ADULT HEALTH II EXAM 1|117 QUESTIONS WITH
VERIFIED ANSWERS 2026
ANS: D
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 Fowlers
position. - CORRECT ANSWER 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?
a. Suction the patient.
b. Administer oxygen via face mask.
c. Place the patient in high Fowlers position.
d. Document the respirations as Cheyne-Stokes.
ANS: C
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. - CORRECT ANSWER The
nurse cares for an adolescent patient who is dying. The patients 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?
a. Brain death occurs if a person is flaccid and unresponsive.
b. If CPR is ineffective in restoring a heartbeat, the brain cannot function.
,c. Brain death has occurred if there is no breathing and certain reflexes are absent.
d. If respiratory efforts cease and no apical pulse is audible, brain death is present.
ANS: B
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. - CORRECT ANSWER 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 patients family member, is most
appropriate?
a. These symptoms will continue to increase until death finally occurs.
b. These symptoms are a normal response before these functions decrease.
c. These symptoms indicate a reflex response to the slowing of other body
systems.
d. These symptoms may be associated with an improvement in the patients
condition.
ANS: C
The patients 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 patients life has been meaningless. - CORRECT ANSWER 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?
a. Restlessness
b. Yearning and protest
c. Anxiety about unfinished business
d. Fear of the meaninglessness of ones life
ANS: A
The spouses 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. -
CORRECT ANSWER 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, Im busy at work,
but otherwise things are fine. Which nursing diagnosis is most appropriate?
a. Ineffective coping related to lack of grieving
b. Anxiety related to complicated grieving process
c. Caregiver role strain related to feeling overwhelmed
d. Hopelessness related to knowledge deficit about cancer
ANS: A
A health care providers 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 patients 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 patients wishes. The
, patient may need a durable power of attorney for health care (or the equivalent),
but this does not address the patients current concern with possible
resuscitation. - CORRECT ANSWER 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?
a. Ask if these wishes have been discussed with the health care provider.
b. Place a Do Not Resuscitate (DNR) notation in the patients care plan.
c. Inform the patient that a notarized advance directive must be included in the
record or resuscitation must be performed.
d. Advise the patient to designate a person to make health care decisions when
the patient is not able to make them independently.
ANS: B
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 patients concerns. Telling the
patient that everything is being done does not address the patients 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. - CORRECT ANSWER 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?
a. Remind the patient that no one feels ready for death.
b. Sit at the bedside and ask if there is anything the patient needs.
c. Insist that family members remain at the bedside with the patient.
d. Tell the patient that everything possible is being done to delay death.
VERIFIED ANSWERS 2026
ANS: D
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 Fowlers
position. - CORRECT ANSWER 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?
a. Suction the patient.
b. Administer oxygen via face mask.
c. Place the patient in high Fowlers position.
d. Document the respirations as Cheyne-Stokes.
ANS: C
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. - CORRECT ANSWER The
nurse cares for an adolescent patient who is dying. The patients 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?
a. Brain death occurs if a person is flaccid and unresponsive.
b. If CPR is ineffective in restoring a heartbeat, the brain cannot function.
,c. Brain death has occurred if there is no breathing and certain reflexes are absent.
d. If respiratory efforts cease and no apical pulse is audible, brain death is present.
ANS: B
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. - CORRECT ANSWER 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 patients family member, is most
appropriate?
a. These symptoms will continue to increase until death finally occurs.
b. These symptoms are a normal response before these functions decrease.
c. These symptoms indicate a reflex response to the slowing of other body
systems.
d. These symptoms may be associated with an improvement in the patients
condition.
ANS: C
The patients 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 patients life has been meaningless. - CORRECT ANSWER 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?
a. Restlessness
b. Yearning and protest
c. Anxiety about unfinished business
d. Fear of the meaninglessness of ones life
ANS: A
The spouses 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. -
CORRECT ANSWER 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, Im busy at work,
but otherwise things are fine. Which nursing diagnosis is most appropriate?
a. Ineffective coping related to lack of grieving
b. Anxiety related to complicated grieving process
c. Caregiver role strain related to feeling overwhelmed
d. Hopelessness related to knowledge deficit about cancer
ANS: A
A health care providers 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 patients 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 patients wishes. The
, patient may need a durable power of attorney for health care (or the equivalent),
but this does not address the patients current concern with possible
resuscitation. - CORRECT ANSWER 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?
a. Ask if these wishes have been discussed with the health care provider.
b. Place a Do Not Resuscitate (DNR) notation in the patients care plan.
c. Inform the patient that a notarized advance directive must be included in the
record or resuscitation must be performed.
d. Advise the patient to designate a person to make health care decisions when
the patient is not able to make them independently.
ANS: B
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 patients concerns. Telling the
patient that everything is being done does not address the patients 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. - CORRECT ANSWER 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?
a. Remind the patient that no one feels ready for death.
b. Sit at the bedside and ask if there is anything the patient needs.
c. Insist that family members remain at the bedside with the patient.
d. Tell the patient that everything possible is being done to delay death.
