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Chapter 59 - End-of-Life Care

Total questions: 92

Worksheet time: 5hrs 36mins

Name
Class
Date
1.

A nurse is caring for a client diagnosed with carcinoma of the prostate along with metastatic infiltration to other parts of the body. Which signs of approaching death does the nurse notice in the client? Select all that apply.

a)

Extremeties may feel cold to touch

b)

Breathing may gradually become noisy

c)

Gag reflexes are gradually increased

d)

Client remains calm and peaceful

e)

Bladder and bowel control is lost

2.

A client involved in a motor vehicle accident is declared dead on admission to the healthcare facility. The client's driver's license indicates a wish to be an eye donor. Which nursing measure should the nurse perform when caring for the client's body?

a)

Place the client's body on a ventilator until the eyes are harvested

b)

Obtain legal written permission from the client's next of kin

c)

Harvest the eyes as soon as possible based on the client's directive

d)

Ask another nurse to assist the family in deciding on the donation

3.

An older adult client is admitted to the healthcare facility with severe respiratory failure and infections. Which nursing measure must the nurse perform when caring for this client?

a)

Ask the client to consume small quantities of milk

b)

Assist the client with a bed shampoo with water for hair care

c)

Ask the client to lie on the back as much as possible

d)

Assist the client to be as active as possible

4.

A nurse is providing end-of-life care to an older adult client at a healthcare facility. The client reports frequent nausea and vomiting. Which nursing considerations must the nurse employ when caring for the client? Select all that apply.

a)

Offer dry foods such as soda crackers

b)

Assist the client to a supine position

c)

Encourage client/family to place a damp cloth on the forehead

d)

Provide the client small quantities of milk

e)

Ask the client to take short and rapid breaths

5.

A nurse is caring for an older adult client who is dying. What interventions should the nurse perform with regard to mouth care for this client?

a)

Provide frequent warm liquids during the day

b)

Moisten the tongue with mineral oil

c)

Apply mineral oil to the client's lips

d)

Ask the client to rinse with mouthwash

6.

A nurse is working with a client who has just been diagnosed as having terminal cancer. The client is visibly agitated and keeps asking staff members at the hospital, "I have tried to do the right thing all my life, and now this...I don't understand why I have to go through this." Which stage of dying would the nurse note for this client?

a)

Depression

b)

Anger and rage

c)

Bargaining and developing awareness

d)

Denial and isolation

7.

The nurse is caring for a terminally ill client who has a "DNI" order on the chart. The nurse notes equipment at the bedside to assist in caring for the client. Which equipment, if noted, would alert the nurse to verify the order and speak to a supervisor?

a)

A night light

b)

Mineral oils and swabs

c)

A tube for feeding

d)

An intubation tube

8.

The nurse is working with a client who is in end-of-life care. The nurse is primarily providing the client with palliative care. Which is an example of palliative care?

a)

Assisting in a surgery to remove a cancerous tumor from the client's brain

b)

Administering chemotherapy to the client to attack and destroy cancer cells

c)

Administering an antibiotic to the client to fight a bacterial infection

d)

Applying mineral oil to the client's lips the prevent them from cracking

9.

A client who is dying is breathing in a fast, labored, and deep manner. The nurse recognizes this breathing pattern as:

a)

Cheyne-Stokes respiration

b)

Apnea

c)

Kussmaul breathing

d)

Hyperpnea

10.

How can a nurse help a client achieve higher-level needs in Maslow hierarchy?

a)

Assist the client in walking down the hall

b)

Keep the client's eyes clean and moist

c)

Encourage the client to make a scrapbook of her life

d)

Administer pain medication to the client

11.

The nurse is caring for a dying client. What is the priority nursing action during the care of this client?

a)

Offer fluids every hour

b)

Alleviate anxiety

c)

Turn the client every 2 hours

d)

Maintain a patent airway

12.

The nurse is caring for a client determined to be approaching death. What signs observed by the nurse would indicate this? Select all that apply.

a)

Increase in thirst and hunger

b)

Increased alertness and awareness

c)

Difficult to arouse

d)

Extremities feel colder to the touch

e)

Loss of bowel/bladder control

13.

