Chapter 09: Palliative Care at End of Life

Chapter 09: Palliative Care at End of Life

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is caring for an unresponsive 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 appropriate?

a.	Suction the patient’s mouth.
b.	Administer oxygen via face mask.
c.	Document Cheyne-Stokes respirations.
d.	Place the patient in high Fowler’s position.

 

 

ANS:  C

Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep and rapid breaths. Cheyne-Stokes respirations are expected in the last days of life and are not position dependent. There is also no need for supplemental oxygen by face mask or suctioning the patient.

 

DIF:    Cognitive Level: Apply (application)           REF:               132

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

2. The nurse is caring for an adolescent patient who is dying. The patient’s parents are interested in organ donation and ask the nurse how the health care providers determine brain death. Which response by the nurse accurately describes brain death determination?

a.	“If CPR does not restore a heartbeat, the brain cannot function.”
b.	“Brain death has occurred if there is not any breathing or brainstem reflexes.”
c.	“Brain death has occurred if a person has flaccid muscles and does not awaken.”
d.	“If respiratory efforts cease and no apical pulse is audible, brain death is present.”

 

 

ANS:  B

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: Apply (application)           REF:               131

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

3. A patient in hospice is manifesting a decrease in all body system functions except for a heart rate of 124 beats/min and a respiratory rate of 28 breaths/min. Which statement, if made by the nurse to the patient’s family member, is most appropriate?

a.	“These vital signs will continue to increase until death finally occurs.”
b.	“These vital signs are an expected response now but will slow down later.”
c.	“These vital signs may indicate an improvement in the patient’s condition.”
d.	“These vital signs are a helpful response to the slowing of other body systems.”

 

 

ANS:  B

An increase in heart and respiratory rate may occur before the slowing of these functions in a 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 or compensation, and it would be inappropriate for the nurse to indicate this to the family.

 

DIF:    Cognitive Level: Apply (application)           REF:               132

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Physiological Integrity

 

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 family members.” The nurse recognizes that the patient is manifesting which psychosocial response to death?

a.	Protesting the unfairness of death
b.	Anxiety about unfinished business
c.	Fear of having lived a meaningless life
d.	Restlessness about the uncertainty of prognosis

 

 

ANS:  B

The patient’s statement indicates that there is some unfinished family business that the patient would like to address before dying. There is no indication that the patient is protesting the prognosis, feels uncertain about the prognosis, or fears that life has been meaningless.

 

DIF:    Cognitive Level: Apply (application)           REF:               132

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity