NSG 430 Exam 1 – GCU Adult Health Nursing II – (2026) Actual Questions &
Answers
Section 1: End-of-Life & Palliative Care (Questions 1-30)
1. A patient with terminal cancer is being admitted to a family-centered inpatient
hospice. The patient's spouse visits daily and cheerfully talks about wedding
anniversary plans for next year. When the nurse asks about concerns, the spouse
says, "I'm busy at work, but otherwise things are fine." Which issue would the
nurse identify as a concern?
A. Fear
B. Anxiety
C. Hopelessness
D. Difficulty coping
Answer: D. Difficulty coping
Rationale: The spouse's behavior and statements indicate the absence of
anticipatory grieving, which may lead to impaired adjustment as the patient
progresses toward death. The spouse does not appear to feel fearful, hopeless, or
,anxious based on the information provided, but rather is avoiding the reality of
the impending loss .
2. As the nurse admits a patient in end-stage renal disease to the hospital, the
patient tells the nurse, "If my heart or breathing stop, I do not want to be
resuscitated." Which action should the nurse take first?
A. Place a Do Not Resuscitate (DNR) notation in the patient's care plan
B. Invite the patient to add a notarized advance directive in the health record
C. Advise the patient to designate a person to make future health care decisions
D. Ask the patient to discuss the decision with the health care provider
Answer: D. Ask the patient to discuss the decision with the health care provider
Rationale: The nurse should first ask the patient to discuss the decision with the
health care provider because a written order from the provider is required to
implement a DNR. The nurse can advocate for the patient by notifying the
provider of the patient's wishes. While advance directives are important, the
immediate priority is obtaining a provider order for the DNR status .
,3. The nurse is caring for a dying adolescent patient who is comatose. The
patient's parents are interested in organ donation and ask how health care
providers determine brain death. Which response accurately describes brain
death determination?
A. "If CPR does not restore a heartbeat, the brain cannot function any longer."
B. "Brain death has occurred if there is not any breathing or brainstem reflexes."
C. "Brain death has occurred if a person has flaccid muscles and does not
awaken."
D. "If respiratory efforts cease and no apical pulse is audible, brain death is
present."
Answer: B. "Brain death has occurred if there is not any breathing or brainstem
reflexes."
Rationale: The diagnosis of brain death is based on irreversible loss of all brain
functions, including brainstem functions that control respirations and brainstem
reflexes. The other descriptions describe other clinical manifestations associated
with death but are insufficient to declare a patient brain dead .
, 4. A patient in hospice is manifesting a decrease in all body system functions
except for a heart rate of 124 beats/min and a respiratory rate of 28 breaths/min.
Which statement would be accurate for the nurse to make to the patient's family?
A. "These vital signs will continue to increase until death finally occurs."
B. "These vital signs demonstrate the body's ability to compensate and heal."
C. "These vital signs are an expected response now but will slow down later."
D. "These vital signs may indicate an improvement in the patient's condition."
Answer: C. "These vital signs are an expected response now but will slow down
later."
Rationale: An increase in heart and respiratory rate may occur before the slowing
of these functions in a dying patient. Heart and respiratory rate typically slow as
the patient progresses further toward death. In a dying patient, high respiratory
and pulse rates do not indicate improvement or compensation .
5. A young adult patient with metastatic cancer who is very close to death
appears restless. The patient keeps repeating, "I am not ready to die." Which
action by the nurse would show respect for the patient?
Answers
Section 1: End-of-Life & Palliative Care (Questions 1-30)
1. A patient with terminal cancer is being admitted to a family-centered inpatient
hospice. The patient's spouse visits daily and cheerfully talks about wedding
anniversary plans for next year. When the nurse asks about concerns, the spouse
says, "I'm busy at work, but otherwise things are fine." Which issue would the
nurse identify as a concern?
A. Fear
B. Anxiety
C. Hopelessness
D. Difficulty coping
Answer: D. Difficulty coping
Rationale: The spouse's behavior and statements indicate the absence of
anticipatory grieving, which may lead to impaired adjustment as the patient
progresses toward death. The spouse does not appear to feel fearful, hopeless, or
,anxious based on the information provided, but rather is avoiding the reality of
the impending loss .
2. As the nurse admits a patient in end-stage renal disease to the hospital, the
patient tells the nurse, "If my heart or breathing stop, I do not want to be
resuscitated." Which action should the nurse take first?
A. Place a Do Not Resuscitate (DNR) notation in the patient's care plan
B. Invite the patient to add a notarized advance directive in the health record
C. Advise the patient to designate a person to make future health care decisions
D. Ask the patient to discuss the decision with the health care provider
Answer: D. Ask the patient to discuss the decision with the health care provider
Rationale: The nurse should first ask the patient to discuss the decision with the
health care provider because a written order from the provider is required to
implement a DNR. The nurse can advocate for the patient by notifying the
provider of the patient's wishes. While advance directives are important, the
immediate priority is obtaining a provider order for the DNR status .
,3. The nurse is caring for a dying adolescent patient who is comatose. The
patient's parents are interested in organ donation and ask how health care
providers determine brain death. Which response accurately describes brain
death determination?
A. "If CPR does not restore a heartbeat, the brain cannot function any longer."
B. "Brain death has occurred if there is not any breathing or brainstem reflexes."
C. "Brain death has occurred if a person has flaccid muscles and does not
awaken."
D. "If respiratory efforts cease and no apical pulse is audible, brain death is
present."
Answer: B. "Brain death has occurred if there is not any breathing or brainstem
reflexes."
Rationale: The diagnosis of brain death is based on irreversible loss of all brain
functions, including brainstem functions that control respirations and brainstem
reflexes. The other descriptions describe other clinical manifestations associated
with death but are insufficient to declare a patient brain dead .
, 4. A patient in hospice is manifesting a decrease in all body system functions
except for a heart rate of 124 beats/min and a respiratory rate of 28 breaths/min.
Which statement would be accurate for the nurse to make to the patient's family?
A. "These vital signs will continue to increase until death finally occurs."
B. "These vital signs demonstrate the body's ability to compensate and heal."
C. "These vital signs are an expected response now but will slow down later."
D. "These vital signs may indicate an improvement in the patient's condition."
Answer: C. "These vital signs are an expected response now but will slow down
later."
Rationale: An increase in heart and respiratory rate may occur before the slowing
of these functions in a dying patient. Heart and respiratory rate typically slow as
the patient progresses further toward death. In a dying patient, high respiratory
and pulse rates do not indicate improvement or compensation .
5. A young adult patient with metastatic cancer who is very close to death
appears restless. The patient keeps repeating, "I am not ready to die." Which
action by the nurse would show respect for the patient?