The nurse is implementing a plan of care for a dying client. What nursing action can assist the client in maintaining dignity?

a)

Apply restraints when the client becomes confused

b)

Allow the client to do as much as possible

c)

Give pain medication even when the client rejects it

d)

Restrict visitors to immediate family only

14.

The nurse observes a family member of a dying client crying by the client’s bedside. What is the appropriate response by the nurse?

a)

"Don't cry, you are going to upset the client."

b)

"The client can't hear you anyway."

c)

"Is there anything that I can do to help."

d)

"You should expect this, the client has been ill for a long time."

15.

A client has a terminal diagnosis and wants to be specific about what treatment and care is rendered when unable to make those decisions. What should the nurse encourage the client to obtain?

a)

A general will

b)

Advance Directives (AD)

c)

Durable Power of Attorney (DPOA)

d)

Do not resuscitate (DNR)

16.

Irreversible cessation of total brain function is termed brain death or (a)   death

17.

Careful positioning of the dying client is vital to maintain a client (a)  

18.

(a)   care emphasizes nursing care and medical treatments that relieve or reduce symptoms of a disease or illness

19.

(a)   death occurs when both respiration and heartbeat stop

20.

(a)   breathing often occurs if a person experiences acidosis

21.

"I promise to be a better person if only..."

(a)  

22.

"I don't care anymore."

(a)  

23.

"Why is this happening to me?"

(a)  

24.

"This isn't happening to me!"

(a)  

25.

Select the correct sequence that needs to occur during the last stage of life.

1. The client's sense of hearing is slowly lost

2. The client experiences sweating

3. The client's extremities feel colder to the touch

4. The client's sense of touch is gradually diminished

a)

2341

b)

1234

c)

4321

d)

2314

26.

An expression of the client's wishes about the kinds of treatment and care that he or she wants to receive if terminally ill or unable to make decisions about healthcare. Some common types are the living will and durable power of attorney for healthcare.

(a)  

27.

A 60-year-old client with human immunodeficiency virus (HIV) infection and a severe respiratory infection dies at the healthcare facility. Which nursing procedure must the nurse perform for the postmortem care of the client's body?

a)

Put on a pair of gloves before handling the client's body

b)

Avoid changing the position of the client's body

c)

Dispose of all the cards and flowers in the client's room

d)

Close the client's mouth by placing a rolled towel under the chin

28.

A 95-year-old client diagnosed with intestinal carcinoma is admitted to a healthcare facility with respiratory complications. Which nursing measure would the nurse perform when providing end-of-life care for the client?

a)

Encourage the client to frequently change positions

b)

Apply a full code on the client's chart

c)

Encourage the client to always lie on her back

d)

Convince the client's family members to agree to organ donation

29.

A 55-year-old client was admitted to the healthcare center for cardiac bypass surgery. Before undergoing the surgery, the client had prepared an advance directive expressing his wish to donate his eyes in case of his death. The client died before the surgery. Which should the nurse keep in mind when caring for the client's body?

a)

Harvest the eyes as soon as possible, based on the client's directive

b)

Avoid placing heat or cold over the client's eyes

c)

Avoid discussing the organ donation with the client's family members

d)

Obtain legal permission from the client's next of kin

30.

A nurse is caring for an 80-year-old client who is in the stages of dying. The client asks the nurse, "Why is this happening to me?" Which stage of dying is the client going through?

a)

Denial

b)

Anger

c)

Depression

d)

Detachment

31.

An elderly client is admitted to the healthcare facility after a heart attack. The client tells the attending nurse that she wants to designate her eldest son to make the healthcare decisions if she becomes incompetent to do so. Which advance directive is the client requesting?

a)

e-Health Key

b)

Advance living will

c)

Power of attorney

d)

Code blue

32.

