Question 1

The nurse cares for an adolescent patient who is dying.The patient's parents are interested in organ donation and ask the nurse how the decision about brain death is made.Which response by the nurse is most appropriate?

Accepted Answer

The diagnosis of brain death is based on irreversible loss of all brain functions,including brainstem functions that control respirations and brainstem reflexes.The other descriptions describe other clinical manifestations associated with death but are insufficient to declare a patient brain dead.

Question 2

The son of a dying patient tells the nurse,"Mother doesn't really respond any more when I visit.I don't think she knows that I am here." Which response by the nurse is appropriate?

Accepted Answer

Withdrawal is a normal psychosocial response to approaching death.Dying patients may maintain the ability to hear while not being able to respond.Stimulation will tire the patient and is not an appropriate response to withdrawal in this circumstance.Visitors are encouraged to be "present" with the patient,talking softly and making physical contact in a way that does not demand a response from the patient.

Question 3

The nurse cares for a terminally ill patient who is experiencing pain that is continuous and severe.How should the nurse schedule the administration of opioid pain medications?

Accepted Answer

The principles of beneficence and nonmaleficence indicate that the goal of pain management in a terminally ill patient is adequate pain relief even if the effect of pain medications could hasten death.Administration of analgesics on a PRN basis will not provide the consistent level of analgesia the patient needs.Patients usually do not require so much pain medication that they are oversedated and unaware of stimuli.Adequate pain relief may require a dosage that will result in a decrease in respiratory rate.

Question 4

As the nurse admits a patient in end-stage kidney disease to the hospital,the patient tells the nurse,"If my heart or breathing stop,I do not want to be resuscitated." Which action is best for the nurse to take?

Accepted Answer

A health care provider's order should be written describing the actions that the nurses should take if the patient requires CPR,but the primary right to decide belongs to the patient or family.The nurse should document the patient's request but does not have the authority to place the DNR order in the care plan.A notarized advance directive is not needed to establish the patient's wishes.The patient may need a durable power of attorney for health care (or the equivalent),but this does not address the patient's current concern with possible resuscitation.

Question 5

The nurse admits a terminally ill patient to the hospital.What is the first action that the nurse should complete when planning this patient's care?

Accepted Answer

The nurse's initial action should be to assess the patient's wishes at this time.The other actions may be implemented if the patient or the family express a desire to discuss fears,understand the grief process,or address family issues,but they should not be implemented until the assessment indicates that they are appropriate.

Question 6

Which patient should the nurse refer for hospice care?

Accepted Answer

Hospice is designed to provide palliative care such as symptom management and pain control for patients at the end of life.Patients who require more care than the family can provide,whose families are unable to discuss important issues related to dying,or who have severe pain are candidates for other nursing services but are not appropriate hospice patients.

Question 7

The spouse of a patient with terminal cancer visits daily and cheerfully talks with the patient about wedding anniversary plans for the next year.When the nurse asks about any concerns,the spouse says,"I'm busy at work,but otherwise things are fine." Which nursing diagnosis is most appropriate?

Accepted Answer

The spouse's behavior and statements indicate the absence of anticipatory grieving,which may lead to impaired adjustment as the patient progresses toward death.The spouse does not appear to feel overwhelmed,hopeless,or anxious.

Question 8

Which nursing actions for the care of a dying patient can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

Medication administration,psychosocial care,and postmortem care are included in LPN/LVN education and scope of practice.Patient and family teaching and assessment and planning of frequency for assessments are skills that require registered nurse level education and scope of practice.

Question 9

The nurse cares for a terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing.Which action by the nurse would be most appropriate?

Accepted Answer

Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep and rapid breaths.Cheyne-Stokes respirations are expected in the last days of life.There is also no need for supplemental oxygen by face mask or suctioning the patient.Raising the head of the bed slightly and/or turning the patient on the side may promote comfort.There is no need to place the patient in high Fowler's position.

Question 10

The nurse cares for a patient with lung cancer in a home hospice program.Which action by the nurse is most appropriate?

Accepted Answer

The role of the hospice nurse includes assisting the patient with the important end-of-life task of finding meaning in the patient's life.Frequent head-to-toe assessments are not needed for hospice patients and may tire the patient unnecessarily.Patients admitted to hospice forego curative treatments such as chemotherapy and radiation for lung cancer.Discussion of cancer risk factors and therapies is not appropriate.

Question 11

Which action is best for the nurse to take to ensure culturally competent care for an alert,terminally ill Filipino patient?

Accepted Answer

Because cultural beliefs may vary among people of the same ethnicity,the nurse's best action is to assess the expectations of both the patient and family.The other actions may be appropriate,but the nurse can only plan for individualized culturally competent care after assessment of this patient and family.

Question 12

A middle-aged patient tells the nurse,"My mother died 4 months ago,and I just can't seem to get over it.I'm not sure it is normal to still think about her every day." Which nursing diagnosis is most appropriate?

Accepted Answer

The patient should be reassured that grieving activities such as frequent thoughts about the deceased are considered normal for months or years after a death.The other nursing diagnoses imply that the patient's grief is unusual or pathologic,which is not the case.

Question 13

A patient who has been diagnosed with inoperable lung cancer and has a poor prognosis plans a trip across the country "to settle some issues with sisters and brothers." The nurse recognizes that the patient is manifesting which psychosocial response to death?

Accepted Answer

The patient's statement indicates that there is some unfinished family business that the patient would like to address before dying.Restlessness is frequently a behavior associated with an inability to express emotional or physical distress,but this patient does not express distress and is able to communicate clearly.There is no indication that the patient is protesting the prognosis,or that there is any fear that the patient's life has been meaningless.

Question 14

A young adult patient with metastatic cancer,who is very close to death,appears restless.The patient keeps repeating,"I am not ready to die." Which action is best for the nurse to take?

Accepted Answer

Staying at the bedside and listening allows the patient to discuss any unresolved issues or physical discomforts that should be addressed.Stating that no one feels ready for death fails to address the individual patient's concerns.Telling the patient that everything is being done does not address the patient's fears about dying,especially since the patient is likely to die soon.Family members may not feel comfortable staying at the bedside of a dying patient,and the nurse should not insist that they remain there.

Question 15

A hospice nurse who has become close to a terminally ill patient is present in the home when the patient dies and feels saddened and tearful as the family members begin to cry.Which action should the nurse take at this time?

Accepted Answer

It is appropriate for the nurse to cry and express sadness in other ways when a patient dies,and the family is likely to feel that this is therapeutic.Contacting a grief counselor,leaving the family to grieve privately,and considering whether hospice continues to be a satisfying place to work are all appropriate actions as well,but the nurse's initial action at this time should be to share the grieving process with the family.

Question 16

A hospice patient is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28.Which statement,if made by the nurse to the patient's family member,is most appropriate?

Accepted Answer

An increase in heart and respiratory rate may occur before the slowing of these functions in the dying patient.Heart and respiratory rate typically slow as the patient progresses further toward death.In a dying patient,high respiratory and pulse rates do not indicate improvement,and it would be inappropriate for the nurse to indicate this to the family.The changes in pulse and respirations are not reflex responses.

Quiz 10: Palliative Care at End of Life