Lewis Medical Surgical Ch 9. Palliative Care Practice Exam Questions and Answers

Lewis Medical Surgical Ch 9. Palliative Care Practice Exam Questions and Answers 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:-ANS: d. Document the respirations as Cheyne- Stokes 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 ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/13 turning the patient on the side may promote comfort. There is no need to place the patient in high Fowlers position. 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? 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:-ANS: c. Brain death has occurred if there is no breathing and certain reflexes are absent. 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. 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? ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/13 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:-ANS: b. These symptoms are a normal response before these functions decrease. 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. 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 ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/13 d. Fear of the meaninglessness of one's life - Ans:-ANS: c. Anxiety about unfinished business 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. 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? 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:-ANS: a. Ineffective coping related to lack of grieving ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/13 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. As the nurse admits a patient with end-stage kidney disease to the hospital, the patient tells the nurse, If my heart or breathing stops, 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 provid