Chapter 13 Palliative and End-of-Life Care
1. In the past three to four decades, nursing has moved into the forefront in providing care
for the dying. Which phenomenon has most contributed to this increased focus of care of
the dying?
A) Increased incidence of infections and acute illnesses
B) Increased focus of health care providers on disease prevention
C) Larger numbers of people dying in hospital settings
D) Demographic changes in the population
Ans: D
Feedback:
The focus on care of the dying has been motivated by the aging of the population, the
prevalence of, and publicity surrounding, life-threatening illnesses (e.g., cancer and AIDS),
and the increasing likelihood of a prolonged period of chronic illness prior to death. The
salience of acute infections, prevention measures, and death in hospital settings are not
noted to have had a major influence on this phenomenon.
2. A nurse who works in the specialty of palliative care frequently encounters issues and
situations that constitute ethical dilemmas. What issue has most often presented
challenging ethical issues, especially in the context of palliative care?
A) The increase in cultural diversity in the United States
B) Staffing shortages in health care and questions concerning quality of care
C) Increased costs of health care coupled with inequalities in access
, D) Ability of technology to prolong life beyond meaningful quality of life
Ans: D
Feedback:
The application of technology to prolong life has raised several ethical issues. The
major question is, ìBecause we can prolong life through increasingly sophisticated
technology, does it necessarily follow that we must do so?î The increase in cultural
diversity has not raised ethical issues in health care. Similarly, costs and staffing issues
are relevant, but not central to the most common ethical issues surrounding palliative
care.
3. The nurse is caring for a patient who has been recently diagnosed with late stage
pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to
treatment. What is the most likely psychosocial purpose of this patient's strategy?
A) The patient may be trying to protect loved ones from the emotional effects of the
illness.
B) The patient is being noncompliant in order to assert power over caregivers.
C) The patient may be skeptical of the benefits of the Western biomedical model of health.
D) The patient thinks that treatment does not provide him comfort. Ans: A
Feedback:
Patients who are characterized as being in denial may be using this strategy to preserve
important interpersonal relationships, to protect others from the emotional effects of
their illness, and to protect themselves because of fears of abandonment. Each of the
other listed options is plausible, but less likely.
, 4. A nurse who sits on the hospital's ethics committee is reviewing a complex case that has
many of the hallmarks of assisted suicide. Which of the following would be an example of
assisted suicide?
A) Administering a lethal dose of medication to a patient whose death is imminent B)
Administering a morphine infusion without assessing for respiratory depression C)
Granting a patient's request not to initiate enteral feeding when the patient is
unable to eat
D) Neglecting to resuscitate a patient with a ìdo not resuscitateî order
Ans: A
Feedback:
Assisted suicide refers to providing another person the means to end his or her own life.
This is not to be confused with the ethically and legally supported practices of
withholding or withdrawing medical treatment in accordance with the wishes of the
terminally ill individual. The other listed options do not fit this accepted definition of
assisted suicide.
5. A medical nurse is providing palliative care to a patient with a diagnosis of end-stage
chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's
care?
A) To improve the patient's and family's quality of life
B) To support aggressive and innovative treatments for cure
C) To provide physical support for the patient
D) To help the patient develop a separate plan with each discipline of the health care team
Ans: A
Feedback:
1. In the past three to four decades, nursing has moved into the forefront in providing care
for the dying. Which phenomenon has most contributed to this increased focus of care of
the dying?
A) Increased incidence of infections and acute illnesses
B) Increased focus of health care providers on disease prevention
C) Larger numbers of people dying in hospital settings
D) Demographic changes in the population
Ans: D
Feedback:
The focus on care of the dying has been motivated by the aging of the population, the
prevalence of, and publicity surrounding, life-threatening illnesses (e.g., cancer and AIDS),
and the increasing likelihood of a prolonged period of chronic illness prior to death. The
salience of acute infections, prevention measures, and death in hospital settings are not
noted to have had a major influence on this phenomenon.
2. A nurse who works in the specialty of palliative care frequently encounters issues and
situations that constitute ethical dilemmas. What issue has most often presented
challenging ethical issues, especially in the context of palliative care?
A) The increase in cultural diversity in the United States
B) Staffing shortages in health care and questions concerning quality of care
C) Increased costs of health care coupled with inequalities in access
, D) Ability of technology to prolong life beyond meaningful quality of life
Ans: D
Feedback:
The application of technology to prolong life has raised several ethical issues. The
major question is, ìBecause we can prolong life through increasingly sophisticated
technology, does it necessarily follow that we must do so?î The increase in cultural
diversity has not raised ethical issues in health care. Similarly, costs and staffing issues
are relevant, but not central to the most common ethical issues surrounding palliative
care.
3. The nurse is caring for a patient who has been recently diagnosed with late stage
pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to
treatment. What is the most likely psychosocial purpose of this patient's strategy?
A) The patient may be trying to protect loved ones from the emotional effects of the
illness.
B) The patient is being noncompliant in order to assert power over caregivers.
C) The patient may be skeptical of the benefits of the Western biomedical model of health.
D) The patient thinks that treatment does not provide him comfort. Ans: A
Feedback:
Patients who are characterized as being in denial may be using this strategy to preserve
important interpersonal relationships, to protect others from the emotional effects of
their illness, and to protect themselves because of fears of abandonment. Each of the
other listed options is plausible, but less likely.
, 4. A nurse who sits on the hospital's ethics committee is reviewing a complex case that has
many of the hallmarks of assisted suicide. Which of the following would be an example of
assisted suicide?
A) Administering a lethal dose of medication to a patient whose death is imminent B)
Administering a morphine infusion without assessing for respiratory depression C)
Granting a patient's request not to initiate enteral feeding when the patient is
unable to eat
D) Neglecting to resuscitate a patient with a ìdo not resuscitateî order
Ans: A
Feedback:
Assisted suicide refers to providing another person the means to end his or her own life.
This is not to be confused with the ethically and legally supported practices of
withholding or withdrawing medical treatment in accordance with the wishes of the
terminally ill individual. The other listed options do not fit this accepted definition of
assisted suicide.
5. A medical nurse is providing palliative care to a patient with a diagnosis of end-stage
chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's
care?
A) To improve the patient's and family's quality of life
B) To support aggressive and innovative treatments for cure
C) To provide physical support for the patient
D) To help the patient develop a separate plan with each discipline of the health care team
Ans: A
Feedback:
