Rating Scale for use in which child?

a.

A 6-month-old patient with failure to thrive

b.

A 12-month-old patient with a burn injury

c.

A 24-month-old patient with injuries after a fall

d.

A 38-month-old patient with sickle cell disease

ANS: D

The Wong FACES Pain Rating Scale can be used for children ages 3 years (36 months) and above. The patient is asked to point to the face that best describes the pain, from a smiley face to a tearful one.

DIF: Cognitive Level: Application REF: Text Pages: 765-766

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. A patient receiving palliative care is treated with large doses of narcotic analgesics to control pain. To minimize side effects of this medication the nurse should ensure that there is a prn prescription for which type of medication?

a.

Antiemetic

b.

Stool softener

c.

Bronchodilator

d.

Nonopioid analgesic

ANS: B

Constipation occurs in as many as two thirds of patients receiving palliative care. Patients taking narcotic pain-control agents regularly should have prophylactic treatment for constipation, which could include stool softeners and laxatives.

DIF: Cognitive Level: Application REF: Text Page: 766

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient undergoing chemotherapy is experiencing anxiety-induced anticipatory nausea and vomiting. A nurse could assist this patient by requesting a prescription for which preferred medication?

a.

Lorazepam (Ativan)

b.

Hydroxyzine (Vistaril)

c.

Promethazine (Phenergan)

d.

Chlorpromazine (Thorazine)

ANS: A

Because the nausea and vomiting are anxiety-induced, lorazepam (a benzodiazepine) may be used to reduce both the anxiety and the nausea and vomiting. The other medications listed are useful in treatment of nausea and vomiting.

DIF: Cognitive Level: Application REF: Text Page: 766

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A nurse should use which measure initially to reduce dyspnea in a patient with end-stage chronic obstructive pulmonary disease?

a.

Administer a dose of an ordered prn bronchodilator.

b.

Encourage the patient to use an incentive spirometer.

c.

Assist the patient to cough and deep breathe.

d.

Elevate the head of the bed.

ANS: D

Dyspnea occurs in many chronic and end-stage diseases and the nurse can assist the patient with shortness of breath by raising the head of the bed to a comfortable position. Bronchodilators may be used as an aid, but positioning is noninvasive and is a first-line intervention. Incentive spirometry, coughing, and deep breathing would prevent atelectasis but would not treat the symptom of dyspnea resulting from the end-stage disease process.

DIF: Cognitive Level: Application REF: Text Page: 766

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

13. The adult child of a terminally ill patient tells a nurse, The doctor recommended considering end-of-life care. The nurse interprets that this most likely means that the patient will not live more than _____ month(s).

a.

1

b.

3

c.

6

d.

24

ANS: C

End of life is generally accepted as the probable last 6 months of life.

DIF: Cognitive Level: Comprehension REF: Text Pages: 766-767

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

14. A patient with metastasized cancer says to the nurse, Ive been reading about some of the cancer research, and I am still hoping for a cure in the next few months. In formulating a response to the patient, which should the nurse consider first?

a.

The patients religion and/or faith-based beliefs

b.

The need for a consultation with a professional grief counselor

c.

The purpose that would be served in confronting the patients denial

d.

The patients ability to understand the meaning of this particular research

ANS: C

Having hope against hope may not mean that the patient is in denial, but rather that he or she is using denial as an adaptive defense mechanism. The nurse should first consider what purpose confrontation would serve at this time.

DIF: Cognitive Level: Analysis REF: Text Page: 767 | Text Page: 770

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

15. An older adult patient diagnosed with Parkinson-induced dementia becomes critically ill with severe pneumonia. No family is available. After repeated failed attempts to contact the patients agent designated by the Health Care Power of Attorney, which standard should the health care team use as the best method for decision making in planning care for this patient?

a.

Informed consent

b.

Best interests standard

c.

Patients Bill of Rights

d.

Substituted judgment standard

ANS: B

The best interests standard is applied when the patient lacks decisional capacity and no other designated health care proxy is available. This standard is based on what would promote the welfare of the average patient.

DIF: Cognitive Level: Application REF: Text Page: 767

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

16. A patient with end-stage renal disease does not want further aggressive treatment but is reluctant to withdraw life-sustaining treatment. The nurse would help the patient to understand that life-sustaining treatment includes maintaining:

a.

full code status.

b.

comfort measures only.

c.

nutrition, hydration, and dialysis.

d.

nutrition and hydration but removal of dialysis.

