NSG 201H Palliative Care and End-of-Life Issues

NSG 201H Palliative Care and End-of-Life Issues

NSG 201H Palliative Care and End-of-Life Issues

Chapter 5: Palliative Care and End-of-Life Issues for medical surgical nursing

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____     1.   A competent older adult patient has a living will that expresses the patient’s desire to avoid resuscitation and heroic life support measures. The patient’s family, however, is not supportive of this directive and plans to contest the living will. Which nursing action is appropriate based on the current situation? NSG 201H Palliative Care and End-of-Life Issues

1)	Notify the hospital attorney.
2)	Contact the Social Services department.
3)	Place the document on the patient’s medical record.
4)	Explain to the patient that the conflict could invalidate the document.

____     2.   The nurse is providing care for a Catholic patient who has suffered a massive cerebral hemorrhage and is not expected to survive. Which intervention by the nurse is most appropriate?

1)	Contact a priest to deliver the Sacrament of the Sick.
2)	Make plans for the family to wash the body after death.
3)	Contact a rabbi so that the patient can participate in prayer.
4)	Discuss the need to cremate the patient, as burial is not accepted in this faith.

NSG 201H -Palliative Care and End-of-Life Issues

____     3.   The nurse is caring for a terminally ill patient and family members. The family has been tearful and sad since the terminal diagnosis was given. Which should be the nurse’s focus when planning care? NSG 201H Palliative Care and End-of-Life Issues

1)	Hopelessness
2)	Caregiver role strain
3)	Anticipatory grieving
4)	Complicated grieving

____     4.   The nurse is providing care to a patient who is diagnosed with terminal lung cancer. The patient is lying in the supine position with noisy wet respirations noted and is not breathing well. The patient has a living will which designates the implementation of comfort measures. Which action by the nurse is appropriate?

1)	Withhold all care until the patient dies.
2)	Provide the patient with pain medication as ordered.
3)	Ask the family what they want to be done for the patient.
4)	Reposition the patient to a lateral position, with the head elevated as tolerated.

____     5.   The nurse is caring for a dying child who is being treated with comfort measures only. Which nursing action supports the primary goal for this patient? NSG 201H Palliative Care and End-of-Life Issues

1)	Assess and medicate, as ordered, for any signs and symptoms of distress.
2)	Maintain a busy schedule for child and family members.
3)	Keep the child entertained so she does not think about dying.
4)	Ensure that a good relationship is maintained with the family.

____     6.   The parents of a child with terminal cancer ask the nurse that the child not be told that he will not recover. The child asks the nurse if he is dying. What should the nurse do at this time?

1)	Ignore the child’s question and change the subject.
2)	Tell the child he is dying and offer to stay with him.
3)	Suggest a meeting with the health-care team and the parents.
4)	Offer to bring in the child life therapist to help explain the situation.

____     7.   An older school-age child is brought to the emergency department (ED) after a car accident. The parents witness and stare at the resuscitation scene unfolding before them. The child is not responding to the resuscitative efforts after 30 minutes. Which is the best communication strategy for the nurse to use in this situation?

1)	Ask the parents to leave until the child has stabilized.
2)	Ask the parents to stand at the foot of the cart to watch.
3)	Discuss with the parents whether they would like resuscitative efforts to be continued at this point.
4)	Inform the parents that resuscitative efforts have not been effective and are not beneficial to the child.

____     8.   An adolescent patient with terminal cancer tells the nurse that she does not want to continue treatment, even though her parents are planning for her to participate in a study trial that involves aggressive chemotherapy. Which action by the nurse is the most appropriate? NSG 201H Palliative Care and End-of-Life Issues

1)	Tell her not to worry, that she knows her parents want the best for her.
2)	Tell the patient that the decision is her parents’ and she has to participate in the study.
3)	Notify the adolescent that she can make her own decisions no matter what her parents want.
4)	Request that the parents and daughter meet together with the health-care team to discuss options and the implications of various choices.

NSG 201H -Palliative Care and End-of-Life Issues

____     9.   The nurse is providing care for a patient receiving curative care who is experiencing chronic pain due to cancer. Which type of care should the nurse plan for upon discharge for this patient?

1)	Home health care
2)	Palliative care
3)	Hospice care
4)	Rehabilitative care

 

____   10.   The nurse is assessing the patient for palliative care. When assessing the social domain, which should the nurse include?

NSG 201H Palliative Care and End-of-Life Issues

1)	Financial concerns
2)	Pain
3)	Depression
4)	Spiritual concerns

 

____   11.   The nurse is assessing the patient for palliative care. When assessing the physical domain, which should the nurse include?

1)	Financial concerns
2)	Pain
3)	Depression
4)	Spiritual concerns

 

____   12.   The nurse is assessing the patient for palliative care. When assessing the psychosocial and psychiatric domain, which should the nurse include?

1)	Financial concerns
2)	Pain
3)	Depression
4)	Spiritual concerns

 

____   13.   The nurse is assessing the patient for palliative care. When assessing the cultural domain, which question should the nurse include?

1)	“Do you have any financial concerns regarding your care?”
2)	“Are you currently experiencing pain?”
3)	“Are you experiencing any depression or anxiety?”
4)	“Do you have any specific dietary preferences that affect your care?”