An 85-year-old client involved in a major motor vehicle accident is brought to the healthcare facility in a comatose state with severe blood loss and multiple injuries to his head. Brain death is diagnosed, and the client is being sustained on a ventilator. There is a disagreement among the family of the client about the further course of action. Which individual organization must make the decisions in such a situation?

a)

Client's next of kin

b)

Attending nurse

c)

Ethics committee

d)

Client himself

33.

A nurse approaches the family of a 45-year-old male client after his death at the healthcare facility with the option of donation his kidneys to another client in the same facility. Which must the nurse ensure during this procedure?

a)

Request the head nurse to assist the family in decision making

b)

Talk the client's relatives in private regarding the organ donation

c)

Try to convince the family members to agree to the kidney donation

d)

Place the client's body in an open casket until permission is obtained

34.

A 35-year-old client is rushed to the emergency unit of a healthcare facility after a motor vehicle accident. The client is not responding to sound and is lying still. Which sign must the nurse use to confirm the brain death of the client?

a)

Lack of activity in the EEG

b)

Cessation of breathing

c)

Complete absence of pulse

d)

Complete unresponsiveness to stimulus

35.

A 45-year-old client with human immunodeficiency virus (HIV) infection is admitted to the healthcare facility with severe respiratory infection. The client is in a semiconscious state, and her vital signs are gradually decreasing. Which must the nurse do for the family members of the dying client?

a)

Restrict them from crying in front of the client

b)

Tell them that the client is too weak to hear what they say

c)

Explain to them the physical and emotional stages of dying

d)

Restrict them from offering any fluids to the client

36.

A 45-year-old client who has liver carcinoma with extensive metastases to other parts of the body was admitted to a healthcare facility. The client was put on the ventilator. He was found to be unresponsive and was declared dead after examination. The client is survived by his wife. Which of the following decisions can the client's wife make? Select all that apply.

a)

Performance of an autopsy

b)

Donation of organs and tissues

c)

Details of death certificate

d)

Choice of funeral home

e)

Switching off the ventilator

37.

AD

(a)  

38.

DNH

(a)  

39.

DNI

(a)  

40.

DNR

(a)  

41.

PSDA

(a)  

42.

TPN

(a)  

43.

Anti-vomiting medication of substance

(a)  

44.

Examination of the body after death; postmortem

(a)  

45.

The irreversible loss of all measurable functions or activity of the brain including the brain stem. Three main criteria apply: coma, absence of brainstem reflexes, and apnea. This definition excludes comatose clients and clients in a persistent vegetative state

(a)  

46.

Breathing characterized by deep breathing alternating with very slow breathing or apnea; indicative of brain damage; often precedes death

(a)  

47.

A facility or program of care that is specifically designed to provide emotional and physical support to end-of-life clients and their families

(a)  

48.

Severe paroxysmal dyspnea, as in diabetic acidosis and coma

(a)  

49.

Measures that give relief, but are not curative (as chemotherapy is palliative for some types of advanced cancer). The goal is comfort and pain control.

(a)  

50.

Examination after death (autopsy)

(a)  

51.

Care provided for long-term or chronic clients so family members can have some time off or away

(a)  

52.

"This isn't happening to me!"

a)

Depression

b)

Detachment

c)

Denial and isolation

d)

Anger and rage

53.

"Why is this happening to me?"

a)

Anger and rage

b)

Depression

c)

Acceptance and peace

d)

Bargaining and developing awareness

54.

"I don't care anymore."

a)

Denial and isolation

b)

Acceptance and peace

c)

Detachment

d)

Depression

55.

"I promise I will be a better person if only..."

a)

Denial and isolation

b)

Bargaining and developing awareness

c)

Anger and rage

d)

Detachment

56.

"I'm ready for whatever happens."

a)

Detachment

b)

Anger and rage

c)

Depression

d)

Acceptance and peace

57.

Withdrawal from life

a)

Bargaining and developing awareness

b)

Anger and rage

c)

Denial and isolation

d)

Detachment

58.

An expression of the client's wishes about the kinds of treatment and care that he or she wants to receive if terminally ill or unable to make decisions about healthcare

a)

Advance directive

b)

Living will

c)

Durable power of attorney

d)

E-Health Key

59.

