RN 202 Med Surge Final Exam UPDATED
ACTUAL Exam Questions and CORRECT
Answers
What is palliative care and its goals? ( Select all that apply) - CORRECT ANSWER - Any
form of care or treatment that focuses on reducing the severity of disease symptoms.
• Regard dying as a normal process
• Provide relief from symptoms, including pain
• Affirm life and neither hasten nor postpone death
• Support holistic patient care and enhance quality of life
• Offer support to patients to live as actively as possible until death
• Offer support to the family during the patient's illness and in their own bereavement
What is hospice and who decides which patients are eligible for hospice care? - CORRECT
ANSWER - Care that provides compassion, concern, and support for persons in the last
phase of a terminal disease.
Eligibility for hospice services
Two physicians certify that the patient's prognosis is terminal, with less than 6 months to live.
What are the physical manifestations for EOL of respiratory system? - CORRECT
ANSWER - • Increased respiratory rate
• Cheyne-Stokes respiration
• Inability to cough or clear secretions resulting in grunting, gurgling, or noisy congested
breathing (death rattle or terminal secretions)
• Irregular breathing, gradually slowing down to terminal gasps (may be described as guppy
breathing)
,What are the common documents for EOL care? - CORRECT ANSWER - Advance
directive
General term used to describe documents that give instructions about future medical care and
treatments and who should make the decisions in the event the person is unable to communicate
• Should adhere to guidelines established by state of residence
Allow natural death (AND)
Written order acknowledging that comfort measures only are being provided to patient. Used in
many palliative care and hospice settings to indicate that patient wants to die naturally with
dignity and comfort
• In many settings, may be used in conjunction with DNR terminology to ensure patient/family
wishes for advance directives are followed
(DNR/AND)
Directive to physicians (DTP)
Written document specifying the patient's wish to be allowed to die without heroic or
extraordinary measures
• Indicates specific measures to be used or withheld
Do not resuscitate (DNR) Written physician's order instructing HCPs not to attempt CPR.
DNR order often requested by family
• Must indicate any specific measures to be used or withheld • Must be signed by a physician to
be valid
Living will
Lay term used to describe any documents that give instructions about future medical care and
treatments or the wish to be allowed to die without heroic or extraordinary measures should the
patient be unable to communicate for self
• Must identify specific treatments that a person wants or does not want at end of life
,Medical power of attorney (MPOA) Term used by some states to describe a document used for
listing the person(s) to make health care decisions should a patient become unable to make
informed decisions for self
• May be the same as durable power of attorney for health care, health care proxy, or
appointment of a health care agent or surrogate • Specifies measures to be used or withheld •
Person appointed may be called a heal
How is brain death diagnosed? - CORRECT ANSWER - •Irreversible loss of all brain
functions
•Requires a clinical diagnosis
•Criteria to meet diagnosis of brain death
•Coma
•Unresponsiveness
•Absence of brainstem reflexes
•Apnea
What are the different types of griefs by family members or caregiver? - CORRECT
ANSWER - Anticipatory Grief
•Grief experienced long before the actual death event
Adaptive Grief
•Grief that helps the person accept the reality of death
-Healthy response
-Ability to see good resulting from the death
-Positive memories of the deceased person
Prolonged grief disorder
•Dysfunction reaction to grief
-Recurring and severe distressing emotions and intrusive thoughts
-Self-neglect
, -Denial of loss longer than 6 months
What are the nursing interventions for bone marrow suppression? - CORRECT
ANSWER - Common side effect of chemotherapy and radiation therapy
Can result in life-threatening conditions:
*Neutropenia
*Thrombocytopenia
*Anemia
Nursing Implementation
Neutropenia
*Monitor the patient's CBC panel: neutrophil, platelet, and RBC count
*Monitor for signs and symptoms of infection: fever
*Administer WBC growth factors
Thrombocytopenia
*Monitor for signs and symptoms of bleeding
*Avoid invasive procedures
*See next slide for patient and family education
*Administer platelet transfusion if platelet levels fall below 20,000/uL
Anemia
*Administer RBC growth factors
*Administer packed RBCs
What are the patient and caregiver teaching for thrombocytopenia? ( select all that apply) -
CORRECT ANSWER - 1. Notify your HCP of any symptoms of bleeding.
