Chronic II End of life module

Mrs. K's family has informed you that she is Roman Catholic and that her wishes were to have a priest administer the sacrament of the sick when she was close to death. You recognize that she is getting very close and suggest: A. "Can I help you call a priest to come and honor her wishes?" B. "We don't have a priest, but I can see if the hospital chaplain on call can visit her." C. "There is no need for a sacrament of the sick because Mrs. K is close to end of life." D. "Mrs. K is actively dying so you had better contact your local priest soon."

A. "Can I help you call a priest to come and honor her wishes?"

Mr. S. has stage IV lung cancer and was admitted to your unit yesterday because of shortness of breath. His breathing has improved with treatment and you tell him you are hoping to get to know him better so you can provide the best care possible. Which of the following statements reflects your interest in getting to know him? A. "Can you tell me what has given your life meaning?" B. "Do you know much about your disease?" C. "Is your cancer treatment helping you?" D. "If I can do anything to help you, let me know."

A. "Can you tell me what has given your life meaning?"

John is a 70-year-old male whose wife died from COPD two months ago. They were very close, married for 52 years, and had no children. He comes by the nursing unit to bring you all candy and a thank you note for all the times you cared for her the past year. He tells you he is struggling to want to eat since she always was the cook, and is just not ready to go out to dinner with his buddies, even though they keep asking him. Your assessment is that John is: A. Experiencing normal grief after his wife died two months ago B. Depressed because he doesn't want to go out with his buddies C. At high risk for complicated grief because his wife died in the hospital D. Is doing poorly alone at home because he is not eating well and needs counseling

A. Experiencing normal grief after his wife died two months ago

You are caring for a patient who has just died. In assisting the family to understand what will occur next, you should: A. Explain how the body will be cared for immediately following the death. B. Request that the family leave the room in order for the body to be washed. C. Give information about the need to remove the body promptly for embalming. D. Ask if they would like to have all the tubes, catheters, and IV lines removed.

A. Explain how the body will be cared for immediately following the death.

During your pain assessment, Lenora describes her pain as an aching and cramping pain in her lower abdomen. What type of pain does this usually describe? A. Nociceptive pain B. Acute pain C. Neuropathic pain D. Psychological pain

A. Nociceptive pain

Mr. Jones is struggling with fatigue from his advanced heart failure. Which of the following referrals would you recommend to help him with this debilitating symptom? A. Occupational therapy B. Social work C. Psychology D. Respiratory therapy

A. Occupational therapy

You have been caring for a Hispanic patient with advanced obstructive lung disease for the past several weeks. The family has been at the bedside daily, with one member spending the night throughout the hospital stay. In assessing cultural beliefs and practices related to death and dying for the patient and family, it is necessary for you to consider which of the following factors? A. What rituals, practices, and beliefs about death are important to the patient and family B. The age of the patient and close family members C. Where the patient's own parents lived before they died D. Why the family member feels the need to spend the night throughout the hospital stay

A. What rituals, practices, and beliefs about death are important to the patient and family

You are caring for an elderly woman who is dying from Parkinson's disease. Her husband died years ago and all of her friends are also now deceased. She has no children or living family members. You are sitting with her and she tells you how lonely she feels. Your best response is: A. "At least you have lived a long life and were married to a wonderful husband." B. "It must feel so lonely with your family and friends no longer with you." C. "You don't have to feel alone; I am here with you now." D. "Isn't there anyone you know who I can call to come visit you?"

B. "It must feel so lonely with your family and friends no longer with you."

The family of a patient who is dying asks you why the nurses always come in and look under the sheets at his legs when they are checking his blood pressure. You explain: A. "They are making sure he is not getting sores under his legs since he is lying so still." B. "They are assessing for signs that death may be near." C. "I don't know why they need to do this at this time since he is not exercising his legs." D. "They are just examining him all over to make sure he is comfortable."

