End-of-Life

10. A client with cancer of the lung says to the nurse, "If I could just be free of pain for a few days, I might be able to eat more and regain strength." Which stage of grieving does the nurse conclude the client is in? A. Bargaining B. Frustration C. Depression D. Rationalization

Correct Answer: A Bargaining is one of the stages of grieving, in which the client promises some type of desirable behavior to postpone the inevitability of death.

2. A patient with terminal cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the most appropriate response by the nurse? A. "What are your feelings about being so sick and thinking you may die soon?" B. "None of us know when we are going to die. Is this a particularly difficult day?" C. "Would you like for me to call your spiritual advisor so you can talk about your feelings?" D. "Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you."

Correct Answer: A The most appropriate response to psychosocial questions is to acknowledge the patient's feelings and explore his or her concerns.

7. The dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient's needs? A. Encourage more physical activity. B. Assess for pain, constipation, and urinary retention. C. Assess for spiritual distress and restrain in varying positions. D. Assess for quality, intensity, location, and contributing factors of discomfort

Correct Answer: B Assessing for all reversible causes of delirium (i.e., pain, constipation, urinary retention, dyspnea, sensory hyperstimulation) so they can be reversed may help decrease confusion and restlessness.

11. A nurse is providing education to a community group about hospice. The nurse clarifies that the primary goal of hospice is help clients do what? A. Have the option of assisted suicide B. Remain comfortable until the end of life C. Explore the newest treatments for their form of cancer D. Release family members from participating in care

Correct Answer: B Hospice care attempts to break the cycle of fear and pain; care focuses on keeping the client as comfortable and high functioning as possible. Hospice care is provided after all treatments have failed; this care is provided during terminal stages of illness.

9. An 8-year-old child with a terminal illness is demanding of the staff. The child asks for many privileges that other children on the unit do not have. The staff members know that the child does not have long to live. The nurse can best help the staff members cope with the child's demands by encouraging them to: A. Provide as many extra treats as possible because the child is dying. B. Set reasonable limits to help the child feel more secure and content. C. Give the child some extra treats so they will feel less anxiety after the child dies. D. Understand that the dying child has unique needs and that special privileges can provide the necessary security

Correct Answer: B Reasonable limits are necessary because they provide security and help keep the child's behavior within acceptable bounds.

12. A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. A. Dementia B. Multiple losses C. Declines in health D. A milestone birthday E. An injury requiring hospitalization

Correct Answer: B and C Depression in the older adult is most often associated with the loss of family members and friends (e.g., death, relocation) and declines in mobility, health, and income. A decline in health, particularly when associated with a chronic illness, frequently precipitates depression in older adults.

6. When going to the hospital, which forms should patients be taught to bring with them in case end-of-life care becomes an ethical or legal issue? A. Euthanasia B. Organ donor card C. Advance directives D. Do not resuscitate (DNR)

Correct Answer: C Advance directives are written documents that provide information about the patient's wishes for medical care and treatments and his or her designated spokesperson.

5. A man died at the age of 71 following a myocardial infarction that he experienced while performing yard work. What would indicate that his wife is experiencing prolonged grief disorder? A. Initially she denied that he died. B. Talking about her husband extensively in year following his death C. Stating that she expects him home soon on the anniversary of his death Correct D. Crying uncontrollably and unpredictably in the weeks following her husband's death

Correct Answer: C Denial of an individual's death that persists beyond 6 months is indicative of prolonged grief disorder.

1. During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness? A. Frustration with pain B. Anorexia and nausea C. Feelings of hopelessness D. Inability to carry out activities of daily living

Correct Answer: C Feelings of hopelessness are likely to be present in a patient with a terminal illness who has clinical depression. This can be attributed to lack of control over the disease process or outcome. The nurse should routinely assess for depression when working with patients with a terminal illness

8. A client on hospice care is receiving palliative treatment. A palliative approach involves planning measures to: A. Restore the client's health. B. Promote the client's recovery. C. Relieve the client's discomfort. D. Support the client's significant others

Correct Answer: C Palliative measures are aimed at relieving discomfort without curing the problem.

13. The nurse is evaluating a client who received intravenous morphine. Which life-threatening response indicates the need to notify the healthcare provider? A. Headache B. Drowsiness C. Diaphoresis D. Bradycardia

Correct Answer: D Because morphine is a central nervous system depressant, it may cause bradycardia, shock, and cardiac arrest.

3. A patient has been receiving palliative care for the past several weeks in light of her worsening condition following a series of strokes. The caregiver has rung the call bell, stating that the patient now "stops breathing for a while, then breathes fast and hard, and then stops again." What should the nurse recognize that the patient is experiencing? A. Apnea B. Bradypnea C. Death rattle D. Cheyne-Stokes respirations

Correct Answer: D Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing. This type of breathing is usually seen as a person nears death.

4. Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply)? A. Strong spiritual beliefs B. Medical diagnosis of the patient C. Advanced age of the patient D. Acceptance of the expected death of the patient E. Adequate time for the caregiver to prepare for the death

Correct Answers: A,D,E Acceptance of an impending loss, spiritual beliefs, and adequate preparation time are all associated with positive outcomes regarding anticipatory grief.