Chapter 16 Quiz

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Question #1

When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include?

A Pain must be controlled regardless of the client’s wishes.

B Pain is viewed as a means of cleansing by God.

C Pain is considered a positive aspect that leads to rebirth.

D Pain provides the client with an opportunity for repentance.

Question #2

A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate into the plan?

A Proxy directive

B Health care power of attorney

C Durable power of attorney for health care

D Medical directive

Question #3

Which term best describes a living will?

A Grief

B Bereavement

C Hospice

D Mourning

Question #4

Which term refers to the period of time during which mourning of a loss takes place?

A Living will

B Treatment directive

C Proxy directive

D Standard addendum to a will

Question #5

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?

A Provide gentle oral care after each meal.

B Begin 9% normal saline IV at 125 mL/hr.

C Place two drops of atropine ophthalmic 1% solution sublingually.

D Gently suction the client’s mouth and buccal cavity.

Question #6

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth?

A Radiation

B Angiogenesis

C Palliative care

D Respite care

Question #7

A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival.

A “What makes you most angry about getting the disease?”

B “I like your idea of living for today and enjoying those around you.”

C “Let’s review the laboratory results and compare them with the diagnostic tests.”

D “I understand that it would be wonderful to see your daughter’s graduation.”

Question #8

Which statement, made by the nurse, can be most helpful when caring for a client in the third stage of Kubler-Ross’ emotional reactions to dying?

A Position the client supine.

B Use chest percussion.

C Suction as needed to clear the lungs.

D Administer the prescribed sedative to decrease anxiety.

Question #9

Which of the following is an appropriate intervention for the client with pulmonary edema?

A Provide spiritual books.

B Encourage family members in their frank communication.

C Allow a period of privacy.

D Ask the family members about spiritual care.

Question #10

Which of the following interventions should the nurse perform while providing spiritual care for a dying client?,,

A Breathing that is very rapid

B Decrease in amount of urine produced

C Refusal to ingest food or fluids

D Increase in visual and auditory abilities

E Gurgling as the client breathes through the mouth

Question #11

While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply.

A Open awareness

B Mutual pretense awareness

C Closed awareness

D Suspected awareness

Question #12

Which “awareness context” is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?

A The client doesn’t want to discuss death around his girlfriend.

B The client entered a clinical trial through the National Cancer Institute.

C The client explains that he isn’t ready to complete his will.

D The physician orders weekly blood transfusions to be given at home.

Question #13

A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care?

A Mourning

B Grief

C Spirituality

D Bereavement

Question #14

Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?

A Give pain medications on a routine schedule.

B Explain that narcotics can cause addiction.

C Explain that oxygen will eventually be used.

D Explain that morphine will be avoided because of its sedative effects.

Question #15

Which of the following nursing interventions is appropriate with regard to pain control in the dying client?,,

A Let’s focus on what your doctor has planned.

B This must be very difficult for you.

C You still have time for a good life.

D I know just how you must feel.

E Tell me more about what’s on your mind.

Question #16

While talking with a client who has been diagnosed with a terminal illness, the client asks, ” Am I dying?” Which response from the nurse would be appropriate? Select all that apply.

A The stages are applicable to any loss.

B Most clients reach acceptance by the time of death.

C Each client experiences each of the stages.

D Typically, the stages occur in succession.

Question #17

A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan?

A Faith and belief

B Importance and influence

C Community

D Address in care

Question #18

A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, “What gives your life meaning?” The nurse is assessing which of the following?

A Inpatient respite care

B General inpatient care

C Routine home care

D Continuous care

Question #19

A nurse is providing in-home hospice care to a terminally ill client. The client experiences a medical crisis requiring monitoring and medication administration. Which level of hospice care would the nurse implement?

A Caregiver role strain related to the need for around-the-clock pain control

B Impaired physical mobility related to sedative effects of the drug

C Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug

D Risk for constipation related to the effects of an opioid

Question #20

A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client’s plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify?

A Palliative care is often provided along with disease-lessening treatments.

B Palliative care is conceptually broader than hospice care.

C Palliative care developed after hospice care developed.

D Palliative care is the same as hospice care.

Question #21

A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following?

A 30

B 20

C 40

D 10

Question #22

According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level?

A General inpatient care

B Continuous care

C Inpatient respite care

D Palliative care

Question #23

The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using?,,

A Control the client’s pain with prescribed medication.

B Comfort the client by saying it will all be over soon.

C Recommend that the client consider physician-assisted suicide.

D Encourage the client to explain his or her wishes.

E Advise the client’s health care provider of the client’s condition.

Question #24

A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, “I’m in agony all the time. I want this to be over now—please help me.” Which interventions should the nurse implement? Select all that apply.

A durable power of attorney for health care

B designated signer

C power of attorney

D living will

Question #25

A 90-year-old home care client’s son has been designated to make decisions regarding the client’s medical care when the client is no longer able to do so. As the client nears the end of life, the son is consulted on an ever-increasing basis. What legal instrument activates the son’s decision-making designation?