B. "They are assessing for signs that death may be near."

You are caring for a 76-year-old patient who is unresponsive and close to end of life from a massive stroke. The patient has a history of breast cancer and had been experiencing severe bone pain in her left hip prior to her stroke. How do you assess her pain now that she is unresponsive? A. Ask her anyway and see if she can nod "yes" to your question. B. Assume she continues to have pain and assess for evidence of wincing or facial grimacing. C. You don't need to assess this, as she is now unresponsive. D. Ask the family to report a pain score, using a 0-10 numeric rating scale, for her.

B. Assume she continues to have pain and assess for evidence of wincing or facial grimacing.

You are caring for a number of patients and family members who are facing loss or death. In speaking with them about grief, you correctly convey that grief: A. Is an orderly process with predictable stages of work to be done B. Begins before a loss or death, as people consider a pending loss C. Lasts a year or less, at which time survivors should be able to move on D. Includes personal feelings that are universal and understood by everyone

B. Begins before a loss or death, as people consider a pending loss

Symptom management in older adults with serious illness is complicated because: A. They never take their medications correctly. B. Many have multiple comorbidities. C. They tend to ignore their symptoms. D. They like to over-report the severity of their symptoms.

B. Many have multiple comorbidities.

You are asking a nursing student to describe the assessment of a patient for dyspnea as part of end-of-life care. Which statement by the student indicates understanding of the best method to assess for dyspnea? A. "I will auscultate my patient's chest." B. "I will take my patient's respiratory rate." C. "I will ask my patient about his breathing." D. "I will check my patient's oxygen saturation."

C. "I will ask my patient about his breathing."

A patient's daughter asks you what she can do to help make her mother, who is dying, more comfortable. The daughter has been sitting at her mother's bedside for the past two days and is feeling helpless. Your best response would be: A. "Your mom is fine. Why don't you take a long walk and get some dinner since you must be so tired and hungry?" B. "I don't think there is any more we can do to make her more comfortable. She is resting now." C. "Some patients relax when we give them a gentle foot massage. Would you like me to show you how?" D. "You don't need to worry. Your mom seems comfortable and the nurses are all giving her great care."

C. "Some patients relax when we give them a gentle foot massage. Would you like me to show you how?"

Jane, a 72-year-old woman with end-stage renal disease, tells you she thinks she doesn't want to continue dialysis anymore. Which of the following would be your best response to this statement? A. "Of course you want to continue dialysis, it is keeping you alive." B. "Don't talk like that, your family loves taking you to your treatments." C. "That is a very important statement, can you tell me more about that?" D. "I understand why you wouldn't want to do it; it is so exhausting for you."

C. "That is a very important statement, can you tell me more about that?"

Mr. C, whose wife of 14 years died five months ago, returns to your unit to thank you all for your great care. He states, "I still can't get through a week without crying sometimes. I know I should be at least starting to move on a bit." Your best response would be: A. "Most people find it takes six months before things get back to normal." B. "It is still so soon after your wife's death; I am sure you will be feeling better soon." C. "This is very hard; can you tell me a bit about what moving on means to you?" D. "Perhaps you would like to have individual counseling for more intensive therapy."

C. "This is very hard; can you tell me a bit about what moving on means to you?"

The parents of a 2-year-old child who is dying from leukemia tell you they are so afraid that they will forget who their child was years after he dies. How should you respond? A. "Don't worry, you will always remember him and will never forget him." B. "There is little that can be done now that he is actively dying, but I am here with you." C. "Would you like me to call our child life team who can help you with some memory making activities?" D. "Have you taken any pictures of him so that you can look back at them in years to come?"

C. "Would you like me to call our child life team who can help you with some memory making activities?"

Which of the following patients should never be given an opioid medication? A. Ms. Jones a 27-year-old with a history of substance abuse B. Mr. Rich who reports severe nausea and vomiting with previous use of opioids for pain C. Mrs. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work D. Mr. Hanover who is 72 and has end-stage heart failure

C. Mrs. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work

You are caring for a patient who is in the advanced stages of AIDS. The patient is reporting severe fatigue. Which finding is commonly associated with the symptom of fatigue? A. Normal thyroid function B. Normal hemoglobin and hematocrit levels C. Sedating medications D. Adequate muscle strength and tone

C. Sedating medications

Mr. F has advanced prostate cancer with bone metastasis. He is unresponsive and is being cared for at home by his daughter. You are teaching the daughter about assessing her father's pain. Which statement by the daughter indicates an understanding of her father's pain status? A. If he is not moaning, he's probably not experiencing pain. I'll have to guess when he is in pain since he can't tell me. B. Now that he's unable to communicate, we can stop his pain medication. C. Since he was in pain when he was conscious, I assume he's still in pain.

C. Since he was in pain when he was conscious, I assume he's still in pain.

Mr. Johnson tells you that although the oral morphine prescription he just started for his cancer pain says to take one tablet every 12 hours, he has found that if he takes it every 6 hours, his pain is much less. What behavior does this represent? A. Addiction B. Physical dependence C. Tolerance D. Substance misuse

C. Substance misuse

The hospice interdisciplinary team is creating a bereavement plan for the family of Mr. A, a 50-year-old patient with advanced HIV/AIDS. The patient defines his family as consisting of his partner, his parents, four siblings, as well as his two closest friends. In creating the plan, each member of the interdisciplinary team understands that bereavement interventions must: A. Focus mainly on the patient's parents and siblings. B. Include a referral to a bereavement support group or spiritual support group. C. Take into account each survivor's cultural practices in mourning and grief reactions. D. Occur at regular intervals for the initial six months after the death of the patient.

C. Take into account each survivor's cultural practices in mourning and grief reactions.

Joey is a 3-month-old who has a serious illness and will probably die in the next few months. His mother is concerned that he looks like he is in pain whenever she has to change his diaper. Your best response to her is: A. Don't worry, Joey is too young to feel real pain. B. All 3-month-old babies hate to have their diaper changed, he is just responding normally. C. I will ask the doctor if it is possible for him to have pain with this illness. D. Can you explain to me what Joey looks like that makes you concerned he is in pain?

D. Can you explain to me what Joey looks like that makes you concerned he is in pain?

You are talking with the staff on your unit about the emotional challenges of working with dying patients and their families. Which of the following is an appropriate response to the grief the staff has been experiencing recently? A. Avoid talking about the recent deaths, focusing on the patients who have survived. B. Seek the support of the family of the dying patient to comfort the staff. C. Share with the staff that personal grief should not be expressed by healthcare professionals. D. Consult with the hospital chaplain or spiritual care counselor for staff support.

D. Consult with the hospital chaplain or spiritual care counselor for staff support.

Mrs. Smith has suffered with terrible bone pain from metastatic breast cancer for the past three admissions to your unit. She is now nearing end of life. Her family requests that you not give her any pain medications because they are afraid it will hasten her death. What should you do? A. Honor the family's wishes so that they will be more comfortable with her plan of care. B. Offer to get the doctor to make the pain medications as needed rather than around the clock. C. Tell the family that she probably won't need her pain medications much longer. D. Educate the family about the importance of keeping her comfortable and that the pain medication will not hasten her death.

D. Educate the family about the importance of keeping her comfortable and that the pain medication will not hasten her death.

Mr. T is nearing end of life and tells you that he has seen his deceased father coming to visit him in his room. What is your best action? A. Call the physician to let her know that Mr. T is having hallucinations and needs medication. B. Tell Mr. T. that his father is dead and it is not possible that he is in the room with him. C. Ask the family if Mr. T has had a history of psychosis or other mental health issues. D. Find out from Mr. T how it feels to have his father visiting, is it frightening him?

