Question 1

The nurse is caring for a terminally ill client who has 20-second periods of apnea followed by periods of deep and rapid breathing. Which of the following terms should the nurse use to document this finding?

Accepted Answer

A)  Agonal breathing
B)  Apneustic breathing
C)  Death rattle respirations
D)  Cheyne-Stokes respirations D

Question 2

The nurse has been caring for a terminally ill client for the past 10 months. The nurse and the family are present when the client dies and feels saddened and tearful as the family members begin to cry. Which of the following actions should the nurse takeatthis time?

Accepted Answer

A)  Contact a grief counsellor as soon as possible.
B)  Cry along with the client's family members.
C)  Leave the home as quickly as possible to allow the family to grieve privately.
D)  Consider whether working in hospice is desirable since client losses are common. B

Question 3

The nurse is providing hospice care to a client who is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28. Which of the following is the basis for the nurses' response about these symptoms?

Accepted Answer

A)  They will continue to increase until death finally occurs.
B)  They are a normal response before these functions decrease.
C)  They indicate a reflex response to the slowing of other body systems.
D)  They may be associated with an improvement in the client's condition. B

Question 4

The spouse of a client with terminal lung cancer visits daily and cheerfully talks with the client about vacation plans for the next year. When the nurse asks about any concerns, the spouse says, "I'm busy at work, but otherwise things are fine." Which of thefollowing nursing diagnoses is appropriate?

Accepted Answer

A)  Ineffective denial related to threat of unpleasant reality
B)  Anxiety related to threat to current status
C)  Caregiver role strain related to inexperience with caregiving
D)  Hopelessness related to chronic stress

Question 5

The nurse is caring for a client with lung cancer as part of a home hospice palliative program. Which of the following interventions should the nurse implement?

Accepted Answer

A)  Discuss cancer risk factors and appropriate lifestyle modifications.
B)  Encourage the client to discuss past life events and their meaning.
C)  Accomplish a thorough head-to-toe assessment once a week.
D)  Educate the client about the purpose of chemotherapy and radiation.

Question 6

Aclient who is very close to death is very restless and keeps repeating, "I am not ready to die." Which of the following actions should the nurse take?

Accepted Answer

A)  Remind the client that no one feels ready for death.
B)  Sit at the bedside and ask if there is anything the client needs.
C)  Insist that family members remain at the bedside with the client.
D)  Tell the client that everything possible is being done to delay death.

Question 7

The family member of a client who is dying tells the nurse, "Mother doesn't really respond any more when I visit. I don't think she knows that I am here." Which of the following responses by the nurse is most appropriate?

Accepted Answer

A)  "You may need to cut back your visits for now to avoid overtiring your mother."
B)  "Withdrawal may sometimes be a normal response when preparing to leave life."
C)  "It will be important for you to stimulate your mother as she gets closer to dying."
D)  "Many clients don't really know what is going on around them at the end of life."

Question 8

A client who is in the clinic for an immunization tells the nurse, "My mother died 4 months ago, and I just can't seem to get over it. I'm not sure it is normal to still think about her every day." Which of the following nursing diagnoses is most appropriate?

Accepted Answer

A)  Ineffective role performance related to depression
B)  Complicated grieving related to emotional disturbance (death of loved one) 
C)  Anxiety related to unmet needs (lack of knowledge about normal grieving) 
D)  Impaired mood regulation related to loneliness

Question 9

The nurse is caring for a client who has been diagnosed with metastatic cancer and plans a trip across the country "to settle some issues with my sisters and brothers." Which of the responses should the nurse recognize that the client is manifesting?

Accepted Answer

A)  Restlessness
B)  Yearning and protest
C)  Anxiety about unfinished business
D)  Fear of the meaninglessness of one's life

Question 10

Which of the following clients is most appropriate for the nurse to refer to hospice palliative care?

Accepted Answer

A)  A 60-year-old with lymphoma whose children are unable to discuss issues related to dying
B)  A 72-year-old with chronic severe pain as a result of spinal arthritis and vertebral collapse
C)  A 28-year-old with AIDS-related dementia who needs palliative care and pain management
D)  A 56-year-old with advanced liver failure whose family members can no longer care for him or her at home

Question 11

The nurse is caring for a young adult who is dying after an automobile accident. The family members want to donate the client's organs and ask the nurse how the decision when death has occurred is made. Which of the following is the basis for the nurses'response to the family in this situation?

Accepted Answer

A)  The client is flaccid and unresponsive.
B)  The client is experiencing respiratory acidosis and is on a ventilator.
C)  The client is unconscious with no brain stem activity.
D)  Respiratory efforts cease and no apical pulse is audible.

Question 12

A terminally ill client is admitted to the hospital. Which of the following actions should the nurse include in the initial plan of care?

Accepted Answer

A)  Determine the client's wishes regarding end-of-life care.
B)  Emphasize the importance of addressing any family issues.
C)  Discuss the normal grief process with the client and family.
D)  Encourage the client to talk about any fears or unresolved issues.

Question 13

The nurse is caring for a client in a hospice palliative care program who is experiencing continuous, increasing amounts of pain. Which of the following time schedules should the nurse implement for the administration of opioid pain medications?

Accepted Answer

A)  Around-the-clock routine administration of analgesics.
B)  PRN doses of medication whenever the client requests.
C)  Enough pain medication to keep the client sedated and unaware of stimuli.
D)  Analgesic doses that provide pain control without decreasing respiratory rate.

Question 14

The nurse is planning for an end-of-life care discussion with a newly admitted client who is terminally ill and has decided to use the NURSE protocol during the difficult conversation to respond to client and/or family emotions. Which of the following terms describes the "E" in the NURSE protocol?

Accepted Answer

A)  Experimentation
B)  Exploration
C)  Empathy
D)  Emotion

Question 15

As the nurse admits a client with severe heart failure to the hospital, the client tells the nurse, "If my heart or breathing stop, I do not want to be resuscitated." Which of the following actions should the nurse take?

Accepted Answer

A)  Ask if these wishes have been discussed with the health care provider.
B)  Place a "Do-Not-Resuscitate" (DNR)  notation in the client's care plan.
C)  Inform the client that a notarized advance directive must be included in the record or resuscitation must be performed.
D)  Advise the client to designate a person to make health care decisions when the client is not able to make them independently.

Exam 13: Palliative Care at the End of Life