Chapter 16: End of Life Care

27. Patients who are enrolled in hospice care through Medicare are often felt to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon? A) Unwillingness to overmedicate the dying patient B) Rules concerning completion of all cure-focused medical treatment C) Unwillingness of patients and families to acknowledge the patient is terminal D) Lack of knowledge of patients and families regarding availability of care

B) Rules concerning completion of all cure-focused medical treatment

26. A nurse is caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patients daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as? A) Lack of an American education of the patient and her family B) A language barrier to hospice care for this patient C) A barrier to hospice care for this patient D) Inability to grasp American concepts of health care

C) A barrier to hospice care for this patient

12. One aspect of the nurses comprehensive assessment when caring for the terminally ill is the assessment of hope. The nurse is assessing a patient with liver failure for the presence of hope. What would the nurse identify as a hope-fostering category? A) Uplifting memories B) Ignoring negative outcomes C) Envisioning one specific outcome D) Avoiding an actual or potential threat

A) Uplifting memories

4. A nurse who sits on the hospitals ethics committee is reviewing a complex case that has many of the hallmarks of assisted suicide. Which of the following would be an example of assisted suicide? A) Administering a lethal dose of medication to a patient whose death is imminent B) Administering a morphine infusion without assessing for respiratory depression C) Granting a patients request not to initiate enteral feeding when the patient is unable to eat D) Neglecting to resuscitate a patient with a do not resuscitate order

A) Administering a lethal dose of medication to a patient whose death is imminent

36. As a staff member in a local hospice, a nurse deals with death and dying on a frequent basis. Where would be the safe venue for the nurse to express her feelings of frustration and grief about a patient who has recently died? A) In the cafeteria B) At a staff meeting C) At a social gathering D) At a memorial service

B) At a staff meeting

39. You are caring for a patient who has just been told that his illness is progressing and nothing more can be done for him. After the physician leaves, the patient asks you to stay with him for a while. The patient becomes tearful and tries several times to say something, but cannot get the words out. What would be an appropriate response for you to make at this time? A) Can I give you some advice? B) Do you need more time to think about this? C) Is there anything you want to say? D) I have cared for lots of patients in your position. It will get easier.

B) Do you need more time to think about this?

You are caring for a patient, a 42-year-old mother of two children, with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. When you admitted this patient, you did a spiritual assessment. What question would it have been most important for you to evaluate during this assessment? A) Is she able to tell her family of negative test results? B) Does she have a sense of peace of mind and a purpose to her life? C) Can she let go of her husband so he can make a new life? D) Does she need time and space to bargain with God for a cure?

B) Does she have a sense of peace of mind and a purpose to her life?

A patients daughter has asked the nurse about helping him end his terrible suffering. The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress? A) Educating families about the moral implications of assisted suicide B) Identifying patient and family concerns and fears C) Identifying resources that meet the patients desire to die D) Supporting effective means to honor the patients desire to die

B) Identifying patient and family concerns and fears

A hospice nurse is caring for a 22-year-old with a terminal diagnosis of leukemia. When updating this patients plan of nursing care, what should the nurse prioritize? A) Interventions aimed at maximizing quantity of life B) Providing financial advice to pay for care C) Providing realistic emotional preparation for death D) Making suggestions to maximize family social interactions after the patients death

C) Providing realistic emotional preparation for death

10. A patient has just been told that her illness is terminal. The patient tearfully states, I cant believe I am going to die. Why me? What is your best response? A) I know how you are feeling. B) You have lived a long life. C) This must be very difficult for you. D) Life can be so unfair.

C) This must be very difficult for you.

28. One of the functions of nursing care of the terminally ill is to support the patient and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support patients and their families during this process? Select all that apply. A) Describe their personal experiences in dealing with end-of-life issues. B) Encourage the patient and family to keep fighting as a cure may come. C) Try to appreciate and understand the illness from the patients perspective. D) Assist patients with performing a life review. E) Provide interventions that facilitate end-of-life closure.

C) Try to appreciate and understand the illness from the patients perspective. D) Assist patients with performing a life review. E) Provide interventions that facilitate end-of-life closure.

2. A nurse who works in the specialty of palliative care frequently encounters issues and situations that constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the context of palliative care? A) The increase in cultural diversity in the United States B) Staffing shortages in health care and questions concerning quality of care C) Increased costs of health care coupled with inequalities in access D) Ability of technology to prolong life beyond meaningful quality of life

D) Ability of technology to prolong life beyond meaningful quality of life

14. A 66-year-old patient is in a hospice receiving palliative care for lung cancer which has metastasized to the patients liver and bones. For the past several hours, the patient has been experiencing dyspnea. What nursing action is most appropriate to help to relive the dyspnea the patient is experiencing? A) Administer a bolus of normal saline, as ordered. B) Initiate high-flow oxygen therapy. C) Administer high doses of opioids. D) Administer bronchodilators and corticosteroids, as ordered.

