Chapter 6- Palliative Care and End-of-Life Issues in Critical Care My Nursing Test Banks

 

1.

A nurse is working with a patient who is near death and experiencing delirium. Which of the following would be an appropriate course of action for this nurse to take in caring for this patient? Select all that apply.

A)

Instruct the patient in pursed-lip breathing.

B)

Provide oxygen support for the patient.

C)

Arrange supportive psychotherapy.

D)

Give the patient benzodiazepines.

E)

Give the patient neuroleptics.

2.

The husband of a terminally ill patient is upset at the sight of his wife continuing to linger on the brink of death. He has heard of end-of-life sedation and wonders whether it would be appropriate for his wife. Which of the following should the nurse mention as criteria for use of end-of-life sedation? Select all that apply.

A)

The patient is experiencing unbearable and unmanageable pain.

B)

The patient is only hours or days away from death.

C)

The patient has requested it.

D)

It is standard procedure for patients with a terminal illness.

3.

A patient in the ICU has entered a coma state, and someone must make a decision about whether to continue life-supporting measures for the patient. No living will exists for this patient. Who is the person legally authorized to make this decision?

A)

The patients wife, who is the executor of his estate

B)

The patients brother, who is his designated health care proxy

C)

The patients physician, who has been managing his care from admittance

D)

The patients nurse, who has been assigned to him on a daily basis

4.

The mother of a patient has requested that she and the rest of the family be allowed to be present in the patients room in the event that the patient requires resuscitation. The nurse, however, is reluctant to comply with this. What is the most likely reason she does not want the family in the room during resuscitation?

A)

Family members who are present during resuscitations may experience more anxiety.

B)

Family members present during resuscitation are more likely to sue.

C)

The nurse is new and is not comfortable with having the family present.

D)

A dedicated staff person is required to attend to the family during resuscitation.

5.

A teenage boy is near death in the ICU after being involved in a severe car accident. His mother and stepfather are in his room visiting him now. His father and stepmother have arrived in the waiting room and are asking to see the patient. A few days ago, the nurse observed the boys father and mother arguing loudly in the patients room. She has also observed that the boys muscles tighten and his breathing and heart rate increase when his father is near his bed. Which of the following would be the best action for the nurse to take?

A)

Ask the father and stepmother to wait until the current visitors have left.

B)

Ask the mother and stepfather to leave so that the father and stepmother can visit.

C)

Allow the father and stepmother to go into the patients room but accompany them.

D)

Tell the father and stepmother that they are not allowed to visit the patient.

6.

A patient in the ICU has ovarian cancer that has metastasized to her stomach and other organs. The physician believes the patient only has days to survive. Which of the following would be a realistic goal for the care of the patient that the nurse could suggest to the family?

A)

Eliminate the cancer cells by starting the patient on chemotherapy.

B)

Slow the rate of growth of the cancer by starting the patient on radiation therapy.

C)

Keep the patient free of pain by increasing the patients pain medication.

D)

Restore gastrointestinal function to the client via surgical intervention.

7.

A 10-year-old girl has just died in the ICU. The nurse is now questioning the patients physician to learn more details about the patients death to communicate to the family. Which stage of notification is the nurse currently in?

A)

Preparation

B)

Inform

C)

Support

D)

Afterwards

8.

The family of a patient who is near death makes the difficult decision to allow the physician to administer a pain-relieving drug to the patient with the intention of making the patient more comfortable, despite the fact that the drug may increase the risk for complications that could lead to the patients death. The principle involved in the familys decision is known as which of the following?

A)

Principle of moral distress

B)

Principle of palliative care

C)

Principle of unintended consequences

D)

Principle of double effect

9.

Which of the following is the best example of moral distress?

A)

A patients family has decided to end mechanical ventilation of the patient, but the nurse has trouble implementing their decision.

B)

A patients family has decided to continue mechanical ventilation for the patient, but the nurse disagrees and discontinues the ventilation on her own initiative.

C)

A patients family has decided to end mechanical ventilation of the patient, and the nurse implements their decision but later feels guilty.

D)

A patients family has decided to continue mechanical ventilation for the patient, and the nurse implements their decision, although she disagrees with it.

10.

