NCLEX questions End-of-Life Care Questions and Answers with verified solutions

NCLEX questions End-of-Life Care Questions and Answers with verified solutions 1. The home health nurse encourages the older adult to file an advance directive to indicate: a. the degree of intervention desired for life support. b. who is to manage medical decisions in case of debilitating illness. c. who will manage finances in case of debilitating illness. d. the mortuary to be used in the case of death. - ANS- vANS: A Advance directives indicate the degree of interventions desired for life support in the case of a terminal illness. DIF: Cognitive Level: Analysis REF: 244 OBJ: 1 TOP: Advance Directives KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 1. The nurse is aware that end-of-life planning is often neglected because __________. (Select all that apply.) a. there is a clear procedure to follow b. people are uncomfortable talking about death c. young people do not see the need for end-of-life planning d. end-of-life planning is a relative new concept e. many persons are not really sure what they want to do - ANS- ANS: B, C, D, E The options are so numerous that there is not any one clear line of action to follow. End-of-life planning is a relatively new concept that the older generation did not experience in their youth. Persons are reluctant to talk about death issues, especially young persons, who do not see the need. DIF: Cognitive Level: Analysis REF: 243-244 OBJ: 1 TOP: End-of-Life Planning KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 10. The nurse notes that a cardiovascular sign of impending death is: a. Cheyne-Stokes respiration. b. bounding pulse. c. bluish mottling of extremities. d. widening pulse pressure. - ANS- ANS: C As death approaches, there is vasoconstriction to the extremities to keep blood going to the heart and brain. This causes mottling of the extremities. Bounding pulse and widening pulse pressure are not seen in the dying person. Cheyne-Stokes respirations are changes seen in the respiratory system, not the cardiovascular system. DIF: Cognitive Level: Application REF: 252 OBJ: 6 TOP: Cardiovascular Changes of Approaching Death KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. The nurse shares the information that the benefits of dehydration for persons near death are __________. (Select all that apply.) a. better gas exchange because of reduction of fluid in the lungs b. decreased need to suction because of reduction of respiratory secretions c. improved bowel elimination because of reduced bulk in the stool d. decreased pain related to release of endorphins e. improved drug distribution via the circulating volume - ANS- ANS: A, B, D Bowel elimination and drug distribution are both reduced when the patient is dehydrated. DIF: Cognitive Level: Analysis REF: 253-254 OBJ: 6 TOP: Dehydration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. A resident in the long-term care facility has just expired at 2 AM, and the family is on the way to say their last goodbyes. Before the arrival of the family, the nurse should __________. (Select all that apply.) a. remove equipment (e.g., IV poles and tubing, feeding tubes, oxygen equipment) b. dress the resident in a clean gown and cover him or her with a clean sheet c. remove dentures d. apply a diaper to catch draining body fluids e. provide privacy by drawing the curtain or moving the other resident to an unoccupied room - ANS- ANS: A, B, D, E Removing the dentures give the face an unnatural appearance. All the other activities are appropriate to prepare the resident and environment after death. DIF: Cognitive Level: Application REF: 255-256 OBJ: 6 TOP: After-Death Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 11. The nurse emphasizes that the objective of pain control for the dying patient is to: a. keep the patient unconscious and relaxed to avoid the perception of pain. b. delay medication until the patient reports that the pain is intense. c. find a control level that reduces pain but allows the patient to interact. d. eradicate pain completely. - ANS- ANS: C Finding a level of pain control that allows the patient to participate in care and communicate with family is the goal of pain control. Analgesics given before pain becomes intense can keep pain at a moderate level. Completely eradicating pain is usually not realistic. DIF: Cognitive Level: Comprehension REF: 251 OBJ: 6 TOP: Pain Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The daughter of a dying patient is distressed about oversedation related to her mothers receiving 2 mg of morphine sulfate every hour. The nurse clarifies that this small dose of morphine is helpful in controlling the end-of-life symptom of: a. dyspnea. b. pain. c. hallucinations. d. fatigue. - ANS- ANS: A Administering frequent, small doses of morphine sulfate is standard protocol to reduce end-of- life air hunger. One dose is not enough for euthanasia. DIF: Cognitive Level: Application REF: 253 OBJ: 6 TOP: Dyspnea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. While working with the bereaved at the time of death, the nurse should __________. (Select all that apply.) a. review the stages of dying with them b. ensure privacy c. observe cultural and spiritual preferences d. legally pronounce the death e. allow the bereaved to express their feelings - ANS- ANS: B, C, E Reviewing the stages of dying should have been addressed before the death. The physician is the individual who legally pronounces the death. Assuring privacy will allow the bereaved to say final farewells and grieve. Observing cultural and spiritual preferences will prevent the bereaved from being offended. DIF: Cognitive Level: Application REF: 255 OBJ: 7 TOP: Bereavement KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The role(s) of the nurse while working with the bereaved include __________. (Select all that apply.) a. guidance b. resource c. advocacy d. support e. spiritual counseling - ANS- ANS: A, B, C, D Individuals are brought in as requested to meet the spiritual needs of the bereaved. The role of the nurse includes guiding the bereaved as to what needs to be done, serving as a resource for information related to death and dying, being an advocate for the deceased and their family to make requests known related to cultural and spiritual preferences, and supporting the need for privacy and emotional release at the time of death. 13. To reduce the threat of aspiration in the unconscious patient who is near death, the nurse should: a. perform deep tracheal suctioning of the patient every hour. b. place the patient in a side-lying position, with the head turned to the side. c. slightly elevate the foot of the bed, with the patient in a supine position. d. give the patient only thickened fluids - ANS- ANS: B Side-lying is a safe position for reducing the threat of aspiration. The supine position is not appropriate for aspiration reduction. Frequent suctioning is stressful to the patient, and fluids are never attempted for an unconscious patient. DIF: Cognitive Level: Application REF: 254 OBJ: 6 TOP: Aspiration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 14. The nurse questions the order for a bulk-forming laxative for the person who is near death because the patient would need a minimum fluid intake of _____ mL to tolerate this type of drug. a. 1000 b. 1500 c. 2000 d. 2500 - ANS- ANS: C To prevent a bowel obstruction from bulk-forming laxatives, the patient must have a fluid intake of at least 2000 mL a day. DIF: Cognitive Level: Knowledge REF: 254 OBJ: 6