Chapter 11: Palliative Care at End of Life

Chapter 11: Palliative Care at End of Life

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE
1. The nurse is caring for a terminally ill patient who has 20-second periods of apnea
followed by periods of deep and rapid breathing. The nurse documents this finding as
a. agonal breathing.
b. apneustic breathing.
c. death-rattle respirations.
d. Cheyne-Stokes respirations.
ANS: D
Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep
and rapid breaths. The “death rattle” is caused by accumulation of mucus in the airways,
causing wet-sounding respirations. Agonal breathing has a very slow and irregular rate
and rhythm. Apneustic respirations are irregular and gasping.
DIF: Cognitive Level: Comprehension REF: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. A 21-year-old is dying after an automobile accident. The family members want to donate
the patient’s organs and ask the nurse how the decision about brain death is made. The
nurse explains that the patient will be considered brain dead when
a. the patient is flaccid and unresponsive.
b. CPR is ineffective in restoring heartbeat.
c. the patient is apneic and without brainstem reflexes.
d. respiratory efforts cease and no apical pulse is audible.
ANS: C
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.
DIF: Cognitive Level: Comprehension REF: 155
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
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. The nurse explains to the family that these
symptoms
a. will continue to increase until death finally occurs.
b. are a normal response before these functions decrease.
c. indicate a reflex response to the slowing of other body systems.
d. may be associated with an improvement in the patient’s condition.
Test Bank 11-2
ANS: B
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.
DIF: Cognitive Level: Comprehension REF: 156
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. A patient who has been diagnosed with metastatic cancer and has a poor prognosis plans
a trip across the country “to settle some issues with my sisters and brothers.” The nurse
recognizes that the patient is manifesting the psychosocial response of
a. restlessness.
b. yearning and protest.
c. anxiety about unfinished business.
d. fear of the meaninglessness of one’s life.
ANS: C
The patient’s 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 patient’s life has been
meaningless.
DIF: Cognitive Level: Application REF: 157
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity