Chapter 16: End-of-Life Care
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical
Nursing, 13th Edition
MULTIPLE CHOICE
1. In the past three to four decades, nursing has moved into the forefront in
providing care for the dying. Which phenomenon has most contributed to this
increased focus of care of the dying?
A) Increased incidence of infections and acute illnesses
B) Increased focus of health care providers on disease prevention
C) Larger numbers of people dying in hospital settings
D) Demographic changes in the population
ANS: D
The focus on care of the dying has been motivated by the aging of the
population, the prevalence of, and publicity surrounding, life-threatening
illnesses (e.g., cancer and AIDS), and the increasing likelihood of a prolonged
period of chronic illness prior to death. The salience of acute infections,
prevention measures, and death in hospital settings are not noted to have had a
major influence on this phenomenon.
2. A nurse who works in the specialty of palliative care frequently encounters
issues and situations that constitute ethical dilemmas. What issue has most often
presented challenging ethical issues, especially in the context of palliative care?
A) The increase in cultural diversity in the United States
B) Staffing shortages in health care and questions concerning quality of care
C) Increased costs of health care coupled with inequalities in access
D) Ability of technology to prolong life beyond meaningful quality of life
ANS: D
The application of technology to prolong life has raised several ethical issues.
, The major question is, Because we can prolong life through increasingly
sophisticated technology, does it necessarily follow that we must do so? The
increase in cultural diversity has not raised ethical issues in health care.
Similarly, costs and staffing issues are relevant, but not central to the most
common ethical issues surrounding palliative care.
3. The nurse is caring for a patient who has been recently diagnosed with late
stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses
to adhere to treatment. What is the most likely psychosocial purpose of this
patient's strategy?
A) The patient may be trying to protect loved ones from the emotional effects of the
illness.
B) The patient is being noncompliant in order to assert power over caregivers.
C) The patient may be skeptical of the benefits of the Western biomedical model of
health.
D) The patient thinks that treatment does not provide him comfort.
ANS: A
Patients who are characterized as being in denial may be using this strategy to
preserve important interpersonal relationships, to protect others from the
emotional effects of their illness, and to protect themselves because of fears of
abandonment. Each of the other listed options is plausible, but less likely.
4. A nurse who sits on the hospital's ethics committee is reviewing a complex
case that has many of the hallmarks of assisted suicide. Which of the
following would be an example of assisted suicide?
A) Administering a lethal dose of medication to a patient whose death is imminent
B) Administering a morphine infusion without assessing for respiratory depression
C) Granting a patient's request not to initiate enteral feeding when the patient is unable
to eat
, D) Neglecting to resuscitate a patient with a do not
resuscitate order ANS: A
Assisted suicide refers to providing another person the means to end his or her own life.
This is not to
be confused with the ethically and legally supported practices of withholding or
withdrawing medical treatment in accordance with the wishes of the terminally
ill individual. The other listed options do not fit this accepted definition of
assisted suicide.
5. A medical nurse is providing palliative care to a patient with a diagnosis
of end-stage chronic obstructive pulmonary disease (COPD). What is the
primary goal of this nurse's care?
A) To improve the patient's and family's quality of life
B) To support aggressive and innovative treatments for cure
C) To provide physical support for the patient
D) To help the patient develop a separate plan with each discipline of the health care
team
ANS: A
The goal of palliative care is to improve the patient's and the family's quality of
life. The support should include the patient's physical, emotional, and spiritual
well-being. Each discipline should contribute to a single care plan that addresses
the needs of the patient and family. The goal of palliative care is not aggressive
support for curing the patient. Providing physical support for the patient is also
not the goal of palliative care. Palliative care does not strive to achieve separate
plans of care developed by the patient with each discipline of the health care
team.
6. After contributing to the care of several patients who died in the hospital, the
nurse has identified some lapses in the care that many of these patients received
toward the end of their lives. What have research studies identified as a
potential deficiency in the care of the dying in hospital settings?
