Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)
Chapter 08: Concepts of Care for Patients at End of Life
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a dying client. Which manifestation of dying does the nurse treat first?
a. Anorexia
b. Pain
c. Nausea
d. Hair loss
ANS: B
Only symptoms that cause distress for a dying client would be treated. Such symptoms
include pain, nausea and vomiting, dyspnea, and agitation. These problems interfere with the
client’s comfort. Even when symptoms, such as anorexia or hair loss, disturb the family, they
would be treated only if the client is distressed by their presence. The nurse would treat the
client’s pain first.
DIF: Applying TOP: Integrated Process: Caring KEY: End-of-life care, Comfort
MSC: Client Needs Category: Psychosocial Integrity
2. A nurse plans care for a client who is nearing end of life. Which question will the nurse ask
when developing this client’s plan of care?
a. “Is your advance directive up to date and notarized?”
b. “Do you want to be at home at the end of your life?”
c. “Would you like a physical therapist to assist you with range-of-motion
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activities?”
d. “Have your children discussed resuscitation with your primary health care
provider?”
ANS: B
When developing a plan of care for a dying client, consideration would be given for where the
client wants to die. Different states have different laws regarding legal requirements for
advance directives, but this would not take priority over establishing client preferences. A
physical therapist would not be involved in end-of-life care. The client would discuss
resuscitation with the primary health care provider and children; do-not-resuscitate status
would be the client’s decision, not the family’s decision.
DIF: Applying TOP: Integrated Process: Caring
KEY: End-of-life care, Advance directives
MSC: Client Needs Category: Psychosocial Integrity
3. A nurse is caring for a client who has lung cancer and is dying. Which prescription does the
nurse question?
a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5
b. Albuterol metered dose inhaler every 4 hours PRN for wheezes
c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions
d. Sodium biphosphate enema once a day PRN for impacted stool
ANS: A
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,Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)
Pain medications would be scheduled around the clock to maintain comfort and prevent
reoccurrence of pain. The dying client should not have to request medications for serious pain.
The other medications are appropriate for this client.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning
KEY: End-of-life care, Pharmacologic pain management
MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A nurse is caring for a dying client whose adult child confides frequent crying episodes to the
nurse. How does the nurse respond?
a. “It’s normal. Most people move on within a few months.”
b. “Whenever you start to cry, distract yourself with pleasant thoughts of your
parent.”
c. “You should try not to cry. Your parent will be in a better place soon.”
d. “Your feelings are completely normal and may continue for a long time.”
ANS: D
Everyone grieves and mourns differently. The nurse would offer support to the client and
family during this time. By telling the adult child that the feelings are normal and may
continue, the nurse is providing support to whatever the person is feeling. The other
statements all show lack of compassion and respect to the family member’s feelings.
DIF: Applying TOP: Integrated Process: Caring KEY: End-of-life care, Caring
MSC: Client Needs Category: Psychological Integrity
5. After teaching a client about advance directives, a nurse assesses the client’s understanding.
Which statement indicates that the client correctly understands the teaching?
a. “An advance directive will G RADmy
keep ESchildren
LAB.CfromOM selling my home when I’m
old.”
b. “An advance directive will be completed as soon as I’m incapacitated and can’t
think for myself.”
c. “An advance directive will specify what I want done when I can no longer make
decisions about health care.”
d. “An advance directive will allow me to keep my money out of the reach of my
family.”
ANS: C
An advance directive is a written document prepared by a competent individual that specifies
what, if any, extraordinary actions a person would want to be taken when he or she can no
longer make decisions about personal health care. It does not address issues such as the
client’s residence or financial matters.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: End-of-life care, Advance directives
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
6. A nurse teaches a client who is considering being admitted to hospice. Which statement does
the nurse include in this client’s teaching?
a. “Hospice admission has specific criteria. You may not be a viable candidate, so we
will look at alternative plans for your discharge.”
b. “Hospice care focuses on a holistic approach to health care. It is not designed to
GARDESLAB.COM
,Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)
hasten death, but rather to relieve symptoms.”
c. “Hospice care will not help with your symptoms of depression. I will refer you to
the facility’s counseling services instead.”
d. “You seem to be experiencing some difficulty with this stage of the grieving
process. Let’s talk about your feelings.”