A patient who is near the end of his life is to be extubated, according to the wishes of his family. Which of the following would be the best action for the nurse to take to support the patient?

A)

Ask the family to leave the room during the extubation.

B)

Hold a family conference to ask the family to reconsider their decision.

C)

Administer opioids to the patient to reduce pain and discomfort.

D)

Administer antibiotics to the patient to prevent infection.

11.

The nurse is caring for a critically ill patient who is expected to die despite the best efforts of the health care team. What aspect of a critical care unit may most interfere with effective nursing care of this dying patient?

A)

View of patient as disease or in terms of technology

B)

Critical illness has a high expectation of death

C)

Constant family presence at the bedside

D)

Multidisciplinary management of patient

12.

The nurse cares for critically ill patients in a busy trauma unit. The nurse manager has instituted a program to incorporate principles of palliative care into the care of all patients in the unit. What is the best reason for this inclusion?

A)

Most of the patients in critical care will die, so palliative care will be necessary.

B)

Primary palliative care focuses on relief of suffering and improvement of quality of life.

C)

This action has been mandated by the nurse manager and must be implemented.

D)

Palliation is another way of managing pain control in critical care.

13.

A patient has been admitted to critical care for management of exacerbation of a chronic illness. During this admission, the patients condition deteriorates and death is deemed imminent. A Do Not Resuscitate (DNR) order has been written and agreed to by the family. Considering the principles of palliative care, what is the most appropriate nursing action?

A)

Transfer the patient to the step-down unit since DNR patients are not eligible for critical care.

B)

Encourage the family to reduce their visits so that they will not have to witness the patients deterioration.

C)

Assess the patient and family for specific spiritual needs at this phase of life and death.

D)

Discontinue all supportive care to hasten the inevitable death of the patient and reduce costs.

14.

The patient has severe pulmonary edema following an acute myocardial infarction and is receiving intravenous diuretics to ease breathing. The nurse understands that this intervention is considered to be what?

A)

Definitive

B)

Curative

C)

Cause-and-effectbased

D)

Palliative

15.

The nurse is caring for a patient approaching the end of life. What symptom common at the end of life would the nurse most expect?

A)

Diminished pain

B)

Hypotension

C)

Tachycardia

D)

Dyspnea

16.

The nurse is caring for a critically ill patient who is dying and complaining of dyspnea while receiving supplemental oxygen. What is the most effective nursing intervention to alleviate the patients symptoms?

A)

Increasing room temperature

B)

Encouraging unlimited visits

C)

Closing blinds and drapes

D)

Providing a fan blowing on face

17.

The nurse is caring for a patient who is dying. The patient has persistent full depression. What is the most appropriate nursing action?

A)

Understand that depression is normal at the end of life.

B)

Facilitate use of antidepressant medications.

C)

Encourage the patient to discuss life achievements.

D)

Increase family visiting time and frequency.

18.

A nurse is caring for a critically ill patient who has identified an unrelated friend as his closest relative. What is the nurses most appropriate action in this situation?

A)

Treat the friend as the patients family.

B)

Do not allow the friend to visit as he is not family.

C)

Adhere to the legal definition of next of kin.

D)

Identify the next-closest-related family member.

19.

The nurse is preparing for a family conference with the family of a critically ill patient. What will best help the nurse to prepare?

A)

Complete knowledge about the status of the patient

B)

Knowing which members of the family will attend

C)

Knowing the goal of the conference

D)

Skill in therapeutic communication

20.

The nurse had been caring for a critically ill patient for several days, and the patient has just died. After completing end-of-life care of the patient and family, the nurse asks to take a short break. What is the best response by the charge nurse?

A)

Ask the nurse to wait to take a break until after she admits another patient.

B)

Deny the nurse a break, as the unit is particularly busy and the nurse cannot be spared.

C)

Arrange for the nurse to have psychological counseling for inability to handle stress.

D)

Ask another staff nurse to cover this nurses duties and allow her to take a break.

Answer Key

1.

D, E

2.

A, B

3.

B

4.

C

5.

A

6.

C

7.

A

8.

D

9.

A

10.

C

11.

A

12.

B

13.

C

14.

D

15.

D

16.

D

17.

B

18.

A

19.

C

20.

D

Page 1

Leave a Reply