MED-SURG NURSING EXAM 1 (CH. 5, 6, 18, 19) NURS 165 QUESTIONS
AND ANSWERS
Palliative care - CORRECT ANSWER✅✅Interdisciplinary care focused on relief of symptoms and stress of
serious illness at any stage, alongside curative care.
Hospice care - CORRECT ANSWER✅✅A model of care for patients with a terminal diagnosis and life
expectancy ≤ 6 months when curative treatment is discontinued; focuses on comfort and quality of life.
Difference: palliative vs hospice - CORRECT ANSWER✅✅Palliative can occur with curative treatment at
any time; hospice is for end-of-life when curative treatment stops.
Goals of hospice - CORRECT ANSWER✅✅Comfort, dignity, symptom relief, psychosocial and spiritual
support for patients and families, bereavement care.
Eligibility for hospice - CORRECT ANSWER✅✅Physician-certified prognosis of 6 months or less if the
disease follows its usual course.
Interdisciplinary hospice team - CORRECT ANSWER✅✅Physician/NP/PA, RN, social worker, chaplain,
hospice aide, pharmacist, volunteers, bereavement counselor.
Advance care planning - CORRECT ANSWER✅✅Ongoing process of discussing and documenting values,
goals, and treatment preferences for future care.
Advance directive - CORRECT ANSWER✅✅Legal document expressing a person's health care
preferences if they lose capacity (e.g., living will, health care proxy).
Living will - CORRECT ANSWER✅✅Document that states desired/undesired treatments in specific
situations (e.g., ventilation, feeding tubes).
Durable power of attorney for health care (health care proxy) - CORRECT ANSWER✅✅Appoints a
surrogate decision-maker to make medical decisions when the patient lacks capacity.
,POLST (Physician Orders for Life-Sustaining Treatment) - CORRECT ANSWER✅✅Medical orders
translating patient goals into actionable orders (CPR, intubation, artificial nutrition) used across settings.
Do Not Resuscitate (DNR) order - CORRECT ANSWER✅✅Medical order directing no CPR if
cardiopulmonary arrest occurs.
Comfort measures only (CMO) - CORRECT ANSWER✅✅Care plan that prioritizes comfort and symptom
management over disease-directed therapy.
Principle of double effect - CORRECT ANSWER✅✅Using medications (e.g., opioids) to relieve suffering is
ethical even if an unintended consequence could be life-shortening, provided intent is symptom relief.
Total pain - CORRECT ANSWER✅✅The combined physical, psychological, social, and spiritual
components of suffering.
Dyspnea at end of life - CORRECT ANSWER✅✅Often treated with low-dose opioids (e.g., morphine),
fan/airflow, positioning, and anxiety reduction.
Terminal secretions ("death rattle") - CORRECT ANSWER✅✅Manage with anticholinergics (e.g.,
glycopyrrolate), repositioning, reduce fluids; avoid deep suctioning.
Nausea/vomiting—palliative approach - CORRECT ANSWER✅✅Treat cause when possible; use
antiemetics (ondansetron, metoclopramide, haloperidol) and nonpharmacologic measures.
Constipation prevention with opioids - CORRECT ANSWER✅✅Always prescribe a stimulant laxative +/-
stool softener; encourage fluids if appropriate.
Delirium at end of life - CORRECT ANSWER✅✅Acute fluctuating inattention/agitation; treat reversible
causes if consistent with goals; consider antipsychotics for distress.
, Terminal delirium - CORRECT ANSWER✅✅Delirium in actively dying patients; focus on comfort and
safety, family education, and minimal necessary medications.
Palliative sedation - CORRECT ANSWER✅✅Proportional sedation to relieve otherwise refractory
suffering at end of life with informed consent and interdisciplinary oversight.
Signs of approaching death - CORRECT ANSWER✅✅Decreased intake, increased sleep, cool/mottled
extremities, Cheyne-Stokes respirations, decreased urine output, terminal secretions.
Cheyne-Stokes respirations - CORRECT ANSWER✅✅Cycles of apnea and hyperpnea seen in actively
dying patients.
Anticipatory grief - CORRECT ANSWER✅✅Grief experienced before a loss occurs.
Disenfranchised grief - CORRECT ANSWER✅✅Grief not socially recognized or supported.
Complicated (prolonged) grief - CORRECT ANSWER✅✅Persistent, disabling grief response that impairs
functioning beyond expected cultural norms.
Bereavement support - CORRECT ANSWER✅✅Follow-up care and resources for survivors after a
patient's death.
Ethical principles in end-of-life care - CORRECT ANSWER✅✅Autonomy, beneficence, nonmaleficence,
justice, veracity.
Case: patient stops eating/drinking—start IV fluids? - CORRECT ANSWER✅✅Usually no; artificial
hydration may worsen edema/secretions; focus on mouth care and comfort feeding if desired.
Mouth care in the actively dying - CORRECT ANSWER✅✅Frequent oral care, lip balm, ice chips if safe;
reduces dryness and discomfort.
