NCLEX Questions ~ End of Life Care

The nurse is caring for a terminally ill adolescent client. When caring for this client the nurse should implement which intervention?

Encourage the client to maintain maximum self-control.

A client with terminal cancer arrives at the emergency department dead on arrival (DOA). After an autopsy is prescribed, the client's family requests that no autopsy be performed. Which response to the family is most appropriate?

"I will contact the medical examiner regarding your request."

A client who suffered a severe head injury has had vigorous treatment to control cerebral edema. Brain death has been determined. The nurse prepares to carry out which measure to maintain viability of the kidneys before organ donation?

Administering intravenous (IV) fluids

The nurse is caring for a client who is terminally ill. When assessing the client, the nurse recognizes which as the most common distress symptom near the end of life?

Anxiety

The nurse is caring for a client with terminal cancer who is close to death. On reviewing the plan of care, the nurse determines that which intervention is the priority?

Maintain the client's dignity and self-esteem, and make the client as comfortable as possible.

The nurse is caring for a terminally ill client who is experiencing delirium. When caring for this client, the nurse should take which action?

Provide a well-lighted room.

The nurse recognizes that which interventions are likely to facilitate effective communication between a dying client and family? Select all that apply.

The nurse encourages the client and family to identify and discuss feelings openly. The nurse assists the client and family in carrying out spiritually meaningful practices. The nurse maintains a calm attitude and one of acceptance when the family or client expresses anger.

The nurse is monitoring ongoing care for a potential organ donor who has been diagnosed with brain death. Which finding indicates to the nurse that the standard for ongoing care has been maintained?

Urine output 100 mL/hr

The nurse is caring for a client with cancer. The client tells the nurse that a lawyer will be arriving today to prepare a living will and asks the nurse to act as one of the witnesses for the will. What is the most appropriate nursing action?

Ask the client who might be available to serve as a witness.

The nurse is supervising the postmortem care of a client. Which action by the assistive personnel (AP) performing the care is appropriate?

Elevates the head of the bed 30 degrees as soon as possible after death

The nurse is caring for a terminally ill client who is unresponsive to verbal stimuli. The client's spouse asks if her husband can still hear her. Which is the best response by the nurse?

"Assume that your husband can still hear you."

The nurse is caring for a terminally ill child who is receiving palliative care. When explaining the purpose of palliative care to the child's caregiver, the nurse recognizes the need for additional instruction when the caregiver makes which statement?

"Palliative care interventions hasten death."

The spouse of a terminally ill client steps out of his room in tears. The spouse tells the nurse, "I don't know what I'm going to do when he's gone!" What is the nurse's best response?

"This must be very hard for you."

The mother of 6-year-old twins says to the nurse, "My mother-in-law doesn't think our children should come to the funeral service for their grandfather. What do you advise?" The nurse should respond by making which statement?

"What do you and your husband believe is the right thing for your children?"

The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply.

Encourage expression of feelings, concerns, and fears. Touch and hold the client's or family member's hand if appropriate. Be honest and let the client and family know they will not be abandoned by the nurse.

The hospice nurse is visiting a client in the client's home. The client has had several episodes of dyspnea, and there is a prescription for morphine elixir. The client's wife states, "I don't understand why he needs morphine. He tells me he's not in pain." What should the nurse include in the explanation of the purpose of the morphine?

It helps to reduce anxiety and oxygen consumption.

While the nurse is caring for a client with severe cardiac disease, the client states, "If anything should happen to me, please make sure that the doctors do not try to push on my chest and revive me." Which nursing action is appropriate?

Notify the primary health care provider (PHCP) of the client's request.

The nurse is caring for a client who has a medical diagnosis of end-stage chronic obstructive pulmonary disease (COPD). The client is in severe respiratory distress and tells the nurse, "Put me on the machine." The client's family says, "No, we are not going to do this again." The client has a do not resuscitate (DNR) prescription. What is the nurse's priority action?

Notify the primary health care provider (PHCP) that the client is rescinding the DNR prescription.

The nurse is caring for a terminally ill toddler. When interacting with the toddler's parents, the nurse should implement which interventions? Select all that apply.

Retain ritualism. Avoid significant changes in lifestyle. Maintain sensitivity toward the parents. Encourage the parents to be near the child. Encourage as normal an environment as possible.

A client who has been diagnosed with a terminal illness has an advance directive form, needs it to be signed, and asks the nurse to sign it as a witness. What is the nurse's best action?

Ask a nonmedical client, such as a social worker, to witness the form.

The nurse is preparing a plan of care for a client who just delivered a dead fetus. Which initial action should the nurse include in the client's plan of care to meet the emotional needs of the client and spouse?

Assess the client's and the spouse's perception of the event.

The hospice nurse visits a client who is dying of ovarian cancer. During the visit, the client says, "If I can just live long enough to celebrate my daughter's sweet-16 birthday party, I'll be ready to die." The nurse notes that the client is experiencing which phase of coping?

Bargaining

Which interventions should the nurse take for a deceased client whose eyes will be donated? Select all that apply.

Close the client's eyes. Elevate the head of the bed. Place wet saline gauze pads and a cool pack on the eyes.