NSG 201H Palliative Care and End-of-Life Issues

____   14.   The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness. Which medication should the nurse tell the family to administer for this patient if delirium occurs?

1)	Morphine
2)	Haloperidol
3)	Diphenhydramine
4)	Docusate

 

____   15.   The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness. Which medication should the nurse tell the family to administer to treat the patient’s pain?

1)	Morphine
2)	Haloperidol
3)	Diphenhydramine
4)	Docusate

 

NSG 201H Palliative Care and End-of-Life Issues

____   16.   The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness. Which benzodiazepine medication should the nurse tell the family to administer to treat the patient if hyperactive delirium occurs?

1)	Morphine
2)	Haloperidol
3)	Diphenhydramine
4)	Lorazepam

 

____   17.   The nurse is providing care to a patient who is approaching death. Which family member statement regarding the physical and psychological changes associated with death is reflective of the late stage?

1)	“A loss of appetite often occurs during this stage.”
2)	“Respirations may sound loud and wet during this stage.”
3)	“I might notice that he will begin to sleep more during this stage.”
4)	“Confusion or disorientation may begin to occur during this stage.”

NSG 201H Palliative Care and End-of-Life Issues

____   18.   The nurse is providing care to a patient who is approaching death. Which family member statement regarding the physical and psychological changes associated with death is reflective of the middle stage?

1)	“A loss of appetite often occurs during this stage.”
2)	“Respirations may sound loud and wet during this stage.”
3)	“I might notice that he will begin to sleep more during this stage.”
4)	“Confusion or disorientation may begin to occur during this stage.”

 

____   19.   Which response by the nurse indicates the use of reflective reasoning when communicating with the family of a patient who is in the process of dying?

1)	“I can see this is difficult for you.”
2)	“Thank you for taking such good care of your mother.”
3)	“Your mother is experiencing quite a bit of pain at the moment.”
4)	“A social worker will be able to answer all the questions that you have.”

NSG 201H Palliative Care and End-of-Life Issues

____   20.   Which concept exemplifies a well-managed death experience for a terminal patient and family members?

1)	Allowing the patient to die alone
2)	Withholding pain medication to decrease addiction
3)	Encouraging a lengthy dying process to allow for goodbyes
4)	Preparing the patient and the family for the process of dying

 

____   21.   Which is a team action that nurses can employ as a stress-reducing strategy?

1)	Practicing yoga on a daily basis
2)	Journaling feelings related to patient care
3)	Engaging in aerobic exercise several times per week
4)	Sending a bereavement card to the family of a patient who recently passed

 

NSG 201H Palliative Care and End-of-Life Issues

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____   22.   Which factors can create moral distress for nurses? Select all that apply.

1)	Supportive management staff
2)	Low stress patient environment
3)	High technology patient care situations
4)	Cultural differences with the patient population
5)	Resource pressures when providing patient care

NSG 201H Palliative Care and End-of-Life Issues

____   23.   The nurse is providing care to a patient who is diagnosed with terminal lung cancer. Which clinical manifestations indicate imminent death? Select all that apply.

1)	Diaphoresis
2)	Increased cardiac output
3)	Decreased blood pressure
4)	Tachycardia followed by bradycardia
5)	An increase in the volume of Korotkoff’s sounds

 

____   24.   The wife of a patient with end-stage chronic obstructive pulmonary disease (COPD) tells the nurse that she wishes her husband were eligible for hospice care but she thinks that hospice is only available for cancer patients and would require a change in health-care providers. Which responses by the nurse are appropriate? Select all that apply.

1)	Inform her that hospice care is very expensive.
2)	Inform her that a diagnosis of cancer is not required for hospice care.
3)	Inform her that all hospice programs provide care 24 hours per day, 7 days per week
4)	Inform her that her husband can retain his provider when transitioning to hospice care.
5)	Inform her that her husband is not eligible for hospice care with the current diagnosis of COPD.

NSG 201H Palliative Care and End-of-Life Issues

____   25.   The nurse is providing care to a terminal patient who is experiencing delirium. Which should the nurse assess prior to administering haloperidol to this patient? Select all that apply.

1)	Last stool
2)	Blood pressure
3)	Respiratory rate
4)	Bladder distention
5)	Medication regimen

____   26.   Which statement from the nurse to family members is appropriate to encourage the participation of providing physical care to the patient during the dying process? Select all that apply.

1)	“You can bring in pictures of the family to comfort your loved one.”
2)	“Apply lip balm to your loves one’s mouth if you feel the lips are dry.”
3)	“You can massage your loved one’s arms and legs to provide comfort.”
4)	“Bring in music that your loved one likes to listen to with headphones.”
5)	“Your child can call your loved one if you don’t want to expose him to this process.”

NSG 201H Palliative Care and End-of-Life Issues

____   27.   A terminal patient has opted to stop treatment. The family, however, believes the patient is no longer competent to make this decision. Which data supports that the patient is capable of making this treatment decision? Select all that apply. 

1)	The patient is aware of the current date and location.
2)	The patient does not want to be a burden on the family.
3)	The patient communicates the decision with the health-care team.
4)	The patient understands the nature and consequences of treatment.
5)	The patient states the benefits and risks associated with the treatment.

NSG 201H Palliative Care and End-of-Life Issues

Professional Nursing: Concepts & Challenges, 7th Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/978-1-4557-0270-1/