AND ANSWERS
Palliative care - CORRECT ANSWER✅✅Interdisciplinary care focused on relief of symptoms and stress of
serious illness at any stage, alongside curative care.
Hospice care - CORRECT ANSWER✅✅A model of care for patients with a terminal diagnosis and life
expectancy ≤ 6 months when curative treatment is discontinued; focuses on comfort and quality of life.
Difference: palliative vs hospice - CORRECT ANSWER✅✅Palliative can occur with curative treatment at
any time; hospice is for end-of-life when curative treatment stops.
Goals of hospice - CORRECT ANSWER✅✅Comfort, dignity, symptom relief, psychosocial and spiritual
support for patients and families, bereavement care.
Eligibility for hospice - CORRECT ANSWER✅✅Physician-certified prognosis of 6 months or less if the
disease follows its usual course.
Interdisciplinary hospice team - CORRECT ANSWER✅✅Physician/NP/PA, RN, social worker, chaplain,
hospice aide, pharmacist, volunteers, bereavement counselor.
Advance care planning - CORRECT ANSWER✅✅Ongoing process of discussing and documenting values,
goals, and treatment preferences for future care.
Advance directive - CORRECT ANSWER✅✅Legal document expressing a person's health care
preferences if they lose capacity (e.g., living will, health care proxy).
Living will - CORRECT ANSWER✅✅Document that states desired/undesired treatments in specific
situations (e.g., ventilation, feeding tubes).
Durable power of attorney for health care (health care proxy) - CORRECT ANSWER✅✅Appoints a
surrogate decision-maker to make medical decisions when the patient lacks capacity.
,POLST (Physician Orders for Life-Sustaining Treatment) - CORRECT ANSWER✅✅Medical orders
translating patient goals into actionable orders (CPR, intubation, artificial nutrition) used across settings.
Do Not Resuscitate (DNR) order - CORRECT ANSWER✅✅Medical order directing no CPR if
cardiopulmonary arrest occurs.
Comfort measures only (CMO) - CORRECT ANSWER✅✅Care plan that prioritizes comfort and symptom
management over disease-directed therapy.
Principle of double effect - CORRECT ANSWER✅✅Using medications (e.g., opioids) to relieve suffering is
ethical even if an unintended consequence could be life-shortening, provided intent is symptom relief.
Total pain - CORRECT ANSWER✅✅The combined physical, psychological, social, and spiritual
components of suffering.
Dyspnea at end of life - CORRECT ANSWER✅✅Often treated with low-dose opioids (e.g., morphine),
fan/airflow, positioning, and anxiety reduction.
Terminal secretions ("death rattle") - CORRECT ANSWER✅✅Manage with anticholinergics (e.g.,
glycopyrrolate), repositioning, reduce fluids; avoid deep suctioning.
Nausea/vomiting—palliative approach - CORRECT ANSWER✅✅Treat cause when possible; use
antiemetics (ondansetron, metoclopramide, haloperidol) and nonpharmacologic measures.
Constipation prevention with opioids - CORRECT ANSWER✅✅Always prescribe a stimulant laxative +/-
stool softener; encourage fluids if appropriate.
Delirium at end of life - CORRECT ANSWER✅✅Acute fluctuating inattention/agitation; treat reversible
causes if consistent with goals; consider antipsychotics for distress.
, Terminal delirium - CORRECT ANSWER✅✅Delirium in actively dying patients; focus on comfort and
safety, family education, and minimal necessary medications.
Palliative sedation - CORRECT ANSWER✅✅Proportional sedation to relieve otherwise refractory
suffering at end of life with informed consent and interdisciplinary oversight.
Signs of approaching death - CORRECT ANSWER✅✅Decreased intake, increased sleep, cool/mottled
extremities, Cheyne-Stokes respirations, decreased urine output, terminal secretions.
Cheyne-Stokes respirations - CORRECT ANSWER✅✅Cycles of apnea and hyperpnea seen in actively
dying patients.
Anticipatory grief - CORRECT ANSWER✅✅Grief experienced before a loss occurs.
Disenfranchised grief - CORRECT ANSWER✅✅Grief not socially recognized or supported.
Complicated (prolonged) grief - CORRECT ANSWER✅✅Persistent, disabling grief response that impairs
functioning beyond expected cultural norms.
Bereavement support - CORRECT ANSWER✅✅Follow-up care and resources for survivors after a
patient's death.
Ethical principles in end-of-life care - CORRECT ANSWER✅✅Autonomy, beneficence, nonmaleficence,
justice, veracity.
Case: patient stops eating/drinking—start IV fluids? - CORRECT ANSWER✅✅Usually no; artificial
hydration may worsen edema/secretions; focus on mouth care and comfort feeding if desired.
Mouth care in the actively dying - CORRECT ANSWER✅✅Frequent oral care, lip balm, ice chips if safe;
reduces dryness and discomfort.
