Understanding Medical Surgical Nursing 5th Edition by Linda S. Williams Paula D. Hopper
Understanding Medical Surgical Nursing 5th Edition by Linda S. Williams Paula D. Hopper
$2.99
Chapter 17. Nursing Care of Patients at the End of Life
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. The nurse observes a terminal patient making a gurgling sound when breathing. Which nursing diagnosis should the nurse use to guide interventions for this patient?
| a. | Impaired Gas Exchange |
| b. | Ineffective Breathing Pattern |
| c. | Ineffective Airway Clearance |
| d. | Impaired Oral Mucous Membranes |
____ 2. The nurse is preparing to provide cardiopulmonary resuscitation (CPR) to a patient found unresponsive and not breathing. What should the nurse keep in mind regarding the survival rate of patients who receive CPR in the hospital?
| a. | Most patients survive after receiving CPR in the hospital. |
| b. | About 5% of patients survive who receive CPR in the hospital. |
| c. | Less than 1% of patients survive who receive CPR in the hospital. |
| d. | Between 10% to 15% of patients survive who receive CPR in the hospital. |
____ 3. A family member is concerned that a patient near the end of life is not eating or drinking and asks the nurse how the family can help the patient increase oral intake. Which response by the nurse is most appropriate?
| a. | “The best way to feed the patient is with a syringe and small amounts of water or liquid feeding.” |
| b. | “The less the patient drinks, the less urination will be necessary and urination can be uncomfortable at this point in the dying process.” |
| c. | “The starvation process at the end of life is quite natural; a side benefit is that lower doses of medications are needed to keep the patient comfortable.” |
| d. | “As your family member becomes dehydrated from not eating or drinking, natural endorphins will be released, which increase comfort near the end of life.” |
____ 4. A patient is very restless and agitated near the end of life, and the physician orders haloperidol (Haldol) by mouth. However, the patient coughs and chokes every time foods or fluids are offered. Which action should the nurse take?
| a. | Crush the medication, and mix it with applesauce. |
| b. | Hold the medication until the patient is more alert and able to swallow. |
| c. | Ask the physician for an order to administer the Haldol intramuscularly. |
| d. | Dissolve the medication in a small amount of water, and administer it with an oral syringe. |
____ 5. A patient with lung cancer who expected to die within a few days is being given a blood transfusion. Family members, who realize death is imminent, ask, “Why are you giving a blood transfusion when we all know death is just around the corner?” What should the nurse respond to the family?
| a. | “That question is best answered by the physician during rounds.” |
| b. | “It is my duty as a nurse to continue to administer life-prolonging treatments until the patient dies.” |
| c. | “The blood will raise the hemoglobin level, which will increase energy level and sense of well-being.” |
| d. | “The transfusion will help increase the patient’s oxygen levels. It will not prolong life but will increase comfort.” |
MULTIPLE CHOICE
Saliva that the patient is now unable to swallow may collect in the back of the throat, causing a sound sometimes called a “death rattle.” A. Impaired gas exchange would occur deeper in the lungs. B. Breathing pattern refers to breathing rhythm or rate, not airway patency. D. Mucous membranes are not necessarily involved.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application
Only 10% to 15% of patients who receive CPR in a hospital survive. One reason for the low survival rate is that CPR must begin within 3 to 5 minutes of collapse. The most successful cases are ones in which CPR plus an automatic external defibrillator (AED) is used within 3 to 5 minutes of collapse. Patients who are not in a hospital and who survive after CPR have a 5% chance of living for one year. Success of CPR in a hospital setting depends greatly on the patient’s age. The best rate of CPR success is 10% in the age 40-to-59-year group. In patients over the age of 80 years, the CPR success rate declines to 3%. In patients over the age of 90 years, it declines further to 1%.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
Benefits in withholding artificial feeding and hydration in the final weeks of life in actively dying patients include fewer pharyngeal and lung secretions, which can reduce dyspnea; reduced swelling around tumors, which can reduce associated pain; and less urination, resulting in dryer skin with fewer breakdowns. It has also been theorized that as dehydration occurs, the body produces a form of endorphin, which enhances comfort. A. Feeding may not be the best action. B. Urination is not uncomfortable. C. Use of the word starvation may be distressing to the family.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application
The patient will benefit from sedation, and the Haldol can be effectively administered by injection. A D. Crushing the medication, mixing it with applesauce, or dissolving the medication in water and providing it through a syringe will not prevent aspiration. B. Withholding the medication will not help the patient’s restlessness.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application
Blood transfusions may be given to improve oxygenation and reduce dyspnea and are not intended to prolong life but to promote comfort. A. It is not necessary for the family to wait for an answer from the physician. Teaching is a nursing role. B. It is not the nurse’s duty to provide life-prolonging treatments until the patient dies. Nurses often administer comfort care at the end of life. C. Comfort is the goal at the end of life, not increased energy.
PTS: 1 DIF: Moderate
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