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical
Nursing, 13th Edition
MULTIPLE CHOICE
1. In the past three to four decades, nursing has moved into the forefront in
providing care for the dying. Which phenomenon has most contributed to this
increased focus of care of the dying?
A) Increased incidence of infections and acute illnesses
B) Increased focus of health care providers on disease prevention
C) Larger numbers of people dying in hospital settings
D) Demographic changes in the population
ANS: D
The focus on care of the dying has been motivated by the aging of the
population, the prevalence of, and publicity surrounding, life-threatening
illnesses (e.g., cancer and AIDS), and the increasing likelihood of a prolonged
period of chronic illness prior to death. The salience of acute infections,
prevention measures, and death in hospital settings are not noted to have had a
major influence on this phenomenon.
2. A nurse who works in the specialty of palliative care frequently encounters
issues and situations that constitute ethical dilemmas. What issue has most often
presented challenging ethical issues, especially in the context of palliative care?
A) The increase in cultural diversity in the United States
B) Staffing shortages in health care and questions concerning quality of care
C) Increased costs of health care coupled with inequalities in access
D) Ability of technology to prolong life beyond meaningful quality of life
ANS: D
The application of technology to prolong life has raised several ethical issues.
, The major question is, Because we can prolong life through increasingly
sophisticated technology, does it necessarily follow that we must do so? The
increase in cultural diversity has not raised ethical issues in health care.
Similarly, costs and staffing issues are relevant, but not central to the most
common ethical issues surrounding palliative care.
3. The nurse is caring for a patient who has been recently diagnosed with late
stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses
to adhere to treatment. What is the most likely psychosocial purpose of this
patient's strategy?
A) The patient may be trying to protect loved ones from the emotional effects of the
illness.
B) The patient is being noncompliant in order to assert power over caregivers.
C) The patient may be skeptical of the benefits of the Western biomedical model of
health.
D) The patient thinks that treatment does not provide him comfort.
ANS: A
Patients who are characterized as being in denial may be using this strategy to
preserve important interpersonal relationships, to protect others from the
emotional effects of their illness, and to protect themselves because of fears of
abandonment. Each of the other listed options is plausible, but less likely.
4. A nurse who sits on the hospital's ethics committee is reviewing a complex
case that has many of the hallmarks of assisted suicide. Which of the
following would be an example of assisted suicide?
A) Administering a lethal dose of medication to a patient whose death is imminent
B) Administering a morphine infusion without assessing for respiratory depression
C) Granting a patient's request not to initiate enteral feeding when the patient is unable
to eat
, D) Neglecting to resuscitate a patient with a do not
resuscitate order ANS: A
Assisted suicide refers to providing another person the means to end his or her own life.
This is not to
be confused with the ethically and legally supported practices of withholding or
withdrawing medical treatment in accordance with the wishes of the terminally
ill individual. The other listed options do not fit this accepted definition of
assisted suicide.
5. A medical nurse is providing palliative care to a patient with a diagnosis
of end-stage chronic obstructive pulmonary disease (COPD). What is the
primary goal of this nurse's care?
A) To improve the patient's and family's quality of life
B) To support aggressive and innovative treatments for cure
C) To provide physical support for the patient
D) To help the patient develop a separate plan with each discipline of the health care
team
ANS: A
The goal of palliative care is to improve the patient's and the family's quality of
life. The support should include the patient's physical, emotional, and spiritual
well-being. Each discipline should contribute to a single care plan that addresses
the needs of the patient and family. The goal of palliative care is not aggressive
support for curing the patient. Providing physical support for the patient is also
not the goal of palliative care. Palliative care does not strive to achieve separate
plans of care developed by the patient with each discipline of the health care
team.
6. After contributing to the care of several patients who died in the hospital, the
nurse has identified some lapses in the care that many of these patients received
toward the end of their lives. What have research studies identified as a
potential deficiency in the care of the dying in hospital settings?
