CLASSROOM CLASSROOM CLASSROOM
Name: ______________________ Class: _________________ Date: _________ ID: A
End-of-Life Care Exam
____ 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
____ 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
____ 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.
____ 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 “do not resuscitate” order
____ 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
1
CLASSROOM CLASSROOM CLASSROOM
,CLASSROOM CLASSROOM CLASSROOM
Name: ______________________ ID: A
____ 6. After contributing to the care of several patients who died in the hospital, the nurse has identified
some lapses in the care that many of these patients received toward the end of their lives. What
have research studies identified as a potential deficiency in the care of the dying in hospital
settings?
A) Families' needs for information and support often go unmet.
B) Patients are too sedated to achieve adequate pain control.
C) Patients are not given opportunities to communicate with caregivers.
D) Patients are ignored by the care team toward the end of life.
____ 7. An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has
asked the nurse about the possibility of hospice care. Which principle is central to a hospice
setting?
A) The patient and family should be viewed as a single unit of care.
B) Persistent symptoms of terminal illness should not be treated.
C) Each member of the interdisciplinary team should develop an individual plan of
care.
D) Terminally ill patients should die in the hospital whenever possible.
____ 8. A clinic nurse is providing patient education prior to a patient's scheduled palliative radiotherapy
to her spine. At the completion of the patient teaching, the patient continues to ask the same
questions that the nurse has already addressed. What is the plausible conclusion that the nurse
should draw from this?
A) The patient is not listening effectively.
B) The patient is noncompliant with the plan of care.
C) The patient may have a low intelligence quotient or a cognitive deficit.
D) The patient has not achieved the desired learning outcomes.
____ 9. The nurse is part of the health care team at an oncology center. A patient has been diagnosed with
leukemia and the prognosis is poor, but the patient is not yet aware of the prognosis. How can the
bad news best be conveyed to the patient?
A) Family should be given the prognosis first.
B) The prognosis should be delivered with the patient at eye level.
C) The physician should deliver the news to the patient alone.
D) The appointment should be scheduled at the end of the day.
____ 10. A patient has just been told that her illness is terminal. The patient tearfully states, “I can't believe
I am going to die. Why me?” What is your best response?
A) “I know how you are feeling.”
B) “You have lived a long life.”
C) “This must be very difficult for you.”
D) “Life can be so unfair.”
2
CLASSROOM CLASSROOM CLASSROOM
, CLASSROOM CLASSROOM CLASSROOM
Name: ______________________ ID: A
____ 11. The nurse has observed that an older adult patient with a diagnosis of end-stage renal failure seems
to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the
patient explains to you that this is a cultural practice and very important to him. How should you
respond?
A) Privately ask the son to allow the patient to make his own health care decisions.
B) Explain to the patient that he is responsible for his own decisions.
C) Work with the team to negotiate informed consent.
D) Avoid divulging information to the eldest son.
____ 12. One aspect of the nurse's comprehensive assessment when caring for the terminally ill is the
assessment of hope. The nurse is assessing a patient with liver failure for the presence of hope.
What would the nurse identify as a hope-fostering category?
A) Uplifting memories
B) Ignoring negative outcomes
C) Envisioning one specific outcome
D) Avoiding an actual or potential threat
____ 13. A medical nurse is providing end-of-life care for a patient with metastatic bone cancer. The nurse
notes that the patient has been receiving oral analgesics for her pain with adequate effect, but is
now having difficulty swallowing the medication. What should the nurse do?
A) Request the physician to order analgesics by an alternative route.
B) Crush the medication in order to aid swallowing and absorption.
C) Administer the patient's medication with the meal tray.
D) Administer the medication rectally.
____ 14. A 66-year-old patient is in a hospice receiving palliative care for lung cancer which has
metastasized to the patient's liver and bones. For the past several hours, the patient has been
experiencing dyspnea. What nursing action is most appropriate to help to relive the dyspnea the
patient is experiencing?
A) Administer a bolus of normal saline, as ordered.
B) Initiate high-flow oxygen therapy.
C) Administer high doses of opioids.
D) Administer bronchodilators and corticosteroids, as ordered.
____ 15. The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which
assessment finding would most clearly indicate to the nurse that the patient's death is imminent?
