Chapter 16: Palliative Care Nursing School Test Banks

MULTIPLE CHOICE

1. The patient has a history of terminal cancer but is being admitted for treatment of a pressure ulcer. The patients wife has been caring for him at home and refuses to discuss admission to a nursing home. The wife looks extremely tired and is near the point of exhaustion. What could the nurse suggest?

a.

A consult for hospice care

b.

Continuing with the plan of care as is

c.

That the doctor order the patient into a nursing home

d.

That the wife stay away while the patient is hospitalized

ANS: A

Hospice benefits include respite for family caregivers. The current plan of care may be the reason for the decubiti and may lead to the patients wifes becoming ill. Palliative and hospice care place a primary focus on the patients values, quality of life, and care preferences.

DIF: Cognitive Level: Application REF: Text reference: p. 375

OBJ: Describe hospice care. TOP: Respite Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

2. The patient is being admitted to the hospital for injuries received when a hurricane destroyed her home. She is upset from the loss of her home and possessions. What type of loss is this considered?

a.

Necessary loss

b.

Maturational loss

c.

Situational loss

d.

Perceived loss

ANS: C

Situational losses include loss from sudden, unpredictable external events such as a hurricane that destroys ones home or city. Necessary losses, such as leaving friends after high school graduation, are a natural part of life. Such losses usually are replaced by something different or better. Some necessary losses are more difficult and never seem acceptable, such as the loss of a loved one through death. Life goes on, but replacements for these losses do not appear. Maturational losses include changes that occur as a part of normal life development. For instance, a parent feels loss when a child marries and moves away from home. Perceived losses are interpreted uniquely by the individual and often are not obvious to others. For example, one person perceives failure to get into a preferred college as a loss of all opportunity, while another person views the same experience as a relief.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 378

OBJ: Discuss principles of palliative care. TOP: Loss

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. The nurse recognizes that anticipatory grieving can be most beneficial for a patient or family because it can:

a.

be done in a private setting.

b.

be discussed with other individuals.

c.

promote separation of the ill patient from the family.

d.

allow time for the process of grief.

ANS: D

The benefit of anticipatory grief is that it allows for a gradual disengagement from the loss. Anticipatory grief may help people move through the stages of grief, allowing time to grieve in private, to discuss the anticipated loss with others, and then to let go of the loved one.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 378

OBJ: Identify the nurses role in assisting patients and families in grief and at the end of life.

TOP: Grief KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

4. The nurse is preparing to assist the patient at the end stage of her life. To provide comfort for the patient in response to anticipated symptom development, the nurse plans to:

a.

decrease the patients fluid intake.

b.

limit the use of pain medication.

c.

provide larger meals with more seasoning.

d.

determine patient wishes and select appropriate therapies.

ANS: D

Have the patient identify what she wants to accomplish, and use strategies to conserve energy for meeting those goals. This provides the patient with a sense of well-being and purpose to meet important personal goals. Decreasing the patients fluid intake may make the terminally ill patient more prone to dehydration and constipation. The nurse should take measures to help maintain oral intake, such as administering antiemetics, applying topical analgesics to oral lesions, and offering ice chips. The use of analgesics should not be limited. Controlling the terminally ill patients level of pain is a primary concern in promoting comfort. Nausea, vomiting, and anorexia may increase the terminally ill patients likelihood of inadequate nutrition. The nurse should serve smaller portions and bland foods, which may be more palatable.

DIF: Cognitive Level: Analysis

REF: Text reference: p. 373|Text reference: p. 376|Text reference: pp. 383-384

OBJ: Identify the nurses role in assisting patients and families in grief and at the end of life.

TOP: Caring for the Dying Patient KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

5. A nurse-initiated or independent activity for promotion of respiratory function in a terminally ill patient is to:

a.

limit PO fluid intake.

b.

position the patient in semi-Fowlers or Fowlers position.

c.

reduce narcotic analgesic use.

d.

administer bronchodilators.