A Some client regress, then move forward again.

B Clients don’t always follow the stages in order.

C The client may be in several stages at once.

D The dying client usually exhibits anger first.

Question #26

Which of the following does not coincide with Kübler-Ross’s stages related to a dying client?

A Bereavement

B Grief

C Mourning

D Spirituality

Question #27

Which term is used to describe the personal feelings that accompany an anticipated or actual loss?

A End-of-life treatment directive

B Living will declaration

C Durable power of attorney for health care

D Medical directive by proxy

Question #28

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?

A “I hear you say that you are not sleeping well.”

B “Your grandchild is almost here, and you will enjoy seeing him.”

C “Do not worry, I will be here for you to help you with your needs.”

D “I will talk with the health care provider to determine the next step in your care.”

Question #29

The nurse is caring for a client who has diminished lung function due to emphysema. The terminally ill client is short of breath on exertion and reports difficulty sleeping in bed. The client states, “I am so afraid of getting any worse.” Which statement, by the nurse, assists the client in sustaining hope?

A Client’s goals

B Length of required treatment

C Physician’s orders

D Invasiveness of the treatment

Question #30

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client’s symptoms?

A “He has secretions that are collecting at the back of the throat.”

B “He is getting less oxygen to the brain, so the moaning means he is dreaming.”

C “The moaning you hear is from air moving over very relaxed vocal cords.”

D “His moaning does indicate pain, so we’ll increase his pain medication.”

Question #31

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client’s daughter states, “He moans when he breathes. Is he in pain?” Which response by the nurse would be most appropriate?

A “I will notify the physician that the current dose of medication is not relieving your pain.”

B “I can’t do that, I will go to jail.”

C “I am surprised that you would ask me to do something like that.”

D “I will see if the physician will order enough for that to occur.”

Question #32

n asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?

A Respect the client’s and family members’ choices

B Share emotional pain

C Ask the family members about spiritual care

D Abide by the dying client’s wishes

Question #33

A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client?

A Lack of Medicare/Medicaid funding for hospice

B Difficulty obtaining Medicare certification for hospice services

C Lack of fully credentialed and trained hospice nurses

D Clients and families view palliative care as giving up

Question #34

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services?

A Respite care

B Palliative care

C Angiogenesis

D Radiation

Question #35

A “You should seek a second medical opinion about your diagnosis.”

B “I know another client with the same diagnosis who has been in remission for 10 years.”

C “Let’s take this one day at a time; remember you have your daughter’s dance recital next month.”

D “I believe that you will fight hard to beat this and see your babies grow up.”

Question #36

A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client?

A Respect the client’s autonomy and right to determine how to spend the rest of his or her life.

B Persuade the client to follow their family’s preferences for end-of-life care.

C Remind the family that the client needs to focus energy on recovery.

D Ask the family members about coordinating spiritual care for the client.

Question #37

The client has been diagnosed with terminal COPD. The client and the client’s family have not yet agreed on the final arrangements and are discussing options. How can the nurse bestintervene in these final decisions?

A Sit with the client’s daughter privately and encourage her to express her feelings frankly.

B Remind the daughter of the client’s impending death and the importance of expressing herself

C Insist that the daughter try her best to make the client’s final days happy ones.

D Remain focused on the client’s needs and care because these are your main responsibilities.

Question #38

The nurse is providing home care to a dying client and has noticed over the course of several weeks that the client’s daughter is usually quiet and withdrawn when in the client’s room. Which intervention should the nurse perform in this situation?

A Dusky appearance

B Absence of incontinence

C Increased body temperature

D Flushed appearance

Question #39

Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death?

A Advice for the family to have fruit juices readily available at the client’s bedside.

B Arrangements for the client to eat meals while others are out of the home.

C Encouragement of the family to serve the client meat, especially beef.

D Suggestions that the family offer the client foods that are hot.

Question #40

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client’s plan of care?

A Continuous care

B Routine home care

C General inpatient care

D Respite care

Question #41

Which is one level of hospice care covered under Medicare and Medicaid hospice benefits, includes a 5-day inpatient stay, and is provided occasionally to relive the family caregivers?

A Depression

B Denial

C Bargaining

D Anger

Question #42

Which is the initial stage of grief, according to Kübler-Ross?

A Morphine

B Percodan

C Demerol

D Codeine

Question #43

A hospice nurse should be aware that the most effective pain medication used at the end of life that also relieves dyspnea and anxiety is which of the following?

A Position the patient to prevent difficulties with breathing.

B Offer supplemental fluids to prevent dehydration.

C Turn the patient every 2 hours to prevent decubitus ulcers.

D Administer pain medication on a schedule that prevents pain from intensifying.

Question #44

Based on the most common concern of a dying patient, the hospice nurse should:

A “When your stay reaches 6 months, you will be recertified for a continued stay.”

B “You will be able to stay only for approximately 1 month and then you will be discharged.”

C “There is no time limit for your stay. You can stay until you die.”

D “You will be able to stay for 2 months before being discharged.”

Question #45

A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, “How long will I be allowed to stay here?” What is the best response by the nurse?

A Provide gentle oral care after each meal.

B Gently suction the client’s mouth and buccal cavity.

C Place two drops of atropine ophthalmic 1% solution sublingually.

D Begin 9% normal saline IV at 125 mL/hr.

Question #46

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care?

A “A key component of hospice care is following your family for up to a year after your death.”

B “Tell me who or what gives you strength.”

C “Denial, sadness, anger, fear, and anxiety are normal grief reactions.”

D “Mourning may be demonstrated by emotional feelings of sadness, anger, guilt, and numbness.”

Question #47

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation?

A Be a silent observer and allow the client to communicate with the family members.

B Encourage conversations about the impending death of the client.

C Encourage the family members to express their feelings and listen to them in their frank communication.

D Encourage the client’s family members to spend time with the client.

Question #48

A nurse is providing care to a terminally ill client who is experiencing dyspnea. Which of the following would be most appropriate to do to assess the severity of the client’s complaint?

A Auscultate the client’s lung sounds for changes.

B Have the client state if the dyspnea is mild, moderate, or severe.

C Ask the client to rate the dyspnea on a scale of 0 to 10.

D Question the client about when the dyspnea eases or worsens.

Question #49

A client is experiencing anorexia and the physician is to order a medication to stimulate the client’s appetite. Which of the following would the nurse least likely expect the physician to prescribe?

A Megestrol

B Atropine

C Dronabinol

D Dexamethasone

Question #50

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?

A Increased eating

B Increased urinary output

C Increased wakefulness

D Increased restlessness

Question #51

A terminally ill patient is admitted to the hospital. The patient grabs the nurse’s hand and asks, “Am I dying?” What response would be best for the nurse to give?

A “I am not at liberty to disclose that information.”

B “Did someone tell you that you are dying?”

C “Why do you think that?”

D “Tell me more about what’s on your mind.”

Question #52

The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician?

A Perform surgery to remove the tumor from the brain.

B Obtain a biopsy to analyze the lymph nodes.

C Add haloperidol to the client’s treatment plan.

D Begin radiation therapy to prevent cellular growth.

Question #53

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

A Allows for the nurse to facilitate the grieving process

B Allows for the nurse to take the client through in the appropriate order

C Allows the nurse to express his or her feelings

D Allows for the nurse to understand when the grieving process should be concluded

Question #54

A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply.,,

A Offers a team approach to care

B Hastens death

C Includes chemotherapy

D Enhances quality of life

E Integrates spirituality

Question #55

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following?

A Participate in a support group to learn clients’ feeling on care.

B A workshop on caring for the dying client

C Use evidence-based practice in daily care regimen.

D Explore own feelings on mortality and death and dying

Question #56

Which of the following is an appropriate method of assessing the dying client?

A Stimulate the client every 30 minutes.

B Sedate the client before completing range-of-motion exercises

C Focus on the client’s basic needs.

D Repeat assessments as necessary.

Question #57

A client states, “My children still need me. Why did I get cancer? I am only 30.” This client is exhibiting which stage according to Kübler-Ross?

A Anger

B Acceptance

C Denial

D Bargaining

Question #58

A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following?

A Most states have enacted laws that allow for physician-assisted suicide.

B Nurses may administer medications prescribed by physicians to hasten end of life.

C Participating in assisted suicide violates the Code of Ethics for Nurses.

D A client has the right to make independent decisions about the timing of his or her death.

Question #59

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation?

A Encourage conversations about the impending death of the client

B Be a silent observer and allow the client to communicate with the family members

C Encourage the client’s family members to spend time with the client

D Encourage the family members to express their feelings and listen to them in their frank communication

Question #60

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a “chronically critical and progressively ill” condition.

A Carcinoma-in-situ

B Coronary artery disease

C End-stage renal disease

D Type 2 diabetes mellitus

Question #61

A End-of-life treatment directive

B Medical directive by proxy

C Durable power of attorney for health care

D Living will declaration

Question #62

The cltient tells the doctor that he and his family have accepted the terminal diagnosis of pancreatic cancer. The client further explains that he is interested in being comfortable and that he no longer wishes to fight the cancer. This approach to end-of-life care is known as

A interdisciplinary care.

B euthanasia care.

C terminal care

D palliative care.

Question #63

Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening?

A Pulse 72 beats/minute, irregular; client confused and agitated

B Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles

C Pulse 100 beats/minute, blood pressure 100/60 mm Hg, pale with poor skin turgor

D Pulse 60 beats/minute, blood pressure 90/42mm Hg, difficult to arouse

Question #64

The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client’s treatment. The nurse should explain that palliative care is:

A an alternative therapy that uses massage and progressive relaxation for pain relief.

B offered to terminally ill clients who wish to remain in their homes in lieu of hospice care.

C care that will reduce the client’s physical discomfort and manage clinical symptoms.

D care that is provided at the very end of an illness to ease the dying process.

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