ANS: B
As both a philosophy and a system of care, hospice care uses an interprofessional approach to
assess and address the holistic needs of clients and families to facilitate quality of life and a
peaceful death. This holistic approach neither hastens nor postpones death but provides relief
of symptoms experienced by the dying client.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: End-of-life care, Palliative, hospice care
MSC: Client Needs Category: Psychosocial Integrity
7. A nurse is caring for a dying client. The client’s spouse states, “I think he is choking to
death.” How would the nurse respond?
a. “Do not worry. The choking sound is normal during the dying process.”
b. “I will administer more morphine to keep your spouse comfortable.”
c. “I can ask the respiratory therapist to suction secretions out through his nose.”
d. “I will have another nurse assist me to turn your spouse onto the side.”
ANS: D
The choking sound or “death rattle” is common in dying clients. The nurse acknowledges the
spouse’s concerns and provides interventions that will reduce the choking sounds.
Repositioning the client onto one side with a towel under the mouth to collect secretions is the
best intervention. The nurse would
GRAnot
DEminimize
SLAB.Cthe OMspouse’s concerns. Morphine will assist
with comfort but will not decrease the choking sounds. Nasotracheal suctioning is not
appropriate in a dying client and may cause agitation.
DIF: Applying TOP: Integrated Process: Caring KEY: End-of-life care, Comfort
MSC: Client Needs Category: Psychosocial Integrity
8. The nurse is teaching a family member about various types of complementary therapies that
might be effective for relieving the dying client’s anxiety and restlessness. Which statement
made by the family member indicates understanding of the nurse’s teaching?
a. “Maybe we should just hire an around-the-clock sitter to stay with Grandmother.”
b. “I have some of her favorite hymns on a CD that I could bring for music therapy.”
c. “I don’t think that she’ll need pain medication along with her herbal treatments.”
d. “I will burn therapeutic incense in the room so we can stop the anxiety pills.”
ANS: B
Music therapy is a complementary therapy that may produce relaxation by quieting the mind
and removing a client’s inner restlessness. Hiring an around-the-clock sitter does not
demonstrate that the client’s family understands complementary therapies. Complementary
therapies are used in conjunction with traditional therapy. Complementary therapy would not
replace pain or anxiety medication but may help decrease the need for these medications.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: End-of-life care, Nonpharmacologic comfort measures
MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort
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, Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)
9. A nurse is caring for a terminally ill client who has just died in a hospital setting with family
members at the bedside. Which action will the nurse take first?
a. Call for emergency assistance so that resuscitation procedures can begin.
b. Ask family members if they would like to spend time alone with the client.
c. Ensure the primary health care provider completed the death certificate.
d. Request family members to prepare the client’s body for the funeral home.
ANS: B
Before moving the client’s body to the funeral home, the nurse asks family members if they
would like to be alone with the client. Emergency assistance will not be necessary. Although
it is important to ensure that a death certificate has been completed before the client is moved
to the mortuary, the nurse first would ask family members if they would like to be alone with
the client. The client’s family would not be expected to prepare the body for the funeral home
but they could be asked if they wish to provide some care such as brushing the hair.
DIF: Applying TOP: Integrated Process: Caring
KEY: End-of-life care, Postmortem care MSC: Client Needs Category: Psychosocial Integrity
10. A nurse assesses a client who is dying. Which sign or symptoms does the nurse assess to
determine whether the client is near death?
a. Level of consciousness
b. Respiratory rate
c. Bowel sounds
d. Pain level on a 0-10 scale
ANS: B
Although all of these assessmentsGRA DESL
would beAperformed
B.COM during the dying process, periods of
apnea and Cheyne-Stokes respirations indicate that death is near. As peripheral circulation
decreases, the client’s level of consciousness and bowel sounds decrease, and the client would
be unable to provide a numeric number on a pain scale. Even with these other symptoms, the
nurse would continue to assess respiratory rate throughout the dying process. As the rate drops
significantly and breathing becomes agonal, death is near.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: End-of-life care
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
11. A nurse is caring for a client who is terminally ill. The client’s spouse states, “I am concerned
because he does not want to eat.” How does the nurse respond?
a. “Let him know that food is available if he wants it, but do not insist that he eat.”
b. “A feeding tube can be placed in the nose to provide important nutrients.”
c. “Force him to eat even if he does not feel hungry, or he will die sooner.”
d. “He is getting all the nutrients he needs through his intravenous catheter.”
ANS: A
Anorexia often causes distress in family members. When family members understand that the
client is not suffering from hunger and is not “starving to death,” they may allow the client to
determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and
clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the
family and contributes to client discomfort.