D) Administer bronchodilators and corticosteroids, as ordered.

8. A clinic nurse is providing patient education prior to a patients scheduled palliative radiotherapy to her spine. At the completion of the patient teaching, the patient continues to ask the same questions that the nurse has already addressed. What is the plausible conclusion that the nurse should draw from this? A) The patient is not listening effectively. B) The patient is noncompliant with the plan of care. C) The patient may have a low intelligence quotient or a cognitive deficit. D) The patient has not achieved the desired learning outcomes.

D) The patient has not achieved the desired learning outcomes.

40. A patient who is receiving care for osteosarcoma has been experiencing severe pain since being diagnosed. As a result, the patient has been receiving analgesics on both a scheduled and PRN basis. For the past several hours, however, the patients level of consciousness has declined and she is now unresponsive. How should the patients pain control regimen be affected? A) The patients pain control regimen should be continued. B) The pain control regimen should be placed on hold until the patients level of consciousness improves. C) IV analgesics should be withheld and replaced with transdermal analgesics. D) The patients analgesic dosages should be reduced by approximately one half.

A) The patients pain control regimen should be continued.

5. A medical nurse is providing palliative care to a patient with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurses care? A) To improve the patients and family's quality of life B) To support aggressive and innovative treatments for cure C) To provide physical support for the patient D) To help the patient develop a separate plan with each discipline of the health care team

A) To improve the patients and family's quality of life

The nurse in a pediatric ICU is caring for a child who is dying of sickle cell anemia. The childs mother has been unable to eat or sleep and can talk only about her impending loss and the guilt she feels about the childs pain and suffering. What intervention has the highest priority? A) Allowing the patient to express her feelings without judging her B) Helping the patient to understand the phases of the grieving process C) Reassuring the patient that the child's death is not her fault D) Arranging for genetic counseling to inform the patient of her chances of having another child with the disease

A) Allowing the patient to express her feelings without judging her

You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first? A) Ask if he would like you to sit with him while he collects his thoughts. B) Tell him that you will leave for now but will be back shortly. C) Offer to call pastoral care or a member of his chosen clergy. D) Reassure him that you can understand how he is feeling.

A) Ask if he would like you to sit with him while he collects his thoughts.

The nurse is assessing a 73-year-old patient who was diagnosed with metastatic prostate cancer. The nurse notes that the patient is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the patient is most likely in what stage of death and dying? A) Depression B) Denial C) Anger D) Resignation

A) Depression

After contributing to the care of several patients who died in the hospital, the nurse has identified some lapses in the care that many of these patients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings? A) Families needs for information and support often go unmet. B) Patients are too sedated to achieve adequate pain control. C) Patients are not given opportunities to communicate with caregivers. D) Patients are ignored by the care team toward the end of life.

A) Families needs for information and support often go unmet.

25. A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer patients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. A) Financial pressures on health care providers B) Patient reluctance to accept this type of care C) Strong association of hospice care with prolonging death D) Advances in curative treatment in late-stage illness E) Ease of making a terminal diagnosis

A) Financial pressures on health care providers B) Patient reluctance to accept this type of care D) Advances in curative treatment in late-stage illness

15. The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the patients death is imminent? A) Mottling of the lower limbs B) Slow, steady pulse C) Bowel incontinence D) Increased swallowing

A) Mottling of the lower limbs

16. A patient on the medical unit is dying and the nurse has determined that the familys psychosocial needs during the dying process need to be addressed. What is a cause of many patient care dilemmas at the end of life? A) Poor communication between the family and the care team B) Denial of imminent death on the part of the family or the patient C) Limited visitation opportunities for friends and family D) Conflict between family members

A) Poor communication between the family and the care team

13. A medical nurse is providing end-of-life care for a patient with metastatic bone cancer. The nurse notes that the patient has been receiving oral analgesics for her pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do? A) Request the physician to order analgesics by an alternative route. B) Crush the medication in order to aid swallowing and absorption. C) Administer the patients medication with the meal tray. D) Administer the medication rectally.

A) Request the physician to order analgesics by an alternative route.

An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting? A) The patient and family should be viewed as a single unit of care. B) Persistent symptoms of terminal illness should not be treated. C) Each member of the interdisciplinary team should develop an individual plan of care. D) Terminally ill patients should die in the hospital whenever possible.

A) The patient and family should be viewed as a single unit of care.

3. The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patients strategy? A) The patient may be trying to protect loved ones from the emotional effects of the illness. B) The patient is being noncompliant in order to assert power over caregivers. C) The patient may be skeptical of the benefits of the Western biomedical model of health. D) The patient thinks that treatment does not provide him comfort.