D. Find out from Mr. T how it feels to have his father visiting, is it frightening him?

You are providing bereavement support to an 8-year-old child whose father just died on your unit. Which of the following statements would be appropriate for you to use? A. Use the phrase "your father has gone away" rather than "your father has died." B. Tell him he will get over the loss of his father when he gets a little older. C. Let him know his father's death was peaceful and that he "just went to sleep." D. Let him know you wish that his father had not died.

D. Let him know you wish that his father had not died.

You have been working on the end-stage heart failure unit for eight months. Many of your patients have died awaiting transplant. You are aware that you are not sleeping well at night and dread going to work each day. Many of your colleagues are irritating you and you are moody when at home. Which of the following would be best to do first? A. Start looking on the jobs board for a transfer to another unit. B. Take up yoga and enroll in daily Pilates classes for more exercise. C. Acknowledge that these are normal feelings when you have only been working for eight months. D. Speak with your nurse manager about how you are feeling and ask for help.

D. Speak with your nurse manager about how you are feeling and ask for help.

You are speaking with the family of a patient recently diagnosed with end-stage heart failure. How can you best demonstrate attentive listening? A. Interrupt the conversation to clarify what the family member means. B. Use yes and no questions to enhance the flow of conversation. C. Begin by telling the family the facts about end-stage heart failure. D. Use non-verbal signals such as nodding one's head and eye contact.

D. Use non-verbal signals such as nodding one's head and eye contact.

You have been the pediatric nurse caring for a young boy with a malignant brain tumor who just died on your unit. The parents are in the room with their son and ask you if you would stay with them. Your best response is A. "I am here and I will not leave you until you are ready for me to." B. "I have to take care of my other patients, but I will be back to check on you in a few minutes." C. "I am so sorry this has happened to you." D. "I know you are sad but your son is in a better place now and is no longer suffering."

A. "I am here and I will not leave you until you are ready for me to."

Which of the following patients' statements suggest that the patient is experiencing an existential crisis? A. "I am so afraid that God has abandoned me in my time of need." B. "I am mad that my minister has not come by to see me in the hospital." C. "I believe strongly that God never gives a person more than they can handle." D. "I find great comfort when I spend time among my flowers in my garden."

A. "I am so afraid that God has abandoned me in my time of need."

Roland was just told that his therapy for advanced prostate cancer is not working. He asks you, "Why is this happening to me?" What is the most appropriate response? A. "I don't know. I wish I had an answer for you, but I don't." B. "Perhaps you're being tested and this will make you a stronger person." C. "I'll ask the doctor to more fully explain the disease process." D. "If I were you, I'd explore additional therapies and treatment options."

A. "I don't know. I wish I had an answer for you, but I don't."

You are teaching the son of a 65-year-old male patient with cancer about his father's anorexia. Which statement by the son reassures you that the son understands your teaching and ways to help his father? A. "We can offer Dad small, frequent feedings rather than large, overwhelming meals." B. "We need to limit Dad to a high protein diet so he gets good calories in." C. "I need to insist that Dad eat at least half of every meal we give him, even if he doesn't feel like eating." D. "Since Dad isn't eating, it's probably time to put in a feeding tube, whether he agrees or not."

A. "We can offer Dad small, frequent feedings rather than large, overwhelming meals."

You are assessing Mrs. Smith's husband's well-being during Mrs. Smith's recent hospitalization. He tells you he has had trouble with heart failure this past year and then says, "All that matters is my wife. I don't have time to go to my doctor even though my prescriptions have run out. Don't you realize how many medications I have to give my wife around the clock? I can't deal with any more medications. I will have time to take care of myself later on." Your best response is: A. "I understand. Your wife certainly requires a lot of care and it is so hard to keep track of all her medications, let alone your own." B. "I am concerned about you too. Keep in mind you can't take care of Mrs. Smith if you get sick; you need to get your prescriptions filled." C. "That is nonsense; don't you know that not taking your heart failure medications could put you in the hospital?" D. "Later on may never come if you don't take care of yourself now; you have to take better care of yourself and get your medications filled."