Types of treatment (receive or not)

a)

Advance directive

b)

Living will

c)

Durable power of attorney

d)

E-Health Key

60.

Designates a person to make healthcare choices

a)

Advance directive

b)

Living will

c)

Durable power of attorney

d)

E-Health Key

61.

Electronic form, can be carried on a key chain

a)

Advance directive

b)

Living will

c)

Durable power of attorney

d)

E-Health Key

62.

_____ _____ stated that most people pass through certain stages at the end of their lives

(a)  

63.

Healthcare facilities that receive federal funds must ask about _____ ____ upon admission

(a)  

64.

The Patient Self-Determination Act was passed in

(a)  

65.

CPR team is to be called in the event of cardiopulmonary arrest

(a)  

66.

-Assists in making difficult client care decisions

-May become involved in situations involving donation of organs or tissues for transplantations

-May also discuss types of medications to be used for symptom control

(a)  

67.

True or false. Nurses will speak to family members regarding organ donation.

a)

True

b)

False

68.

A place or plan of care designed to assist the end-of-life client and family

a)

Hospice

b)

Palliative

c)

Respite

69.

Aids clients to work through care as comfortably as possible

a)

Hospice

b)

Palliative

c)

Respite

70.

Time away

a)

Hospice

b)

Palliative

c)

Respite

71.

To enter a hospice program, a client must be certified by a medical professional and their life will typically not exceed _____

a)

3 months

b)

4 weeks

c)

14 days

d)

6 months

72.

Rule of Threes:

A person can live 3 (a)   without oxygen

73.

Rule of Threes:

A person can live 3 (a)   without warmth

74.

Rule of Threes:

A person can live 3 (a)   without water

75.

Rule of Threes:

A person can live 3 (a)   without food

76.

Absence of breathing

(a)  

77.

Rapid breathing

(a)  

78.

(Acidosis) breathing is fast, >20 per/min, labored and deep

(a)  

79.

Alternating periods of apnea and hyperpnea as death approaches

(a)  

80.

Which of the following would be best for the dying client in order to promote hydration?

a)

Clear, warm liquids

b)

Clear, cold liquids

81.

Reglan, Tigan, Zofran, Compazine, Marinol - a derivative of THC, also stimulates appetite

a)

antianxieties

b)

antiemetics

c)

hypnotics

d)

analgesics

82.

True or false. Milk is contraindicated in dying clients as it tends to form mucus, making it harder to breathe.

a)

True

b)

False

83.

Cannot control bowel and/or bladder function

(a)  

84.

Unable to void

(a)  

85.

Cessation of all physical and chemical processes

(a)  

86.

Respiration and heartbeat both stop

(a)  

87.

Irreversible cessation of heart and lung functioning

(a)  

88.

Irreversible cessation of total brain function, including the brain stem, as determined by clinical examination

(a)  

89.

When a client with cancer does not respond to medical treatment any longer and a restorative cure is unrealistic, which nursing action is most helpful initially to a client dealing with a terminal condition?

a)

Allow the client privacy to think alone

b)

Let the client talk about how they are feeling

c)

Provide the client with literature on death and dying

d)

Suggest that the client get a second medical opinion

90.

Arrange the following reactions to terminal illness in the sequence they are most likely to occur.

1. Bargaining

2. Depression

3. Anger

4. Acceptance

5. Denial

a)

51324

b)

53142

c)

51234

d)

53124

91.

The family of a terminal client who has chosen to die at home with hospice care asks the nurse how they will know when death is near. Which of the following is correct information? Select all that apply.

a)

The client's respirations may sound noisy

b)

The client's pain will increase

c)

The client's skin may appear mottled

d)

The client's extremities will feel warm

e)

The client's breathing will be irregular or stop temporarily

92.

Which of the following interventions is best for the nurse to perform when drooling occurs in a dying client?

a)

Help the client sit upright in a chair

b)

Move the client from sitting to supine

c)

Elevate and turn the client's head to the side

d)

Place the client in a Fowler's position