Chapter 04: End-of-Life Care and Palliative Care in Critical Care Settings

Chapter 04: End-of-Life Care and Palliative Care in Critical Care Settings

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated. The patient is on a continuous morphine infusion and has an additional order for lorazepam (Ativan) 1 to 2 mg IV as needed (prn). The patient has received no lorazepam (Ativan) during this course of illness. What is the most appropriate nursing intervention to control agitation?

ANS:  B

Lorazepam (Ativan) 1 mg IV is an appropriate drug dose for a patient who is experiencing agitation during withdrawal of life support. Because it is ordered but not yet given, the nurse should give this drug now. Fentanyl treats pain and morphine controls pain. Paralytic agents are not warranted.

DIF:    Cognitive Level: Apply/Application                                  REF:   p. 46

OBJ:   Describe nursing interventions to support the patient and family during the end-of-life stage.

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

2. A 75-year-old patient, who suffered a massive stroke 3 weeks ago, has been unresponsive and has required ventilatory support since the time of the stroke. The physician has approached the spouse regarding placement of a permanent feeding tube. The spouse states that the patient never wanted to be kept alive by tubes and personally didn’t want what was being done. After holding a family conference with the spouse, the medical team concurs, and the feeding tube is not placed. This situation is an example of

ANS:  D

Because the tube feeding had not been yet placed in the care of this patient, this scenario is an example of withholding of life support. Withholding of life support does not constitute euthanasia. Withdrawal of life support involves the discontinuation of previously established therapies in a terminally ill patient.

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 43

OBJ:   Discuss concepts of end-of-life care, including palliative care; communication and conflict resolution; withholding or withdrawing therapy; and psychological support of the patient, family members, and health care providers.                 TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Safe and Effective Care Environment

3. What were the findings of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)?

ANS:  C

Disparities and lack of communication are common in the relationships between patients and health care providers. Critical care units are often poorly equipped to meet the needs of dying patients. The SUPPORT study demonstrated that pain and suffering are widespread in hospitals.

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 40

OBJ:   Discuss concepts of end-of-life care, including palliative care; communication and conflict resolution; withholding or withdrawing therapy; and psychological support of the patient, family members, and health care providers.                 TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe and Effective Care Environment

4. A statement that provides a legally recognized description of an individual’s desires regarding care at the end of life is a (an)

ANS:  A

Legally recognized documents that provide guidance on an individual’s end-of-life choices are advance directives. Advance directives include living wills, durable powers of attorney for health care, and health care surrogate designations. A guardianship ad litem is a parent who files legal action on the behalf of a child. A health care proxy is an individual who is legally designated through statute to make decisions for an incapacitated person. A power of attorney is an individual who is, through filing of legal papers, authorized to act on the behalf of an incapacitated person in legal matters.

DIF:    Cognitive Level: Understand/Comprehension                    REF:   p. 47

OBJ:   Describe ethical and legal concerns related to end-of-life care.

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs Category: Safe and Effective Care Environment

5. A patient with metastatic lung carcinoma has been unresponsive to chemotherapy. The medical team has determined that there are no additional treatments available that will prolong life or improve the quality of life in any meaningful way. Despite the poor prognosis, the patient continues to receive chemotherapy and full nutritional support. This is an example of which end-of-life concept?

ANS:  A

Medical futility is a situation in which therapy or interventions will not provide a foreseeable possibility of improvement in the patient’s health status. Palliative care focuses on symptom relief and is not limited to the dying. Terminal weaning refers to withdrawal of artificial ventilation interventions. Withdrawal of treatment refers to the removal of established therapies in a terminally ill patient.

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 41

OBJ:   Discuss concepts of end-of-life care, including palliative care; communication and conflict resolution; withholding or withdrawing therapy; and psychological support of the patient, family members, and health care providers.

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs Category: Safe and Effective Care Environment