Developmental Stages - End-of-Life Care

The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 
1. Discourage reminiscing. 
2. Make the decisions for the family. 
3. Encourage expression of feelings, concerns, and fears. 
4. Explain everything that is happening to all family members. 
5. Touch and hold the client's or family member's hand if appropriate. 
6. Be honest and let the client and family know that they will not be abandoned by the nurse.

The nurse recognizes that which intervention is unlikely to facilitate effective communication between a dying client and family? 
1. The nurse encourages the client and family to identify and discuss feelings openly. 
2. The nurse assists the client and family in carrying out spiritually meaningful practices. 
3. The nurse makes decisions for the client and family to relieve them of unnecessary demands. 
4. The nurse maintains a calm attitude and one of acceptance when the family or client expresses anger.

A client with terminal cancer arrives at the emergency department dead on arrival (DOA). After an autopsy is prescribed, the client's family requests no autopsy be performed. Which response to the family is most appropriate? 
1. "The decision is made by the medical examiner." 
2. "An autopsy is mandatory for any client who is DOA." 
3. "I will contact the medical examiner regarding your request." 
4. "It is required by federal law. Tell me why you don't want the autopsy done?"

The community health nurse is providing an educational session to a group of community members at a local high school regarding the issue of organ donation. A member of the group asks the nurse, "How old does someone have to be to provide consent for organ donation?" Which response should the nurse make? 
1. "Written consent is never required to become a donor." 
2. "A donor must be 18 years of age or older to provide consent." 
3. "A person can sign papers to become a donor at 16 years of age." 
4. "The family is responsible for decision making about organ donation at the time of death."

The nurse is caring for a client with terminal cancer who is close to death. On reviewing the plan of care, the nurse determines that which intervention is the priority? 
1. Keep the client well sedated so that the client is totally unaware of what is actually happening. 
2. Make sure the family has privacy and is kept informed of what is happening at all times. 
3. Maintain the client's dignity and self-esteem, and make the client as comfortable as possible. 
4. Carry out the health care provider's prescriptions so that all prescribed treatments are done on time.

A client brought to the emergency department is dead on arrival (DOA). The family of the client tells the health care provider (HCP) that the client had terminal cancer. The emergency department HCP examines the client and asks the nurse to contact the medical examiner regarding an autopsy. Family members of the client tell the nurse that they do not want an autopsy performed. Which response to the family is appropriate? 
1. "The decision is made by the medical examiner." 
2. "An autopsy is mandatory for any client who is DOA." 
3. "I will contact the medical examiner regarding your request." 
4. "It is required by federal law. Why don't we talk about it, and why don't you tell me why you don't want the autopsy done?"

The nurse is caring for a client with cancer. The client tells the nurse that a lawyer will be arriving today to prepare a living will and asks the nurse to act as one of the witnesses for the will. What is the most appropriate nursing action? 
1. Agree to act as a witness. 
2. Call the health care provider (HCP). 
3. Ask another nurse to serve as a witness. 
4. Ask the client who might be available to serve as a witness.

The nurse is monitoring ongoing care for a potential organ donor who has been diagnosed with brain death. Which finding indicates to the nurse that the standard for ongoing care has been maintained? 
1. PaO2 at 78 mm Hg 
2. Urine output 100 mL/hr 
3. Heart rate at 58 beats/min 
4. Blood pressure 90/48 mm Hg

A client who suffered a severe head injury has had vigorous treatment to control cerebral edema. Brain death has been determined. The nurse prepares to carry out which measure to maintain viability of the kidneys before organ donation? 
1. Assessing lung sounds 
2. Monitoring temperature 
3. Administering intravenous (IV) fluids 
4. Performing range-of-motion exercises to the extremities

Which interventions should the nurse take for a deceased client whose eyes will be donated? Select all that apply. 
1. Close the client's eyes. 
2. Elevate the head of the bed. 
3. Place a warm compress on the eyes. 
4. Place a dry sterile dressing over the eyes. 
5. Place wet saline gauze pads and a cool pack on the eyes.

The nurse is preparing a plan of care for a client who just delivered a dead fetus. Which initial action should the nurse include in the client's plan of care to meet the emotional needs of the client and spouse? 
1. Allow family members to name the infant. 
2. Encourage the client to talk about the dead fetus. 
3. Allow the client and the spouse to hold the infant. 
4. Assess the client's and the spouse's perception of the event.

The nurse is caring for a client who is dying. The nurse recognizes that which intervention is unlikely to facilitate therapeutic communication between the dying client and his or her family? 
1. The nurse encourages the client and family to identify and discuss feelings openly. 
2. The nurse assists the client and family in carrying out spiritually meaningful practices. 
3. The nurse makes decisions for the client and family to relieve them of unnecessary demands. 
4. The nurse maintains a calm attitude and one of acceptance when the family or client expresses anger.

The nurse caring for a terminally ill client has developed a close relationship with the client's family. Which interventions should the nurse include in dealing with the family during this difficult time?Select all that apply. 
1. Making decisions for the family 
2. Encouraging family discussion of feelings 
3. Accepting the family's expressions of anger 
4. Preserving the family's sense of self-direction and control 
5. Maintaining open communication among family members 
6. Facilitating the use of spiritual practices identified by the family

The hospice nurse visits a client who is dying of ovarian cancer. During the visit, the client says, "If I can just live long enough to celebrate my daughter's ‘sweet 16' birthday party, I'll be ready to die." Which phase of coping is this client experiencing? 
1. Anger 
2. Denial 
3. Bargaining 
4. Depression

The nurse is caring for a terminally ill child who is receiving palliative care. When explaining the purpose of palliative care to the child's caregiver, the nurse recognizes the need for additional instruction when the caregiver makes which statement? 
1. "Palliative care interventions hasten death." 
2. "Palliative care promotes optimal functioning." 
3. "Palliative care will provide pain management." 
4. "Palliative care will provide symptom management."

The nurse is caring for a terminally ill adolescent client. When caring for this client the nurse should implement which intervention? 
1. Comply with the client's wishes at all times. 
2. Encourage the client to be dependent on hospital staff. 
3. Refuse to answer questions related to impending death. 
4. Encourage the client to maintain maximum self-control.

The nurse is caring for a terminally ill toddler. When interacting with the toddler's parents, the nurse should implement which interventions? Select all that apply. 
1. Retain ritualism. 
2. Avoid significant changes in lifestyle. 
3. Maintain sensitivity toward the parents. 
4. Encourage the parents to be near the child. 
5. Encourage as normal an environment as possible. 
6. Discourage the parents from dealing with their feelings.

The nurse monitors a terminally ill client for which physical signs of approaching death? Select all that apply. 
1. Increased appetite 
2. Loss of consciousness 
3. Loss of bowel control 
4. Loss of bladder control 
5. Decreased blood pressure 
6. Decreased tactile sensation

A terminally ill client asks the nurse about hospice. The nurse plans a response, knowing that a qualification for hospice care is that the health care provider must certify that the client has how much longer to live? 
1. Six months or less 
2. Nine months or less 
3. Twelve months or less 
4. Eighteen months or less

The nurse is caring for a client who is terminally ill. When assessing the client, the nurse recognizes which as the most common distress symptom near the end of life? 
1. Pain 
2. Anxiety 
3. Depression 
4. Withdrawal

The nurse is caring for a dehydrated client who is terminally ill. When caring for this client the nurse should take which action? 
1. Force the client to eat. 
2. Force the client to drink. 
3. Use moist cloths and swabs for mouth comfort. 
4. Provide the unconscious client with ice chips.

The nurse is caring for a terminally ill client who is experiencing delirium. When caring for this client, the nurse should take which action? 
1. Provide a dark room. 
2. Provide a well-lighted room. 
3. Reorient the client every 8 hours only. 
4. Withhold benzodiazepines and sedatives.

The nurse is caring for a terminally ill client who is experiencing dyspnea. When caring for this client, the nurse should place the client in which position? 
1. Prone 
2. Supine 
3. Lateral 
4. Trendelenburg's

The nurse is caring for a terminally ill client who is unresponsive to verbal stimuli. The client's spouse asks if her husband can still hear her. Which is the best response by the nurse? 
1. "Why do you want to know that?" 
2. "I don't know the answer to your question." 
3. "Assume that your husband can still hear you." 
4. "Your husband is unresponsive. He can't hear you anymore."

The nurse is caring for a terminally ill client who is experiencing Cheyne-Stokes respirations. Whichbest describes Cheyne-Stokes respirations? 
1. Continuous rapid regular breathing 
2. Periods of apnea followed by bradypnea 
3. Periods of apnea followed by deep rapid breathing 
4. Periods of bradypnea followed by periods of tachypnea

The nurse is caring for a Hindu client who has just died. The nurse demonstrates cultural awareness when providing postmortem care by taking which action? 
1. Washing the body after death 
2. Removing sacred threads from the body 
3. Prohibiting family members from viewing the body 
4. Instructing the unlicensed assistive personnel (UAP) to not wash the body

The nurse is caring for a dying client who adheres to Judaism. The nurse demonstrates cultural sensitivity when caring for this client by taking which action? 
1. Encouraging a rabbi to sit with the client 
2. Encouraging the client to have time alone 
3. Asking the family if they would like an autopsy done 
4. Encouraging family to agree to removal of life support

A client has an advance directive form and needs it to be signed, and asks the nurse to sign it as a witness. What is the nurse's best action? 
1. Sign the form as requested. 
2. Request the client's son to sign as a witness. 
3. Ask a nonmedical client, such as a social worker, to witness the form. 
4. Ask another nurse who is not assigned to the client to witness the form.

The spouse of a terminally ill client steps out of his room in tears. The spouse tells the nurse, "I don't know what I'm going to do when he's gone!" What is the nurse's best response? 
1. "This must be very hard for you." 
2. "Don't worry, things will be fine." 
3. "I know. It will get easier with time." 
4. "You need to be strong for him! Don't cry."

A nurse is supervising the postmortem care of a client. Which action by the unlicensed assistive personnel (UAP) performing the care is appropriate? 
1. Keeps the client's body in a flat, supine position 
2. Closes the client's eyes by taping the eyelids shut 
3. Elevates the head of the bed 30 degrees as soon as possible after death 
4. Removes the client's dentures and places them in a denture cup with the client's name on the lid

A hospice nurse is visiting a client in the client's home. The client has had several episodes of dyspnea, and there is a prescription for morphine elixir. The client's wife states, "I don't understand why he needs morphine. He tells me he's not in pain." What should the nurse include in the explanation of the purpose of the morphine? 
1. It reduces the secretions in the bronchi. 
2. It causes dilation of the bronchial smooth muscles. 
3. It relieves pain, which helps to reduce the dyspnea. 
4. It helps to reduce anxiety and oxygen consumption.

During morning rounds a nurse comes into the room of a client who is unresponsive and near death. Two unlicensed assistive personnel (UAP) are bathing the client, and their conversation is centering on their plans for a weekend party. How should the nurse intervene best? 
1. Say nothing but check the client's vital signs and level of consciousness. 
2. Tell the UAPs, "You need to be focusing on the client right now, not your party." 
3. Remind the UAPs, "Remember that Mr. Smith can hear everything you are saying!" 
4. Speak to the client and touch his hand, saying, "Hello, Mr. Smith, we will be finished with your bath shortly."

The nurse is caring for a client who has a medical diagnosis of end-stage chronic obstructive pulmonary disease (COPD). The client is in severe respiratory distress and tells the nurse, "Put me on the machine." The client's family says, "No, we are not going to do this again." The client has a do-not-resuscitate (DNR) order. What is the nurse's priority action? 
1. Prepare the client for intubation and mechanical ventilation. 
2. Talk to the family about the client's right to change his mind. 
3. Administer an anti-anxiety medication to the client to ease his breathing. 
4. Notify the health care provider that the client is rescinding the DNR order.

The mother of 6-year-old twins says to the nurse, "My mother-in-law doesn't think our children should come to the funeral service for their grandfather. What do you advise?" The nurse most appropriately responds by making which statement? 
1. "What do you and your husband believe is the right thing for your children?" 
2. "By all means have them attend. Not to do so would promote postmortem grief." 
3. "It's a difficult decision, but given their young age, perhaps omitting the wake and just including the funeral would be best." 
4. "I agree with your mother-in-law. Your mother-in-law is upset enough as it is. Tell your children that their grandfather is in heaven."

The nurse is caring for a terminally ill client. The nurse has developed a close relationship with the family of the client. Which intervention should the nurse avoid? 
1. Making decisions for the family 
2. Encouraging family discussion of feelings 
3. Accepting the family's expressions of anger 
4. Allowing spiritual practices identified by the family

While a nurse is caring for a client with severe cardiac disease, the client states, "If anything should happen to me, please make sure that the doctors do not try to push on my chest and revive me." Which nursing action is most appropriate? 
1. Notify the health care provider of the client's request. 
2. Tell the client that the family must agree with this decision. 
3. Consult with ethics committee to assist the client and family. 
4. Plan a nursing staff conference to discuss the client's statement.

A client brought to the emergency department is dead on arrival (DOA). The emergency department health care provider examines the client and asks the nurse to contact the medical examiner regarding an autopsy. The family of the client tells the nurse that they do not want an autopsy performed. Which response by the nurse is most appropriate? 
1. "The decision is made by the medical examiner." 
2. "An autopsy is mandatory for any client who is DOA." 
3. "It is required by federal law to receive a death certificate." 
4. "I will contact the medical examiner regarding your request."