ANS: C

The patient who wants to withhold further aggressive therapy but not withdraw life-sustaining therapy would be informed that nutrition, hydration, and current treatments such as dialysis would be maintained.

DIF: Cognitive Level: Application REF: Text Pages: 767-768

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

17. When a terminally ill patient is attempting to make the decision to withhold further treatment, the nurse would indicate that which medication would no longer be prescribed if treatment were to be withheld?

a.

Antibiotics

b.

Antiemetics

c.

Opioid analgesics

d.

Nonopioid analgesics

ANS: A

Antibiotics are used to treat infection and therefore would be withheld in the care of a patient who has designated that life-sustaining treatment should be withheld. The medications in the other options promote comfort and would continue to be administered.

DIF: Cognitive Level: Application REF: Text Page: 768

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

18. A nurse explained hospice services to a patient with metastatic cancer. In evaluating the teaching, the nurse determines the need for further information when the patient states that one of the services provided in hospice care is:

a.

experimental chemotherapy.

b.

symptom management.

c.

psychosocial support.

d.

nutritional counseling.

ANS: A

Hospice care would not include any form of chemotherapy, which is a therapy generally intended to treat or cure cancer. Hospice care does involve pain and symptom management, nutritional counseling, physical/occupational/speech therapies, home health services for personal care, psychosocial and emotional support, grief counseling, and crisis care during medical emergencies.

DIF: Cognitive Level: Application REF: Text Pages: 768-769

TOP: Nursing Process: Evaluation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

19. A nurse is working with the family of a terminally ill child with leukemia. The nurse shares with the parents that which sibling will likely have a more factual than emotional response to the siblings death?

a.

16-year-old

b.

12-year-old

c.

8-year-old

d.

3-year-old

ANS: D

Below the age of 6 years, attitudes toward death are often matter-of-fact rather than emotional.

DIF: Cognitive Level: Comprehension REF: Text Page: 769

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

20. When the parents of a terminally ill teenager whose death is imminent are approached and counseled regarding the possibility of organ donation, the parents refuse. The nurse is concerned that they may not have fully considered the positive effect organ donation has on both the surviving family members as well as organ recipients. Which nursing action will have the greatest therapeutic effect regarding the parents decision?

a.

Ask the chaplain to address the issue with the parents after giving them time to reconsider.

b.

Gently share with the parents that they could be making a mistake they will later regret.

c.

Say nothing, and support the parents in their decision to the fullest extent possible.

d.

Refer the matter to the hospitals organ procurement agent.

ANS: C

Even when a nurse finds it difficult to accept an informed decision a parent has made, professional ethics clearly require that the decision be supported.

DIF: Cognitive Level: Application REF: Text Page: 770

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

21. A 22-year-old nurse is working with a seriously ill 23-year-old patient who is recovering from a motor vehicle accident. The nurse recognizes having difficulty maintaining professional boundaries based on their similar ages. Which action should the nurse take initially?

a.

Seek guidance from another experienced nurse or the unit manager.

b.

Provide excellent care, but keep conversation and contact to a minimum.

c.

Arrange to have ancillary staff complete as much care as possible within their scope of practice.

d.

Discuss with the nursing supervisor the possibility of having another nurse assume this patient assignment.

ANS: A

It may be challenging for the nurse to maintain professional boundaries when the age of the nurse and patient are near the same. It is advisable for the nurse to discuss the conflict with an experienced nurse or supervisor. Seeking reassignment from that patient is considered only after it becomes apparent that the issue cannot be effectively resolved.

DIF: Cognitive Level: Application REF: Text Page: 769

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

22. A patient who is terminally ill expresses a wish to hurry up and end it all. In exploring reasons for this wish, which should the nurse assess first?

a.

Guilt and fatigue

b.

Pain and depression

c.

Self-esteem and hope

d.

Competency and pain

ANS: B

Studies have shown that when pain and depression are adequately treated, patient requests to hasten death diminish.

DIF: Cognitive Level: Application REF: Text Page: 770

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Palliative care includes: (Select all that apply.)

a.

comfort measures.

b.

fluid-volume replacement.

c.

range-of-motion exercises.

d.

nasogastric tube feedings.

e.

pain medication therapies.

ANS: A, E

Palliative care includes pain medications, stomach ulcer prevention, skin and mouth care, and other comfort measures. Palliative care does not necessarily include IV hydration (or tube feedings). There is no purpose for doing range-of-motion exercises for this patient.

DIF: Cognitive Level: Comprehension REF: Text Pages: 765-766

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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