GARDESLAB.COM
Chapter 08: Concepts of Care for Patients at End of Life
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a dying client. Which manifestation of dying does the nurse treat first?
a. Anorexia
b. Pain
c. Nausea
d. Hair loss
ANS: B
Only symptoms that cause distress for a dying client would be treated. Such symptoms
include pain, nausea and vomiting, dyspnea, and agitation. These problems interfere with the
client’s comfort. Even when symptoms, such as anorexia or hair loss, disturb the family, they
would be treated only if the client is distressed by their presence. The nurse would treat the
client’s pain first.
DIF: Applying TOP: Integrated Process: Caring KEY: End-of-life care, Comfort
MSC: Client Needs Category: Psychosocial Integrity
2. A nurse plans care for a client who is nearing end of life. Which question will the nurse ask
when developing this client’s plan of care?
a. “Is your advance directive up to date and notarized?”
b. “Do you want to be at home at the end of your life?”
c. “Would you like a physical therapist to assist you with range-of-motion
GRADESLAB.COM
activities?”
d. “Have your children discussed resuscitation with your primary health care
provider?”
ANS: B
When developing a plan of care for a dying client, consideration would be given for where the
client wants to die. Different states have different laws regarding legal requirements for
advance directives, but this would not take priority over establishing client preferences. A
physical therapist would not be involved in end-of-life care. The client would discuss
resuscitation with the primary health care provider and children; do-not-resuscitate status
would be the client’s decision, not the family’s decision.
DIF: Applying TOP: Integrated Process: Caring
KEY: End-of-life care, Advance directives
MSC: Client Needs Category: Psychosocial Integrity
3. A nurse is caring for a client who has lung cancer and is dying. Which prescription does the
nurse question?
a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5
b. Albuterol metered dose inhaler every 4 hours PRN for wheezes
c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions
d. Sodium biphosphate enema once a day PRN for impacted stool
ANS: A
GARDESLAB.COM
,Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)
Pain medications would be scheduled around the clock to maintain comfort and prevent
reoccurrence of pain. The dying client should not have to request medications for serious pain.
The other medications are appropriate for this client.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning
KEY: End-of-life care, Pharmacologic pain management
MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A nurse is caring for a dying client whose adult child confides frequent crying episodes to the
nurse. How does the nurse respond?
a. “It’s normal. Most people move on within a few months.”
b. “Whenever you start to cry, distract yourself with pleasant thoughts of your
parent.”
c. “You should try not to cry. Your parent will be in a better place soon.”
d. “Your feelings are completely normal and may continue for a long time.”
ANS: D
Everyone grieves and mourns differently. The nurse would offer support to the client and
family during this time. By telling the adult child that the feelings are normal and may
continue, the nurse is providing support to whatever the person is feeling. The other
statements all show lack of compassion and respect to the family member’s feelings.
DIF: Applying TOP: Integrated Process: Caring KEY: End-of-life care, Caring
MSC: Client Needs Category: Psychological Integrity
5. After teaching a client about advance directives, a nurse assesses the client’s understanding.
Which statement indicates that the client correctly understands the teaching?
a. “An advance directive will G RADmy
keep ESchildren
LAB.CfromOM selling my home when I’m
old.”
b. “An advance directive will be completed as soon as I’m incapacitated and can’t
think for myself.”
c. “An advance directive will specify what I want done when I can no longer make
decisions about health care.”
d. “An advance directive will allow me to keep my money out of the reach of my
family.”
ANS: C
An advance directive is a written document prepared by a competent individual that specifies
what, if any, extraordinary actions a person would want to be taken when he or she can no
longer make decisions about personal health care. It does not address issues such as the
client’s residence or financial matters.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: End-of-life care, Advance directives
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
6. A nurse teaches a client who is considering being admitted to hospice. Which statement does
the nurse include in this client’s teaching?
a. “Hospice admission has specific criteria. You may not be a viable candidate, so we
will look at alternative plans for your discharge.”
b. “Hospice care focuses on a holistic approach to health care. It is not designed to
GARDESLAB.COM
,Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)
hasten death, but rather to relieve symptoms.”
c. “Hospice care will not help with your symptoms of depression. I will refer you to
the facility’s counseling services instead.”
d. “You seem to be experiencing some difficulty with this stage of the grieving
process. Let’s talk about your feelings.”
