NR341 Exam 1 Review
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1. The nurse is caring for an adolescent patient who is dying. 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
2. 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 to death?
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
3. A patient with terminal cancer is being admitted to a family-centered inpa-
tient 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
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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
4. 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 deci-
sions.
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. A notarized advance directive 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.
5. 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.
6. The nurse is caring for a terminally ill patient who is experiencing continuous
and severe pain. How should the nurse schedule the administration of opioid
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pain medications?
a. Plan around-the-clock routine administration of prescribed analgesics.
b. Provide PRN 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
7. The nurse is caring for a patient with lung cancer in a home hospice program.
Which action by the nurse is appropriate?
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 appropriate.
8. 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 should 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.
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9. 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." What
type of grief is the patient describing?
a. Adaptive grieving
b. Anticipatory grief
c. Dysfunctional reactions
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.
10. 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 by the
nurse is appropriate?
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 is important 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
11. Which patient should the nurse refer for hospice care?
a. A 40-yr-old patient with AIDS-related dementia who needs pain manage-
ment
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.
Study online at https://quizlet.com/_hzud75
1. The nurse is caring for an adolescent patient who is dying. 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
2. 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 to death?
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
3. A patient with terminal cancer is being admitted to a family-centered inpa-
tient 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
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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
4. 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 deci-
sions.
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. A notarized advance directive 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.
5. 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.
6. The nurse is caring for a terminally ill patient who is experiencing continuous
and severe pain. How should the nurse schedule the administration of opioid
, NR341 Exam 1 Review
Study online at https://quizlet.com/_hzud75
pain medications?
a. Plan around-the-clock routine administration of prescribed analgesics.
b. Provide PRN 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
7. The nurse is caring for a patient with lung cancer in a home hospice program.
Which action by the nurse is appropriate?
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 appropriate.
8. 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 should 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.
, NR341 Exam 1 Review
Study online at https://quizlet.com/_hzud75
9. 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." What
type of grief is the patient describing?
a. Adaptive grieving
b. Anticipatory grief
c. Dysfunctional reactions
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.
10. 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 by the
nurse is appropriate?
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 is important 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
11. Which patient should the nurse refer for hospice care?
a. A 40-yr-old patient with AIDS-related dementia who needs pain manage-
ment
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.