These include:
• Black, tarry, or bloody bowel movements
ACTUAL Exam Questions and CORRECT
Answers
What is palliative care and its goals? ( Select all that apply) - CORRECT ANSWER - Any
form of care or treatment that focuses on reducing the severity of disease symptoms.
• Regard dying as a normal process
• Provide relief from symptoms, including pain
• Affirm life and neither hasten nor postpone death
• Support holistic patient care and enhance quality of life
• Offer support to patients to live as actively as possible until death
• Offer support to the family during the patient's illness and in their own bereavement
What is hospice and who decides which patients are eligible for hospice care? - CORRECT
ANSWER - Care that provides compassion, concern, and support for persons in the last
phase of a terminal disease.
Eligibility for hospice services
Two physicians certify that the patient's prognosis is terminal, with less than 6 months to live.
What are the physical manifestations for EOL of respiratory system? - CORRECT
ANSWER - • Increased respiratory rate
• Cheyne-Stokes respiration
• Inability to cough or clear secretions resulting in grunting, gurgling, or noisy congested
breathing (death rattle or terminal secretions)
• Irregular breathing, gradually slowing down to terminal gasps (may be described as guppy
breathing)
,What are the common documents for EOL care? - CORRECT ANSWER - Advance
directive
General term used to describe documents that give instructions about future medical care and
treatments and who should make the decisions in the event the person is unable to communicate
• Should adhere to guidelines established by state of residence
Allow natural death (AND)
Written order acknowledging that comfort measures only are being provided to patient. Used in
many palliative care and hospice settings to indicate that patient wants to die naturally with
dignity and comfort
• In many settings, may be used in conjunction with DNR terminology to ensure patient/family
wishes for advance directives are followed
(DNR/AND)
Directive to physicians (DTP)
Written document specifying the patient's wish to be allowed to die without heroic or
extraordinary measures
• Indicates specific measures to be used or withheld
Do not resuscitate (DNR) Written physician's order instructing HCPs not to attempt CPR.
DNR order often requested by family
• Must indicate any specific measures to be used or withheld • Must be signed by a physician to
be valid
Living will
Lay term used to describe any documents that give instructions about future medical care and
treatments or the wish to be allowed to die without heroic or extraordinary measures should the
patient be unable to communicate for self
• Must identify specific treatments that a person wants or does not want at end of life
,Medical power of attorney (MPOA) Term used by some states to describe a document used for
listing the person(s) to make health care decisions should a patient become unable to make
informed decisions for self
• May be the same as durable power of attorney for health care, health care proxy, or
appointment of a health care agent or surrogate • Specifies measures to be used or withheld •
Person appointed may be called a heal
How is brain death diagnosed? - CORRECT ANSWER - •Irreversible loss of all brain
functions
•Requires a clinical diagnosis
•Criteria to meet diagnosis of brain death
•Coma
•Unresponsiveness
•Absence of brainstem reflexes
•Apnea
What are the different types of griefs by family members or caregiver? - CORRECT
ANSWER - Anticipatory Grief
•Grief experienced long before the actual death event
Adaptive Grief
•Grief that helps the person accept the reality of death
-Healthy response
-Ability to see good resulting from the death
-Positive memories of the deceased person
Prolonged grief disorder
•Dysfunction reaction to grief
-Recurring and severe distressing emotions and intrusive thoughts
-Self-neglect
, -Denial of loss longer than 6 months
What are the nursing interventions for bone marrow suppression? - CORRECT
ANSWER - Common side effect of chemotherapy and radiation therapy
Can result in life-threatening conditions:
*Neutropenia
*Thrombocytopenia
*Anemia
Nursing Implementation
Neutropenia
*Monitor the patient's CBC panel: neutrophil, platelet, and RBC count
*Monitor for signs and symptoms of infection: fever
*Administer WBC growth factors
Thrombocytopenia
*Monitor for signs and symptoms of bleeding
*Avoid invasive procedures
*See next slide for patient and family education
*Administer platelet transfusion if platelet levels fall below 20,000/uL
Anemia
*Administer RBC growth factors
*Administer packed RBCs
What are the patient and caregiver teaching for thrombocytopenia? ( select all that apply) -
CORRECT ANSWER - 1. Notify your HCP of any symptoms of bleeding.
These include:
• Black, tarry, or bloody bowel movements
