Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 9 - Palliative and End of Life Care
1. 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.
Answer: D
Explanation: Cheyne-Stokes respirations are a common and expected breathing pattern in the
final days of life, characterized by cycles of apnea and deep, rapid breathing. The appropriate
nursing action is to accurately document this finding, as it is a normal part of the dying
process and does not require intervention like suctioning, oxygen, or repositioning to high
Fowler's.
2. 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.
Answer: C
Explanation: Brain death is determined by the irreversible loss of all brain functions,
including brainstem reflexes and the ability to breathe spontaneously. The other options
describe clinical signs associated with death but do not fully define the specific, irreversible
criteria required for a brain death diagnosis.
3. 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.
,Answer: B
Explanation: An initial increase in heart and respiratory rates can be a normal part of the
dying process before these functions ultimately decline. It is important to reassure the family
that such changes are expected and do not indicate improvement or a reflexive action.
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 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
Answer: C
Explanation: The patient's desire to resolve family matters indicates anxiety about unfinished
business, a common psychosocial response when facing the end of life. This reflects a need to
achieve closure and peace.
5. 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
Answer: A
Explanation: The spouse's cheerful denial and avoidance of discussing the terminal prognosis
suggest a lack of anticipatory grieving, which can lead to ineffective coping and difficulty
adjusting to the impending loss.
6. 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.
Answer: A
Explanation: The nurse should first determine if the patient's wishes have been
communicated to and documented by the healthcare provider, as a DNR order requires a
provider's authorization. This ensures the patient's preferences are legally and appropriately
integrated into the care plan.
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 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.
Answer: B
Explanation: Providing a supportive presence and offering an open-ended invitation to talk
allows the patient to express fears, concerns, or unmet needs. This therapeutic
communication addresses the patient's emotional and spiritual distress.
8. The nurse cares for a terminally ill patient who is experiencing pain that is
continuous and severe. How should the nurse schedule the administration of
opioid pain medications?
A. Give around-the-clock routine administration of analgesics.
B. Provide PRN doses of medication whenever the patient requests.
C. Offer enough pain medication to keep the patient sedated and unaware of stimuli.
D. Suggest analgesic doses that provide pain control without decreasing respiratory
rate.
Answer: A
Explanation: Around-the-clock dosing maintains consistent therapeutic drug levels,
preventing the recurrence of severe pain and providing continuous comfort. This approach is
preferred over PRN dosing for managing persistent, severe pain in terminally ill patients.
9. The nurse cares for a patient with lung cancer in a home hospice program.
Which action by the nurse is most appropriate?
A. Discuss cancer risk factors and appropriate lifestyle modifications.
B. Encourage the patient to discuss past life events and their meaning.
Chapter 9 - Palliative and End of Life Care
1. 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.
Answer: D
Explanation: Cheyne-Stokes respirations are a common and expected breathing pattern in the
final days of life, characterized by cycles of apnea and deep, rapid breathing. The appropriate
nursing action is to accurately document this finding, as it is a normal part of the dying
process and does not require intervention like suctioning, oxygen, or repositioning to high
Fowler's.
2. 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.
Answer: C
Explanation: Brain death is determined by the irreversible loss of all brain functions,
including brainstem reflexes and the ability to breathe spontaneously. The other options
describe clinical signs associated with death but do not fully define the specific, irreversible
criteria required for a brain death diagnosis.
3. 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.
,Answer: B
Explanation: An initial increase in heart and respiratory rates can be a normal part of the
dying process before these functions ultimately decline. It is important to reassure the family
that such changes are expected and do not indicate improvement or a reflexive action.
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 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
Answer: C
Explanation: The patient's desire to resolve family matters indicates anxiety about unfinished
business, a common psychosocial response when facing the end of life. This reflects a need to
achieve closure and peace.
5. 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
Answer: A
Explanation: The spouse's cheerful denial and avoidance of discussing the terminal prognosis
suggest a lack of anticipatory grieving, which can lead to ineffective coping and difficulty
adjusting to the impending loss.
6. 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.
Answer: A
Explanation: The nurse should first determine if the patient's wishes have been
communicated to and documented by the healthcare provider, as a DNR order requires a
provider's authorization. This ensures the patient's preferences are legally and appropriately
integrated into the care plan.
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 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.
Answer: B
Explanation: Providing a supportive presence and offering an open-ended invitation to talk
allows the patient to express fears, concerns, or unmet needs. This therapeutic
communication addresses the patient's emotional and spiritual distress.
8. The nurse cares for a terminally ill patient who is experiencing pain that is
continuous and severe. How should the nurse schedule the administration of
opioid pain medications?
A. Give around-the-clock routine administration of analgesics.
B. Provide PRN doses of medication whenever the patient requests.
C. Offer enough pain medication to keep the patient sedated and unaware of stimuli.
D. Suggest analgesic doses that provide pain control without decreasing respiratory
rate.
Answer: A
Explanation: Around-the-clock dosing maintains consistent therapeutic drug levels,
preventing the recurrence of severe pain and providing continuous comfort. This approach is
preferred over PRN dosing for managing persistent, severe pain in terminally ill patients.
9. The nurse cares for a patient with lung cancer in a home hospice program.
Which action by the nurse is most appropriate?
A. Discuss cancer risk factors and appropriate lifestyle modifications.
B. Encourage the patient to discuss past life events and their meaning.