A) The patient may be trying to protect loved ones from the emotional effects of the illness.

31. A 67-year-old woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply. A) Reiterating her anger at her husbands care team B) Reinvesting in new relationships at the appropriate time C) Reminiscing about the relationship she had with her husband D) Relinquishing old attachments to her husband at the appropriate time E) Renewing her lifelong commitment to her husband

B) Reinvesting in new relationships at the appropriate time C) Reminiscing about the relationship she had with her husband D) Relinquishing old attachments to her husband at the appropriate time

23. As the American population ages, nurses expect see more patients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care? A) Ongoing acute care B) Restorative measures C) Mobility and socialization D) Incentives to palliative care

B) Restorative measures

9. The nurse is part of the health care team at an oncology center. A patient has been diagnosed with leukemia and the prognosis is poor, but the patient is not yet aware of the prognosis. How can the bad news best be conveyed to the patient? A) Family should be given the prognosis first. B) The prognosis should be delivered with the patient at eye level. C) The physician should deliver the news to the patient alone. D) The appointment should be scheduled at the end of the day.

B) The prognosis should be delivered with the patient at eye level.

21. A patients rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this patients care, the nurse should identify what primary aim? A) To prioritize emotional needs B) To prevent and relieve suffering C) To bridge between curative care and hospice care D) To provide care while there is still hope

B) To prevent and relieve suffering

30. A patient has just died following urosepsis that progressed to septic shock. The patients spouse says, I knew this was coming, but I feel so numb and hollow inside. The nurse should know that these statements are characteristic of what? A) Complicated grief and mourning B) Uncomplicated grief and mourning C) Depression stage of dying D) Acceptance stage of dying

B) Uncomplicated grief and mourning

37. A hospice nurse is well aware of how difficult it is to deal with others pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome? A) Inefficiency in the provision of care B) Excessive weight gain C) Emotional exhaustion D) Social withdrawal

C) Emotional exhaustion

22. The organization of a patients care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice? A) It is based on the participation of clinicians without a team leader. B) It is based on clinicians of varied backgrounds integrating their separate plans of care. C) It is based on communication and cooperation between disciplines. D) It is based on medical expertise and patient preference with the support of nursing.

C) It is based on communication and cooperation between disciplines.

24. A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patients care in this setting be based? A) Meaningful living during terminal illness requires technologic interventions. B) Meaningful living during terminal illness is best supported in designated facilities. C) Meaningful living during terminal illness is best supported in the home. D) Meaningful living during terminal illness is best achieved by prolonging physiologic dying.

C) Meaningful living during terminal illness is best supported in the home.

11. The nurse has observed that an older adult patient with a diagnosis of end-stage renal failure seems to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the patient explains to you that this is a cultural practice and very important to him. How should you respond? A) Privately ask the son to allow the patient to make his own health care decisions. B) Explain to the patient that he is responsible for his own decisions. C) Work with the team to negotiate informed consent. D) Avoid divulging information to the eldest son.

C) Work with the team to negotiate informed consent.

35. A pediatric nurse is emotionally distraught by the death of a 9-year-old girl who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurses own grief? A) Take time off from work to mourn the death. B) Post mementos of the patient on the unit. C) Solicit emotional support from the patients family. D) Attend the patients memorial service.

D) Attend the patients memorial service.

1. In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying? A) Increased incidence of infections and acute illnesses B) Increased focus of health care providers on disease prevention C) Larger numbers of people dying in hospital settings D) Demographic changes in the population

D) Demographic changes in the population

32. A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group? A) Providing a framework for incorporating the old life into the new life B) Normalizing adaptation to a continuation of the old life C) Aiding in adjusting to using old, familiar social skills D) Normalization of feelings and experiences

D) Normalization of feelings and experiences

29. The nurse is admitting a 52-year-old father of four into hospice care. The patient has a diagnosis of Parkinsons disease, which is progressing rapidly. The patient has made clear his preference to receive care at home. What interventions should the nurse prioritize in the plan of care? A) Aggressively continuing to fight the disease process B) Moving the patient to a long-term care facility when it becomes necessary C) Including the children in planning their fathers care D) Supporting the patients and family's values and choices

D) Supporting the patients and family's values and choices

38. The hospice nurse is caring for a 45-year-old mother of three young children in the patients home. During the most recent visit, the nurse has observed that the patient has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. What goal of nursing interventions should the nurse identify? A) Helping the family to understand why the patient needs to be sedated B) Making arrangements to promptly move the patient to an acute-care facility C) Explaining to the family that death is near and the patient needs around-the-clock nursing care D) Teaching family members how to interact with, and ensure safety for, the patient with impaired cognition

D) Teaching family members how to interact with, and ensure safety for, the patient with impaired cognition