Chapter 10: Palliative and End-of-Life Care Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

Test Bank For Lewis's Medical-Surgical Nursing, 12th Edition by Mariann M. Harding, Jeffrey Kwong, Debra Hagler Chapter 10: Palliative and End-of-Life Care Harding: Lewis’s Medical-Surgical Nursing, 12th Edition MULTIPLE CHOICE 1. The nurse is caring for an unresponsive terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing. Which action would the nurse take? A. Suction the patient‘s mouth. B. Administer oxygen via face mask. C. Document the patient‘s respiratory pattern. D. Place the patient in high Fowler‘s position. ANS: C Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep and rapid breaths. This respiratory pattern is expected in the last days of life and is not position dependent. There is also no need for supplemental oxygen by face mask or suctioning the patient. 2. The nurse is caring for a dying adolescent patient who is comatose. The patient‘s parents are interested in organ donation and ask the nurse how the health care providers determine brain death. Which response by the nurse accurately describes brain death determination? A. “If CPR does not restore a heartbeat, the brain cannot function any longer.” B. “Brain death has occurred if there is not any breathing or brainstem reflexes.” C. “Brain death has occurred if a person has flaccid muscles and does not awaken.” D. “If respiratory efforts cease and no apical pulse is audible, brain death is present.” ANS: B 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. 3. A patient in hospice is manifesting a decrease in all body system functions except for a heart rate of 124 beats/min and a respiratory rate of 28 breaths/min. Which statement would be accurate for the nurse to make to the patient‘s family? A. “These vital signs will continue to increase until death finally occurs.” B. “These vital signs demonstrate the body‘s ability to compensate and heal.” C. “These vital signs are an expected response now but will slow down later.” D. “These vital signs may indicate an improvement in the patient‘s condition.” ANS: C An increase in heart and respiratory rate may occur before the slowing of these functions in a 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 or compensation, and it would be inappropriate for the nurse to indicate this to the family. 4. 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 family members.” The nurse recognizes that the patient is manifesting which psychosocial response? A. Protesting the unfairness of death B. Anxiety about unfinished business C. Fear of having lived a meaningless life D. Restlessness about the uncertain prognosis ANS: B The patient‘s statement indicates that there is some unfinished family business that the patient would like to address before dying. There is no indication that the patient is protesting the prognosis, feels uncertain about the prognosis, or fears that life has been meaningless. 5. A patient with terminal cancer is being admitted to a family-centered inpatient hospice. The patient‘s spouse 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 issue would the nurse identify as a concern in working with the patient‘s spouse? A. Fear B. Anxiety C. Hopelessness D. Difficulty coping ANS: D 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 fearful, hopeless, or anxious. 6. As the nurse admits a patient in end-stage renal disease to the hospital, the patient tells the nurse, “If my heart or breathing stop, I do not want to be resuscitated.” Which action should the nurse take first? A. Place a “Do Not Resuscitate” (DNR) notation in the patient‘s care plan. B. Invite the patient to add a notarized advance directive in the health record. C. Advise the patient to designate a person to make future health care decisions. D. Ask if the decision has been discussed with the patient‘s health care provider. ANS: D 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 until it is prescribed by the HCP. A notarized advance directive may be completed but 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. 7. 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 by the nurse would show respect for the patient? 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. 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 does not address the patient‘s concerns. Telling the patient that everything is being done does not address the patient‘s fears about dying, especially because 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 stay there. 8. The nurse is caring for a terminally ill patient who is experiencing continuous and severe pain. How would the nurse schedule the administration of opioid pain medications? A. Plan around-the-clock routine administration of prescribed analgesics. B. Provide prescribed doses of medication whenever the patient requests them. C. Suggest small analgesic doses to avoid decreasing the respiratory rate. D. Offer enough pain medication to keep the patient sedated and unaware of stimuli. ANS: A 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. 9. The nurse is caring for a patient with lung cancer in a home hospice program. Which action would the nurse implement? A. Discuss cancer risk factors and appropriate lifestyle modifications. B. Teach the patient about the purpose of chemotherapy and radiation. C. Encourage the patient to discuss past life events and their meanings. D. Accomplish a thorough head-to-toe assessment several times a week. ANS: C 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 useful for a patient approaching death. 10. 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 would the nurse take at this time? A. Contact a grief counselor as soon as possible. B. Cry along with the patient‘s family members. C. Leave the home quickly to allow the family to grieve privately. D. Consider leaving hospice work because patient losses are common. ANS: B 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 supportive. 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. 11. A middle-aged patient tells the nurse, “My mother died 2 months ago. I have been thinking about all the good times we shared together every day.” Which type of grief is the patient describing? A. Adaptive grief B. Anticipatory grief C. Dysfunctional grief D. Prolonged grief disorder ANS: A The patient should be reassured that grieving activities such as frequent thoughts about the deceased are considered a normal part of adaptive grieving. Dysfunctional reactions include severe emotional reactions. Prolonged grief lasts longer than 6 months. Anticipatory grief occurs before the death event. 12. The son of a dying patient tells the nurse, “Mother doesn‘t respond any more when I visit. I don‘t think she knows that I am here.” Which response would the nurse provide? A. “Cut back your visits for now to avoid overtiring your mother.” B. “Withdrawal can be a normal response in the process of dying.” C. “Most dying patients don‘t know what is going on around them.” D. “It isimportant to stimulate your mother so she can‘t retreat from you.” ANS: B 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. 13. Which patient would the nurse refer for hospice care? A. A 40-yr-old patient with AIDS-related dementia who needs pain management B. A 70-yr-old patient with lymphoma who is unable to discuss issues related to dying C. A 60-yr-old patient with chronic severe pain because of spinal arthritis and vertebral collapse D. A 50-yr-old patient with advanced liver failure whose family can no longer provide care at home ANS: A Hospice is designed to provide 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. 14. The nurse admits a terminally ill patient to the hospital. Which action would the nurse plan to complete first? A. Determine the patient‘s wishes about end-of-life care. B. Discuss the normal grief process with the patient and family. C. Emphasize the importance of addressing any family concerns. D. Encourage the patient to talk about fears or unresolved issues. ANS: A 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. 15. Which action would the nurse take first when admitting an alert, terminally ill patient who is from a different culture than the nurse? A. Request a visit from the hospital chaplain to provide spiritual care. B. Ask the patient and family about their preferences for care during this time. C. Obtain information from other staff members about possible cultural needs. D. Remind family members that dying patients may want them to stay at the bedside. ANS: B Because cultural beliefs may vary, 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.