NURSING
6560
EXAM 1
TEST
BANK
Chapter 7: End-of-Life Care
1. A nurse cares for a dying client. Which manifestation of dying should the nurse treat first?
a. Anorexia
b. Pain
c. Nausea
d. Hair loss
Only symptoms that cause distress for a dying client should 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 should be treated only if the client is distressed by their
presence. The nurse should treat the client’s pain first.
2. A nurse plans care for a client who is nearing end of life. Which question should 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 activities?”
d. “Have your children discussed resuscitation with your health care provider?”
When developing a plan of care for a dying client, consideration should be given for where the client wants to
die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life
care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status
should be the client’s decision, not the family’s decision.
3. A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse
question?
a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5
b. Albuterol (Proventil) 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 (Fleet) enema once a day PRN for impacted stool
Pain medications should be scheduled around the clock to maintain comfort and prevent reoccurrence of pain.
The other medications are appropriate for this client.
4. A client tells the nurse that, even though it has been 4 months since her sister’s death, she frequently
finds herself crying uncontrollably. How should the nurse respond?
a. “Most people move on within a few months. You should see a grief counselor.”
b. “Whenever you start to cry, distract yourself from thoughts of your sister.”
c. “You should try not to cry. I’m sure your sister is in a better place now.”
d. “Your feelings are completely normal and may continue for a long
time.”
Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and
okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be
,grieving after a few months. The other responses are not as therapeutic because they justify or minimize the
client’s response.
,5. After teaching a client about advance directives, a nurse assesses the client’s understanding.
Which statement indicates the client correctly understands the teaching?
a. “An advance directive will keep my children from 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.”
An advance directive is a written document prepared by a competent individual that specifies what, if any,
extraordinary actions a person would want 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.
6. A nurse teaches a client who is considering being admitted to hospice. Which statement should 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 designed not to 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.”
As both a philosophy and a system of care, hospice care uses an interdisciplinary 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.
7. A nurse is caring for a dying client. The client’s spouse states, “I think he is choking to death.” How
should 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 husband 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 husband on his side.”
The choking sound or “death rattle” is common in dying clients. The nurse should acknowledge the spouse’s
concerns and provide 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 should not minimize the
spouse’s concerns. Morphine will assist with comfort but will not decrease the choking sounds. Nasotracheal
suctioning is not appropriate in a dying client.
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.”
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.
, 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 should 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 that a death certificate has been completed by the physician.
d. Request family members to prepare the client’s body for the funeral home.
Before moving the client’s body to the funeral home, the nurse should ask 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 should ask family
members if they would like to be alone with the client. The client’s family should not be expected to prepare the
body for the funeral home.
10. A nurse assesses a client who is dying. Which manifestation of a dying client should 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-to-10 scale
Although all of these assessments should be performed during the dying process, periods of apnea and Cheyne-
Strokes respirations indicate 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 should continue to assess respiratory rate throughout the
dying process. As the rate drops significantly and breathing becomes agonal, death is near.
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 should 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.”
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.
12. A nurse discusses inpatient hospice with a client and the client’s family. A family member
expresses concern that her loved one will receive only custodial care. How should the nurse respond?
a. “The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person
enjoy whatever time is left.”
b. “Palliative care will release you from the burden of having to care for someone in the home. It does not
mean that curative treatment will stop.”
c. “A palliative care facility is like a nursing home and costs less than a hospital because only pain medications
are given.”
d. “Your relative is unaware of her surroundings and will not notice the difference between her home and
a palliative care facility.”
Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is
on pain control and helping the relative die with dignity.
6560
EXAM 1
TEST
BANK
Chapter 7: End-of-Life Care
1. A nurse cares for a dying client. Which manifestation of dying should the nurse treat first?
a. Anorexia
b. Pain
c. Nausea
d. Hair loss
Only symptoms that cause distress for a dying client should 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 should be treated only if the client is distressed by their
presence. The nurse should treat the client’s pain first.
2. A nurse plans care for a client who is nearing end of life. Which question should 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 activities?”
d. “Have your children discussed resuscitation with your health care provider?”
When developing a plan of care for a dying client, consideration should be given for where the client wants to
die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life
care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status
should be the client’s decision, not the family’s decision.
3. A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse
question?
a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5
b. Albuterol (Proventil) 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 (Fleet) enema once a day PRN for impacted stool
Pain medications should be scheduled around the clock to maintain comfort and prevent reoccurrence of pain.
The other medications are appropriate for this client.
4. A client tells the nurse that, even though it has been 4 months since her sister’s death, she frequently
finds herself crying uncontrollably. How should the nurse respond?
a. “Most people move on within a few months. You should see a grief counselor.”
b. “Whenever you start to cry, distract yourself from thoughts of your sister.”
c. “You should try not to cry. I’m sure your sister is in a better place now.”
d. “Your feelings are completely normal and may continue for a long
time.”
Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and
okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be
,grieving after a few months. The other responses are not as therapeutic because they justify or minimize the
client’s response.
,5. After teaching a client about advance directives, a nurse assesses the client’s understanding.
Which statement indicates the client correctly understands the teaching?
a. “An advance directive will keep my children from 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.”
An advance directive is a written document prepared by a competent individual that specifies what, if any,
extraordinary actions a person would want 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.
6. A nurse teaches a client who is considering being admitted to hospice. Which statement should 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 designed not to 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.”
As both a philosophy and a system of care, hospice care uses an interdisciplinary 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.
7. A nurse is caring for a dying client. The client’s spouse states, “I think he is choking to death.” How
should 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 husband 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 husband on his side.”
The choking sound or “death rattle” is common in dying clients. The nurse should acknowledge the spouse’s
concerns and provide 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 should not minimize the
spouse’s concerns. Morphine will assist with comfort but will not decrease the choking sounds. Nasotracheal
suctioning is not appropriate in a dying client.
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.”
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.
, 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 should 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 that a death certificate has been completed by the physician.
d. Request family members to prepare the client’s body for the funeral home.
Before moving the client’s body to the funeral home, the nurse should ask 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 should ask family
members if they would like to be alone with the client. The client’s family should not be expected to prepare the
body for the funeral home.
10. A nurse assesses a client who is dying. Which manifestation of a dying client should 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-to-10 scale
Although all of these assessments should be performed during the dying process, periods of apnea and Cheyne-
Strokes respirations indicate 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 should continue to assess respiratory rate throughout the
dying process. As the rate drops significantly and breathing becomes agonal, death is near.
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 should 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.”
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.
12. A nurse discusses inpatient hospice with a client and the client’s family. A family member
expresses concern that her loved one will receive only custodial care. How should the nurse respond?
a. “The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person
enjoy whatever time is left.”
b. “Palliative care will release you from the burden of having to care for someone in the home. It does not
mean that curative treatment will stop.”
c. “A palliative care facility is like a nursing home and costs less than a hospital because only pain medications
are given.”
d. “Your relative is unaware of her surroundings and will not notice the difference between her home and
a palliative care facility.”
Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is
on pain control and helping the relative die with dignity.