ANS: B

Position the patient in semi-Fowlers or Fowlers position. This promotes maximal ventilation, lung expansion, and drainage of secretions. Limiting fluids may not promote respiratory function, and unless a patient is on a fluid-restricted diet, the nurse should not do so. Reducing narcotic analgesic use is not a nurse-initiated activity to promote respiratory function. Respiratory rate should be assessed before narcotics are administered, to prevent further respiratory depression. Management of air hunger involves judicious administration of morphine and anxiolytics for relief of respiratory distress. The administration of bronchodilators would require a physicians order. It is not an independent nursing activity.

DIF: Cognitive Level: Application REF: Text reference: p. 383

OBJ: Identify the nurses role in assisting patients and families in grief and at the end of life.

TOP: Caring for the Dying Patient KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6. When caring for a patient who is an appropriate candidate for organ or tissue donation, the nurse knows that requests for donation are:

a.

required by state law.

b.

the total responsibility of the survivors.

c.

a possible inclusion in the advance directive.

d.

made only by the physician.

ANS: C

A patients choice regarding organ and tissue donation can be included in an advance directive. The 1986 Omnibus Budget Reconciliation Act (OBRA) requires that a patients significant others be offered the option of organ and tissue donation; however, organ donation is voluntary. It is important for persons to keep family members informed of their wishes regarding organ donation. Because of the sensitive nature of making requests for organ donation, professionals educated in organ procurement often assume that responsibility. They inform family members of their options for donation, provide information about costs (no cost to the family), and inform the family that donation does not delay funeral arrangements.

DIF: Cognitive Level: Application REF: Text reference: p. 385

OBJ: Discuss the nurses role in facilitating autopsy and organ and tissue donation requests.

TOP: Organ Donation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7. The patient is on a ventilator and has a heartbeat but has been declared brain dead. The family has agreed to organ donation. The nurse realizes that which of the following organ donations would require that the patient be left on life support?

a.

Eyes

b.

Bone

c.

Kidney

d.

Skin

ANS: C

In the case of vital organ donation (e.g., heart, lungs, liver, pancreas, kidneys), the patient must remain on life support until the organs are removed surgically. Tissues such as eyes, bone, and skin are commonly retrieved from deceased patients who are not on life support.

DIF: Cognitive Level: Application REF: Text reference: p. 385

OBJ: Discuss the nurses role in facilitating autopsy and organ and tissue donation requests.

TOP: Organ Donation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

8. An appropriate technique for the nurse to implement when caring for a patients body after death is to:

a.

remove the patients ID band and put a new gown on the patient.

b.

cover the patient with a sheet and transfer him or her to the morgue.

c.

inquire about particular cultural or spiritual practices.

d.

remove tubes and lines if the patient is to be autopsied.

ANS: C

Respect the individuality of the patient and family and support their right to have cultural or religious values and beliefs upheld. Identify and tag the body, leaving identification on the body as directed by agency policy to ensure proper identification of the body for delivery to the morgue or mortuary. After viewing, remove linens and gown, per agency policy. Place the body in a shroud provided by the agency. The shroud protects from injury to the skin, avoids exposure of the body, and provides a barrier against potentially contaminated body fluids. Removal of tubes and lines is contraindicated if an autopsy is planned.

DIF: Cognitive Level: Application REF: Text reference: pp. 385-386

OBJ: Describe postmortem care. TOP: Postmortem Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. After the death of a patient and before other nursing interventions are implemented, the nurse should:

a.

place the patient in a supine position and elevate the head of the bed 30 degrees.

b.

wait an hour to prepare the patient for viewing.

c.

place the patient in a side-lying position to allow drainage.

d.

exclude the family while the body is being prepared.

ANS: A

Immediately after death and before other activities are begun, place the body in supine position, and elevate the head of the bed 30 degrees to decrease rigor mortis. Ask family members if they have requests for preparation or viewing of the body (such as position of the body, special clothing, shaving). Determine whether they wish to be present or assist with care of the body. This provides closure for those who wish to assist with body preparation.