B. "I am concerned about you too. Keep in mind you can't take care of Mrs. Smith if you get sick; you need to get your prescriptions filled."

You are working with Mr. T who has just been told his heart failure is getting worse. You go into his room to see how he is doing after the team has shared this information with him. He is staring out the window, looking sad. How do you start your conversation? A. "Isn't it a beautiful day today Mr. T.?" B. "I saw that the team was just here, can you tell me about their conversation with you?" C. "Are you feeling ok?" D. "I heard you just got bad news, but I know of someone just like you who lived for three more years."

B. "I saw that the team was just here, can you tell me about their conversation with you?"

Mr. G has just been told he has a serious illness. Which of the following statements reflects respectful communication with him about his treatment and illness? A. "We will decide which treatment options are best for you Mr. G." B. "It is important that we understand what your hopes are for your treatment of this illness." C. "Treatment will be difficult; you just have to be strong and get through it." D. "This disease is terminal and there is nothing we can do for you."

B. "It is important that we understand what your hopes are for your treatment of this illness."

Which of the following statements reflects that you are responding appropriately to a conflict between you and a physician regarding a patient's decision to stop chemotherapy? A. "Why can't you understand that this patient has had enough?" B. "This decision is the patient's decision - it is not ours to make." C. "Just because there is a chemotherapy available, it doesn't mean you have to give it to her." D. "I am so tired of you doctors continuing to treat patients who are ready to let nature take its course."

B. "This decision is the patient's decision - it is not ours to make."

Your patient, who has end-stage renal disease, has been asked by the doctor covering the hospital if he would like to have "everything done," including CPR. The patient asks you if CPR is a good thing to do. Your best response is: A. "CPR saves lives; of course you want everything possible done." B. "What do you know about CPR? Have you ever heard about it before?" C. "That is really your decision to make; I cannot tell you what to do." D. "I have seen it done and it is really violent; you shouldn't have it."

B. "What do you know about CPR? Have you ever heard about it before?"

Geraldine is an 80-year-old woman with Parkinson's disease. She is still functioning at home and is able to safely care for herself. Ever since her diagnosis she has been extremely anxious about her disease and how debilitated she might get as it progresses. Which of the following interventions is most appropriate to help treat her anxiety? A. benzodiazepine like valium B. Active listening and presence as she talks about her fears and concerns C. Activities to distract her from her anxiety so she won't dwell on the future D. Suggest she go to an exercise class to preserve her balance and strength

B. Active listening and presence as she talks about her fears and concerns

You are caring for an elderly woman who has severe osteoporosis and is suffering with bone pain from several spinal fractures. She is in bed most of the day, on a low dose opioid for the most recent fracture, and is not eating or drinking much. Which of the following nursing interventions to prevent constipation is best? A. Suggest her family bring her in a fiber supplement, since she has used these in the past. B. Recommend a physician order for a scheduled laxative and stool softener. C. Just assess her regularly for constipation as she is not eating much. D. Insist that she increase her fluids to three liters per day as an intervention.

B. Recommend a physician order for a scheduled laxative and stool softener.

Mr. J is in the final hours of life. He is dying from his end-stage chronic lung disease. His breathing pattern has changed and is very irregular and he is even going 10-15 seconds without a breath. The family asks you to please call respiratory therapy to see what they can do to help his breathing. You respond: A. "I can call them, but I don't think there is anything they can do to make this better." B. "I know he looks uncomfortable breathing like this, but I can assure you, he is ok." C. "His breathing pattern is difficult to watch, but the irregularity is a normal part of the dying process." D. "I will call both the doctor and respiratory therapy to see if he needs more oxygen."

