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142 Final - Part 3 - PRACTICE QUESTIONS (1)
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142 Final - Part 3 - PRACTICE QUESTIONS (1)
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142 Final - Part 3 - PRACTICE QUESTIONSA nurse who sits on the hospital's ethics committee is reviewing a complex case that
has many of the characteristics of assisted suicide. Which of the following would be an
example of assisted suicide?
A. Administering a lethal dose of medication to a client whose death is imminent
B. Administering a morphine infusion without assessing for respiratory depression
C. Granting a client's request not to initiate enteral feeding when the client is
unable to eat
D. Neglecting to resuscitate a client with a do not resuscitate order - CORRECT ANSWER-A.
Assisted suicide refers to providing another person the means to end his or her own life. This is
not to be confused with the ethically and legally supported practices of withholding or withdrawing
medical treatment in accordance with the wishes of the terminally ill individual. The other listed
options do not fit this accepted definition of assisted suicide.
A medical nurse is providing palliative care to a client with a diagnosis of end-stage
chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's
care?
A. To improve the client's and family's quality of life
B. To support aggressive and innovative treatments for cure
C. To provide physical support for the client
D. To help the client develop a separate plan with each discipline of the health care
team - CORRECT ANSWER-A. The goal of palliative care is to improve the client's and the
family's quality of life. The support should include the client's physical, emotional, and spiritual
well-being. Each discipline should contribute to a single care plan that addresses the needs of the
client and family. The goal of palliative care is not aggressive support for curing the client.
Providing physical support for the client is also not the goal of palliative care. Palliative care does
not strive to achieve separate plans of care developed by the client with each discipline of the
healthcare team.
An adult oncology client has a diagnosis of bladder cancer with metastasis and the
client has asked the nurse about the possibility of hospice care. Which principle is central
to a hospice setting?
A. The client and family should be viewed as a single unit of care.
B. Persistent symptoms of terminal illness should not be treated.
C. Each member of the interdisciplinary team should develop an individual plan of
care.
D. Terminally ill clients should die in the hospital whenever possible. - CORRECT ANSWER-A.
Hospice care requires that the client and family be viewed as a single unit of care. The other listed
principles are wholly inconsistent with the principles of hospice care.
A client with cancer has just been told that the disease is now terminal. The client
tearfully states, I can't believe I am going to die. Why me? What is the nurse's best
response to elicit more information from the client?
A. I know how you are feeling.
B. You have lived a long life; that should bring you peace.
C. Tell me more about how you feel about this news.
D. Life can be so unfair. - CORRECT ANSWER-The most important intervention the nurse can
provide is listening empathetically. To elicit more information about the client's feelings, the nurse
,should ask exploratory questions that encourage the client to relate a personal narrative. The
other statements deflect, ignore, or offer false sympathy and should be avoided.
The nurse has observed that an older adult client with a diagnosis of end-stage kidney
disease seems to prefer to have the client's eldest child make all of the health care
decisions. While the family is visiting, the client explains that this is a cultural practice
and very important that it occurs. How should the nurse best handle this situation?
A. Privately ask the child to allow the client to make the health care decisions.
B. Explain to the client that the client is responsible for all decisions.
C. Work with the team to negotiate informed consent.
D. Avoid divulging information to the eldest child. - CORRECT ANSWER-C. Rationale: In the case
of a client who wishes to defer decisions to his oldest child, the nurse can work with the team to
negotiate informed consent, respecting the client's right not to participate in decision making and
honoring his family's cultural practices.
A medical nurse is providing end-of-life care for a client with metastatic bone cancer.
The nurse notes that the client has been receiving oral analgesics for pain with adequate
effect, but is now having difficulty swallowing the medication. What should the nurse do?
A. Request the health care provider to prescribe analgesics by an alternative route.
B. Crush the medication in order to aid swallowing and absorption.
C. Administer the client's medication with the meal tray.
D. Administer the medication rectally. - CORRECT ANSWER-A. A change in medication route is
indicated and must be made by a health care provider's prescription. Many pain medications
cannot be crushed and given to a client. Giving the medication with a meal is not going to make it
any easier to swallow. Rectal administration may or may not be an option.
A client is in a hospice receiving palliative care for lung cancer which has
metastasized to the client's liver and bones. For the past several hours, the client has
been experiencing dyspnea. What nursing action is most appropriate?
A. Administer a bolus of normal saline, as prescribed.
B. Initiate high-flow oxygen therapy.
C. Administer high doses of opioids.
D. Administer bronchodilators and corticosteroids, as prescribed. - CORRECT ANSWER-D. A
client is in a hospice receiving palliative care for lung cancer which has metastasized to the client's
liver and bones. For the past several hours, the client has been experiencing dyspnea. What
nursing action is most appropriate? A. Administer a bolus of normal saline, as prescribed. B.
Initiate high-flow oxygen therapy. C. Administer high doses of opioids. D. Administer
bronchodilators and corticosteroids, as prescribed.
The nurse is caring for a client who has terminal lung cancer and is unconscious.
Which assessment finding would most clearly indicate to the nurse that the client's death
is imminent?
A. Mottling of the lower limbs
B. Slow, steady pulse
C. Bowel incontinence
D. Increased swallowing - CORRECT ANSWER-The time of death is generally preceded by a
period of gradual diminishment of bodily functions in which increasing intervals between
respirations, weakened and irregular pulse, and skin color changes or mottling may be observed.
The client will not be able to swallow secretions, so suctioning, frequent and gentle mouth care,
and possibly the administration of a transdermal anticholinergic drug are appropriate actions.