DIF: Cognitive Level: Application REF: Text reference: pp. 385-386

OBJ: Describe postmortem care. TOP: Postmortem Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. Before allowing the family of a deceased patient to view the body, the nurse should:

a.

insert the patients dentures.

b.

lower the head of the bed.

c.

fold the arms and hands over the chest.

d.

leave all of the old dressings and tape in place.

ANS: A

If the person wore dentures, reinsert them. If the mouth fails to close, and if it is culturally appropriate to close the mouth, place a rolled-up towel under the chin. Dentures maintain the patients natural facial expression. Place a small pillow or a folded towel under the head. This prevents pooling of blood in the face and subsequent discoloration. Avoid placing one hand on top of the other. Placing one hand on top of the other can lead to discoloration of the skin. Remove soiled dressings and replace with clean gauze dressings. Use paper tape. Paper tape minimizes skin trauma. Changing dressings helps to control odors caused by microorganisms and creates a more acceptable appearance.

DIF: Cognitive Level: Application REF: Text reference: p. 387

OBJ: Describe postmortem care. TOP: Postmortem Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

11. A new staff member is working with a patient who is dying. A nurse evaluates that this new employee requires additional teaching when he or she is observed:

a.

limiting the familys visiting hours.

b.

staying with the patient and family as much as possible.

c.

finding a quiet place for family members to gather.

d.

asking the family if they would like to help with preparing the body.

ANS: A

Some cultures require silence at the time of death; others express grief with loud wailing, falling out, or hysteria. Do not rush any grieving process. Give family members and friends a private place to gather. Allow them time to ask questions. This creates a safe environment for the grieving family. Questions provide information about how they are coping with loss and their needs. Ask family members if they have requests for preparation or viewing of the body (such as position of the body, special clothing, or shaving). Determine whether they wish to be present or assist with care of the body. This may provide closure for those who wish to assist with body preparation.

DIF: Cognitive Level: Application REF: Text reference: p. 387

OBJ: Describe postmortem care. TOP: Postmortem Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. The patient was a practicing Hindu when he died. Knowing this, the nurse realizes that:

a.

the body should be covered with a cotton sheet.

b.

anointing of the sick is performed even after death.

c.

family members often prefer to wash the body after death.

d.

the body should be buried within 24 hours.

ANS: C

With Hinduism, family members prefer to wash the body after death and are present to chant, pray, and use incense. In Buddhism, when the person has died, the body should be covered with a cotton sheet. Others should not touch the body, and the mouth and eyes of the deceased are left open. Christians in the Roman Catholic tradition often request sacraments of Penance and Anointing of the Sick and Holy Communion at the end of life. In Orthodox Judaism, a family member remains with the body until burial, which takes place within 24 hours, not on the Sabbath.

DIF: Cognitive Level: Application REF: Text reference: p. 377

OBJ: Describe postmortem care. TOP: Postmortem Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

13. For a patient in the final stages of dying, a nurse expects to:

a.

keep the patients room cool.

b.

avoid catheterizing the patient.

c.

elevate the head of the bed as tolerated.

d.

encourage the patient to eat and drink more.

ANS: C

Poor circulation of body fluids, immobilization, and inability to expectorate secretions cause rattles and bubbling. Elevate the head with a pillow or raise the head of the bed; gently turn the head to the side to drain secretions. Coolness, color, and temperature change in the hands, arms, legs, and feet. Place socks on the feet. Cover with a light cotton blanket. Keep warm blankets on the patient. Decreased muscle tone and consciousness may lead to incontinence of urine and/or bowel. Change bedding as appropriate. Use an indwelling catheter for patient comfort. Do not force the patient to eat or drink; give ice chips, soft drinks, or juice, as possible. Provide mouth care.

DIF: Cognitive Level: Application REF: Text reference: p. 383|Text reference: p. 388

OBJ: Identify the nurses role in assisting patients and families in grief and at the end of life.

TOP: Physical Signs and Symptoms in the Final Stages of Dying

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Hospice care can be provided in which of the following settings? (Select all that apply.)

a.

Home

b.

Free-standing hospice facilities

c.