A) Mottling of the lower limbs
B) Slow, steady pulse
C) Bowel incontinence
D) Increased swallowing
3
CLASSROOM CLASSROOM CLASSROOM
Name: ______________________ Class: _________________ Date: _________ ID: A
End-of-Life Care Exam
____ 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
____ 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
____ 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.
____ 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 “do not resuscitate” order
____ 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
1
CLASSROOM CLASSROOM CLASSROOM
,CLASSROOM CLASSROOM CLASSROOM
Name: ______________________ ID: A
____ 6. After contributing to the care of several patients who died in the hospital, the nurse has identified
some lapses in the care that many of these patients received toward the end of their lives. What
have research studies identified as a potential deficiency in the care of the dying in hospital
settings?
A) Families' needs for information and support often go unmet.
B) Patients are too sedated to achieve adequate pain control.
C) Patients are not given opportunities to communicate with caregivers.
D) Patients are ignored by the care team toward the end of life.
____ 7. An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has
asked the nurse about the possibility of hospice care. Which principle is central to a hospice
setting?
A) The patient and family should be viewed as a single unit of care.
B) Persistent symptoms of terminal illness should not be treated.
C) Each member of the interdisciplinary team should develop an individual plan of
care.
D) Terminally ill patients should die in the hospital whenever possible.
____ 8. A clinic nurse is providing patient education prior to a patient's scheduled palliative radiotherapy
to her spine. At the completion of the patient teaching, the patient continues to ask the same
questions that the nurse has already addressed. What is the plausible conclusion that the nurse
should draw from this?
A) The patient is not listening effectively.
B) The patient is noncompliant with the plan of care.
C) The patient may have a low intelligence quotient or a cognitive deficit.
D) The patient has not achieved the desired learning outcomes.
____ 9. The nurse is part of the health care team at an oncology center. A patient has been diagnosed with
leukemia and the prognosis is poor, but the patient is not yet aware of the prognosis. How can the
bad news best be conveyed to the patient?
A) Family should be given the prognosis first.
B) The prognosis should be delivered with the patient at eye level.
C) The physician should deliver the news to the patient alone.
D) The appointment should be scheduled at the end of the day.
____ 10. A patient has just been told that her illness is terminal. The patient tearfully states, “I can't believe
I am going to die. Why me?” What is your best response?
A) “I know how you are feeling.”
B) “You have lived a long life.”
C) “This must be very difficult for you.”
D) “Life can be so unfair.”
2
CLASSROOM CLASSROOM CLASSROOM
, CLASSROOM CLASSROOM CLASSROOM
Name: ______________________ ID: A
____ 11. The nurse has observed that an older adult patient with a diagnosis of end-stage renal failure seems
to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the
patient explains to you that this is a cultural practice and very important to him. How should you
respond?
A) Privately ask the son to allow the patient to make his own health care decisions.
B) Explain to the patient that he is responsible for his own decisions.
C) Work with the team to negotiate informed consent.
D) Avoid divulging information to the eldest son.
____ 12. One aspect of the nurse's comprehensive assessment when caring for the terminally ill is the
assessment of hope. The nurse is assessing a patient with liver failure for the presence of hope.
What would the nurse identify as a hope-fostering category?
A) Uplifting memories
B) Ignoring negative outcomes
C) Envisioning one specific outcome
D) Avoiding an actual or potential threat
____ 13. A medical nurse is providing end-of-life care for a patient with metastatic bone cancer. The nurse
notes that the patient has been receiving oral analgesics for her pain with adequate effect, but is
now having difficulty swallowing the medication. What should the nurse do?
A) Request the physician to order analgesics by an alternative route.
B) Crush the medication in order to aid swallowing and absorption.
C) Administer the patient's medication with the meal tray.
D) Administer the medication rectally.
____ 14. A 66-year-old patient is in a hospice receiving palliative care for lung cancer which has
metastasized to the patient's liver and bones. For the past several hours, the patient has been
experiencing dyspnea. What nursing action is most appropriate to help to relive the dyspnea the
patient is experiencing?
A) Administer a bolus of normal saline, as ordered.
B) Initiate high-flow oxygen therapy.
C) Administer high doses of opioids.
D) Administer bronchodilators and corticosteroids, as ordered.
____ 15. The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which
assessment finding would most clearly indicate to the nurse that the patient's death is imminent?
A) Mottling of the lower limbs
B) Slow, steady pulse
C) Bowel incontinence
D) Increased swallowing
3
CLASSROOM CLASSROOM CLASSROOM