Bowel incontinence may or may not occur.
,A client on the medical unit is dying and the nurse has determined that the family's
psychosocial needs during the dying process need to be addressed. What is a cause of
many client care dilemmas at the end of life?
A. Poor communication between the family and the care team
B. Denial of imminent death on the part of the family or the client
C. Limited visitation opportunities for friends and family
D. Conflict between family members - CORRECT ANSWER-A. Many dilemmas in client care at
the end of life are related to poor communication between team members and the client and
family, as well as to failure of team members to communicate with each other effectively.
Regardless of the care setting, the nurse can ensure a proactive approach to the psychosocial
care of the client and family. Denial of death may be a response to the situation, but it is not
classified as a need. Visitation should accommodate wishes of the family member as long as client
care is not compromised.
The nurse is assessing a 73-year-old client who was diagnosed with metastatic
prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and
intense sadness. Based on this assessment data, the nurse will document that the client
is most likely in what stage of death and dying?
A. Depression
B. Denial
C. Anger
D. Resignation - CORRECT ANSWER-A. Loss, grief, and intense sadness indicate depression.
Denial is indicated by the refusal to admit the truth or reality. Anger is indicated by rage and
resentment. Acceptance is indicated by a gradual, peaceful withdrawal from life.
A nurse on a medical unit in the hospital often provides palliative care to clients with
a variety of diagnoses. Which activities describe the primary palliative care functions of
this nurse? Select all that apply.
A. Provides assessment of symptoms
B. Manages basic nursing problems
C. Handles difficult conversations with clients
D. Uses therapeutic communication skills with clients
E. Identifies multifactorial symptoms - CORRECT ANSWER-A, B, D. A primary palliative care
nurse uses fundamental nursing skills to care for clients in palliative care, such as basic
assessment of symptoms, management of basic care, and use of therapeutic communication
skills. A nurse who is a specialist in palliative care assesses and manages complex and
multifactorial symptoms and engages in difficult end-of-life conversations with clients and families.
The nurse is describing palliative care and hospice services to a client with end-stage
congestive heart failure. The client and family have many questions about the differences
between palliative care and hospice. Which statement should the nurse provide the
family?
A. Hospice is the application of palliative care at the end of life.
B. Palliative care requires hospitalization.
C. Hospice occurs in a facility with specially trained staff.
D. Curative care can continue in hospice. - CORRECT ANSWER-A. Palliative care focuses on
symptom management and quality of life in clients with serious symptoms and life-limiting
diseases. Hospice is a type of palliative care that focuses on comfort at the end of life. Palliative
care can take place in a number of settings; it does not need to take place in the inpatient hospital
setting. Hospice care may also occur in a variety of settings, or it can take place in a client's home
, without the need for a special facility. The client in hospice care is no longer receiving curative
treatment.
A client's rapid cancer metastases have prompted a shift from active treatment to
palliative care. When planning this client's care, the nurse should identify what primary
aim?
A. To prioritize emotional needs
B. To prevent and relieve suffering
C. To bridge between curative care and hospice care
D. To provide care while there is still hope - CORRECT ANSWER-B. Palliative care, which is
conceptually broader than hospice care, is both an approach to care and a structured system for
care delivery that aims to prevent and relieve suffering and to support the best possible quality of
life for clients and their families, regardless of the stage of the disease or the need for other
therapies. Palliative care goes beyond simple prioritization of emotional needs; these are always
considered and addressed. Palliative care is considered a bridge, but it is not limited to just
hospice care. Hope is something clients and families have even while the client is actively dying.
Clients who are enrolled in hospice care are often believed to suffer unnecessarily
because they do not receive adequate attention for their symptoms of the underlying
illness. What factor most contributes to this phenomenon?
A. Unwillingness to overmedicate the dying client
B. Rules concerning completion of all cure-focused medical treatment
C. Unwillingness of clients and families to acknowledge the client is terminal
D. Lack of knowledge by clients and families regarding availability of care - CORRECT
ANSWER-B. Because of rules concerning completion of all cure-focused medical treatment before
the Medicare hospice benefit may be accessed, many clients delay enrollment in hospice
programs until very close to the end of life. Hospice care does not include an unwillingness to
medicate the client to keep him or her from suffering. Clients must accept that they are terminal
before being admitted to hospice care. Lack of knowledge is common; however, this is not why
some clients do not receive adequate attention for the symptoms of their underlying illness.
The nurse is admitting a 52-year-old father of four into hospice care. The client has a
diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear
his preference to receive care at home. What intervention should the nurse prioritize in
the plan of care?
A. Aggressively continuing to fight the disease process
B. Moving the client to a long-term care facility when it becomes necessary
C. Including the children in planning their father's care
D. Supporting the client's and family's values and choices - CORRECT ANSWER-D. Nurses need
to develop skill and comfort in assessing clients' and families' responses to serious illness and
planning interventions that support their values and choices throughout the continuum of care. To
be admitted to hospice care, the client must have come to terms with the fact that he is dying. The
scenario states that the client wants to be cared for at home, not in a long-term care setting. The
children may be able to participate in their father's care, but they should not be assigned
responsibility for planning it.
A client experienced the death of a spouse from a sudden myocardial infarction 5
weeks ago. The nurse recognizes that the client will be going through the process of
mourning for an extended period of time. What process(es) of mourning will allow the
client to accommodate the loss in a healthy way? Select all that apply.
A. Reiterating the client's anger at the spouse's care team
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