C. "His breathing pattern is difficult to watch, but the irregularity is a normal part of the dying process."

Mr. Tate tells you that he is very worried about dying. He knows his disease is terminal and he only has a few months to live. He tells you he has done "some bad things" in his younger days and thinks God is going to make him suffer with pain now because of his past. After listening to his story, what is your best response? A. "Oh don't worry Mr. Tate, that was a long time ago." B. "Some people have pain at the end of life, but we can help you manage the pain." C. "Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours?" D. "I know that God doesn't make people suffer and I am sure that you will not suffer at end of life for your past."

C. "Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours?"

You are performing a pain assessment on Matilda. Your assessment reveals that Matilda has pain rated as a 5 in her left hip that worsens with movement. She has been having this pain off and on for the last three years. Which of the following pain assessment components have you not addressed in your assessment? A. Duration B. Aggravating factors C. Alleviating factors D. Intensity

C. Alleviating factors

You are caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, which person is at risk for disenfranchised grief? A. The daughter who lives in a different state B. The son who was with the patient when he died C. The ex-wife of the patient who lives nearby D. The 16-year-old grandchild of the patient

C. The ex-wife of the patient who lives nearby

You are teaching a patient how to take her new prescription for morphine, an opioid pain medication. Which of the following teaching statements reflects an understanding of potential adverse effects? A. Be careful with these medications because they can cause addiction. B. Only take this medication if you are really suffering. C. This medication causes constipation, so you need to take a laxative to prevent that. D. This is the medication they prescribe when you are getting near the end of life.

C. This medication causes constipation, so you need to take a laxative to prevent that.

Mr. T. is taking an NSAID for bone pain. Which of the following statements suggests he may be experiencing a worrisome side effect from the NSAID? A. I am having trouble urinating. B. I noticed that my skin has gotten very dry. C. Yesterday I had an episode of black, tarry stools. D. My eyes have been very itchy and irritated lately.

C. Yesterday I had an episode of black, tarry stools.

John tells you that he doesn't want his wife to know that he has cancer. You sit down to talk about this with him. You begin this conversation with: A. "Why not tell her John? She probably already suspects it since you have been so sick." B. "It is your right not to tell her, it would probably just upset her anyway." C. "Maybe we could have the doctor tell her so you don't have to." D. "Can you tell me what it is about your wife knowing about the cancer that is bothering you?"

D. "Can you tell me what it is about your wife knowing about the cancer that is bothering you?"

Mrs. F., a 78-year-old Italian woman, is caring for her husband who has end-stage COPD and is experiencing anorexia and cachexia. She tells you that she is so upset that he won't eat her pasta anymore, which was "always his favorite." She cannot understand why he doesn't like it anymore. Which of the following is your best response? A. "I don't know why he wouldn't eat it. You have brought some to our unit and it is wonderful." B. "Don't take it personally Mrs. F - maybe you should stop pushing him to try to eat." C. "Maybe you should change your recipe and try making it a little blander for him." D. "Food is such an important way that we show we care; it must be so hard for you that he doesn't feel like eating."

D. "Food is such an important way that we show we care; it must be so hard for you that he doesn't feel like eating."

You are working on developing your communication techniques to use when talking to patients and families. Which of the following indicates you have a good understanding of important communication skills in palliative care? A. "I should not use the words death or dying in my conversations." B. "I should assume that the patient and family has understood what I've told them." C. "I need to be sure to fill in any gaps in conversation with more information." D. "I should acknowledge the emotions that the patient and family is expressing."

D. "I should acknowledge the emotions that the patient and family is expressing."

Mr. T's wife tells the nurse she doesn't want him to take the morphine the doctor ordered for his cancer pain because she heard from a friend that he could stop breathing because of it. Your best response would be: A. That is just an old belief that you don't need to worry about. B. It could happen, but the most important thing is that he needs to take the medication for pain. C. The side effects of these strong narcotics are scary- you should watch his breathing carefully. D. Breathing problems are rare when these medications are used as ordered.

D. Breathing problems are rare when these medications are used as ordered.