ANS: B
As both a philosophy and a system of care, hospice care uses an interprofessional approach to
assess and address the holistic needs of clients and families to facilitate quality of life and a
peaceful death. This holistic approach neither hastens nor postpones death but provides relief
of symptoms experienced by the dying client.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: End-of-life care, Palliative, hospice care
MSC: Client Needs Category: Psychosocial Integrity
7. A nurse is caring for a dying client. The client’s spouse states, “I think he is choking to
death.” How would the nurse respond?
a. “Do not worry. The choking sound is normal during the dying process.”
b. “I will administer more morphine to keep your spouse comfortable.”
c. “I can ask the respiratory therapist to suction secretions out through his nose.”
d. “I will have another nurse assist me to turn your spouse onto the side.”
ANS: D
The choking sound or “death rattle” is common in dying clients. The nurse acknowledges the
spouse’s concerns and provides interventions that will reduce the choking sounds.
Repositioning the client onto one side with a towel under the mouth to collect secretions is the
best intervention. The nurse would
GRAnot
DEminimize
SLAB.Cthe OMspouse’s concerns. Morphine will assist
with comfort but will not decrease the choking sounds. Nasotracheal suctioning is not
appropriate in a dying client and may cause agitation.
DIF: Applying TOP: Integrated Process: Caring KEY: End-of-life care, Comfort
MSC: Client Needs Category: Psychosocial Integrity
8. The nurse is teaching a family member about various types of complementary therapies that
might be effective for relieving the dying client’s anxiety and restlessness. Which statement
made by the family member indicates understanding of the nurse’s teaching?
a. “Maybe we should just hire an around-the-clock sitter to stay with Grandmother.”
b. “I have some of her favorite hymns on a CD that I could bring for music therapy.”
c. “I don’t think that she’ll need pain medication along with her herbal treatments.”
d. “I will burn therapeutic incense in the room so we can stop the anxiety pills.”
ANS: B
Music therapy is a complementary therapy that may produce relaxation by quieting the mind
and removing a client’s inner restlessness. Hiring an around-the-clock sitter does not
demonstrate that the client’s family understands complementary therapies. Complementary
therapies are used in conjunction with traditional therapy. Complementary therapy would not
replace pain or anxiety medication but may help decrease the need for these medications.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: End-of-life care, Nonpharmacologic comfort measures
MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort
GARDESLAB.COM
, Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)
9. A nurse is caring for a terminally ill client who has just died in a hospital setting with family
members at the bedside. Which action will the nurse take first?
a. Call for emergency assistance so that resuscitation procedures can begin.
b. Ask family members if they would like to spend time alone with the client.
c. Ensure the primary health care provider completed the death certificate.
d. Request family members to prepare the client’s body for the funeral home.
ANS: B
Before moving the client’s body to the funeral home, the nurse asks family members if they
would like to be alone with the client. Emergency assistance will not be necessary. Although
it is important to ensure that a death certificate has been completed before the client is moved
to the mortuary, the nurse first would ask family members if they would like to be alone with
the client. The client’s family would not be expected to prepare the body for the funeral home
but they could be asked if they wish to provide some care such as brushing the hair.
DIF: Applying TOP: Integrated Process: Caring
KEY: End-of-life care, Postmortem care MSC: Client Needs Category: Psychosocial Integrity
10. A nurse assesses a client who is dying. Which sign or symptoms does the nurse assess to
determine whether the client is near death?
a. Level of consciousness
b. Respiratory rate
c. Bowel sounds
d. Pain level on a 0-10 scale
ANS: B
Although all of these assessmentsGRA DESL
would beAperformed
B.COM during the dying process, periods of
apnea and Cheyne-Stokes respirations indicate that death is near. As peripheral circulation
decreases, the client’s level of consciousness and bowel sounds decrease, and the client would
be unable to provide a numeric number on a pain scale. Even with these other symptoms, the
nurse would continue to assess respiratory rate throughout the dying process. As the rate drops
significantly and breathing becomes agonal, death is near.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: End-of-life care
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
11. A nurse is caring for a client who is terminally ill. The client’s spouse states, “I am concerned
because he does not want to eat.” How does the nurse respond?
a. “Let him know that food is available if he wants it, but do not insist that he eat.”
b. “A feeding tube can be placed in the nose to provide important nutrients.”
c. “Force him to eat even if he does not feel hungry, or he will die sooner.”
d. “He is getting all the nutrients he needs through his intravenous catheter.”
ANS: A
Anorexia often causes distress in family members. When family members understand that the
client is not suffering from hunger and is not “starving to death,” they may allow the client to
determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and
clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the
family and contributes to client discomfort.
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