Extended care facilities

d.

Acute care facilities

ANS: A, B, C, D

Because hospice is a philosophy of care, not necessarily a place, the services are sometimes provided at home, in free-standing hospice facilities, or in nursing home, extended care, or acute care settings.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 375

OBJ: Describe hospice care. TOP: Hospice

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. Hospice benefits include which of the following? (Select all that apply.)

a.

Respite for family caregivers

b.

Hospitalization for acute symptom management

c.

Emotional and psychological support

d.

Financial assistance and funeral arrangement

ANS: A, B, C

Hospice benefits include respite for family caregivers, limited hospitalization for acute symptom management, and bereavement care after death. Hospice does not provide financial assistance or funeral arrangements.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 375

OBJ: Describe hospice care. TOP: Hospice

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

COMPLETION

1. The World Health Organization (2002) defines ___________ as an approach that improves the quality of life of individuals and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychological, and spiritual problems.

ANS:

palliative care

The World Health Organization (2002) defines palliative care as an approach that improves the quality of life of individuals and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychological, and spiritual problems.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 375

OBJ: Discuss principles of palliative care. TOP: Palliative Care

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. _____________ helps people live as well as possible through the dying process.

ANS:

Hospice

Hospice, an interdisciplinary, patient- and family-centered program of total palliative care, helps people live as well as possible through the dying process.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 375

OBJ: Describe hospice care. TOP: Hospice

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. ___________________ specify medical interventions that the patient does not want in certain situations, such as mechanical ventilation, and are used to communicate the care a patient wants, for example, pain relief to the fullest extent possible.

ANS:

Advance directives

In an advance directive, patients indicate in writing the types of treatments that are acceptable or unacceptable to them, describe their life values, or designate a person to speak for them as their durable power of attorney (DPOA) for health care decisions. Advance directives specify medical interventions that the patient does not want in certain situations, such as mechanical ventilation, and are used to communicate the care a patient wants, for example, pain relief to the fullest extent possible.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 376

OBJ: Describe hospice care. TOP: Advance Directives

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

4. Nurses provide _______________ that is defined as care of the body after death in a manner consistent with the patients religious and cultural beliefs.

ANS:

postmortem care

Nurses provide postmortem care, care of the body after death, in a manner consistent with the patients religious and cultural beliefs.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 376

OBJ: Describe postmortem care. TOP: Postmortem Care

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

5. A person experiences an actual _________ when an object or a person can no longer be felt, heard, or experienced.

ANS:

loss

A person experiences an actual loss when an object or a person can no longer be felt, heard, or experienced. Examples include the loss of a person, a body part, or a home.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 378

OBJ: Discuss principles of palliative care. TOP: Loss

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

6. The irreversible absence of all brain function is termed ______________.

ANS:

brain death

Family members often need help understanding what brain death, the irreversible absence of all brain function (including the brainstem), means for the person who has died.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 385

OBJ: Discuss the nurses role in facilitating autopsy and organ and tissue donation requests.

TOP: Brain Death KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

7. An _______________ is the surgical dissection of a body after death.

ANS:

autopsy

An autopsy, the surgical dissection of a body after death, helps determine the exact cause and circumstances of a death, discovers the pathway of a disease, or provides data for research purposes.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 385

OBJ: Discuss the nurses role in facilitating autopsy and organ and tissue donation requests.

TOP: Autopsy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

8. The patient was brought into the emergency department with a cardiac arrest after suffering multiple gunshot wounds. The patient did not survive even after multiple attempts at resuscitation. The nurse is preparing the body for transport to the morgue by completing hospital procedures for __________________.

ANS:

autopsy

An autopsy is not performed in every death. State laws determine when autopsies are required, but they usually are performed in circumstances of unusual death (e.g., violent trauma, unattended or unexpected death in the home) and when death occurs within 24 hours of hospital admission.

DIF: Cognitive Level: Application REF: Text reference: p. 385

OBJ: Discuss the nurses role in facilitating autopsy and organ and tissue donation requests.

TOP: Autopsy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

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