Lewis Medical Surgical Ch 9. Palliative
Care Exam with verified questions and
answers 2024
The nurse cares for a terminally ill patient who has 20-second periods of apnea followed
by periods of deep and rapid breathing. Which action by the nurse would be most
appropriate?
a. Suction the patient.
b. Administer oxygen via face mask.
c. Place the patient in high Fowlers position.
d. Document the respirations as Cheyne-Stokes. - ANSWERSANS: d. Document the
respirations as Cheyne-Stokes
Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep
and rapid breaths. Cheyne-Stokes respirations are expected in the last days of life.
There is also no need for supplemental oxygen by face mask or suctioning the patient.
Raising the head of the bed slightly and/or turning the patient on the side may promote
comfort. There is no need to place the patient in high Fowlers position.
The nurse cares for an adolescent patient who is dying. The patient's parents are
interested in organ donation and ask the nurse how the decision about brain death is
made. Which response by the nurse is most appropriate?
a. Brain death occurs if a person is flaccid and unresponsive.
b. If CPR is ineffective in restoring a heartbeat, the brain cannot function.
c. Brain death has occurred if there is no breathing and certain reflexes are absent.
d. If respiratory efforts cease and no apical pulse is audible, brain death is present. -
ANSWERSANS: c. Brain death has occurred if there is no breathing and certain
reflexes are absent.
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.
A hospice patient is manifesting a decrease in all body system functions except for a
heart rate of 124 and a respiratory rate of 28. Which statement, if made by the nurse to
the patients family member, is most appropriate?
a. These symptoms will continue to increase until death finally occurs.
b. These symptoms are a normal response before these functions decrease.
c. These symptoms indicate a reflex response to the slowing of other body systems.
d. These symptoms may be associated with an improvement in the patients condition. -
ANSWERSANS: b. These symptoms are a normal response before these functions
decrease.
, An increase in heart and respiratory rate may occur before the slowing of these
functions in the 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, and it would be inappropriate for the nurse to indicate this to
the family. The changes in pulse and respirations are not reflex responses.
A patient who has been diagnosed with inoperable lung cancer and has a poor
prognosis plans a trip across the country to settle some issues with sisters and brothers.
The nurse recognizes that the patient is manifesting which psychosocial response to
death?
a. Restlessness
b. Yearning and protest
c. Anxiety about unfinished business
d. Fear of the meaninglessness of one's life - ANSWERSANS: c. Anxiety about
unfinished business
The patients statement indicates that there is some unfinished family business that the
patient would like to address before dying. Restlessness is frequently a behavior
associated with an inability to express emotional or physical distress, but this patient
does not express distress and is able to communicate clearly. There is no indication that
the patient is protesting the prognosis, or that there is any fear that the patients life has
been meaningless.
The spouse of a patient with terminal cancer visits daily and cheerfully talks with the
patient about wedding anniversary plans for the next year. When the nurse asks about
any concerns, the spouse says, I'm busy at work, but otherwise, things are fine. Which
nursing diagnosis is most appropriate?
a. Ineffective coping related to lack of grieving
b. Anxiety-related to complicated grieving process
c. Caregiver role strain related to feeling overwhelmed
d. Hopelessness related to knowledge deficit about cancer - ANSWERSANS: a.
Ineffective coping related to lack of grieving
The spouses 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 overwhelmed, hopeless, or anxious.
As the nurse admits a patient with end-stage kidney disease to the hospital, the patient
tells the nurse, If my heart or breathing stops, I do not want to be resuscitated. Which
action is best for the nurse to take?
a. Ask if these wishes have been discussed with the health care provider.
b. Place a Do Not Resuscitate (DNR) notation in the patient's care plan.
c. Inform the patient that a notarized advance directive must be included in the record or
resuscitation must be performed.
Care Exam with verified questions and
answers 2024
The nurse cares for a terminally ill patient who has 20-second periods of apnea followed
by periods of deep and rapid breathing. Which action by the nurse would be most
appropriate?
a. Suction the patient.
b. Administer oxygen via face mask.
c. Place the patient in high Fowlers position.
d. Document the respirations as Cheyne-Stokes. - ANSWERSANS: d. Document the
respirations as Cheyne-Stokes
Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep
and rapid breaths. Cheyne-Stokes respirations are expected in the last days of life.
There is also no need for supplemental oxygen by face mask or suctioning the patient.
Raising the head of the bed slightly and/or turning the patient on the side may promote
comfort. There is no need to place the patient in high Fowlers position.
The nurse cares for an adolescent patient who is dying. The patient's parents are
interested in organ donation and ask the nurse how the decision about brain death is
made. Which response by the nurse is most appropriate?
a. Brain death occurs if a person is flaccid and unresponsive.
b. If CPR is ineffective in restoring a heartbeat, the brain cannot function.
c. Brain death has occurred if there is no breathing and certain reflexes are absent.
d. If respiratory efforts cease and no apical pulse is audible, brain death is present. -
ANSWERSANS: c. Brain death has occurred if there is no breathing and certain
reflexes are absent.
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.
A hospice patient is manifesting a decrease in all body system functions except for a
heart rate of 124 and a respiratory rate of 28. Which statement, if made by the nurse to
the patients family member, is most appropriate?
a. These symptoms will continue to increase until death finally occurs.
b. These symptoms are a normal response before these functions decrease.
c. These symptoms indicate a reflex response to the slowing of other body systems.
d. These symptoms may be associated with an improvement in the patients condition. -
ANSWERSANS: b. These symptoms are a normal response before these functions
decrease.
, An increase in heart and respiratory rate may occur before the slowing of these
functions in the 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, and it would be inappropriate for the nurse to indicate this to
the family. The changes in pulse and respirations are not reflex responses.
A patient who has been diagnosed with inoperable lung cancer and has a poor
prognosis plans a trip across the country to settle some issues with sisters and brothers.
The nurse recognizes that the patient is manifesting which psychosocial response to
death?
a. Restlessness
b. Yearning and protest
c. Anxiety about unfinished business
d. Fear of the meaninglessness of one's life - ANSWERSANS: c. Anxiety about
unfinished business
The patients statement indicates that there is some unfinished family business that the
patient would like to address before dying. Restlessness is frequently a behavior
associated with an inability to express emotional or physical distress, but this patient
does not express distress and is able to communicate clearly. There is no indication that
the patient is protesting the prognosis, or that there is any fear that the patients life has
been meaningless.
The spouse of a patient with terminal cancer visits daily and cheerfully talks with the
patient about wedding anniversary plans for the next year. When the nurse asks about
any concerns, the spouse says, I'm busy at work, but otherwise, things are fine. Which
nursing diagnosis is most appropriate?
a. Ineffective coping related to lack of grieving
b. Anxiety-related to complicated grieving process
c. Caregiver role strain related to feeling overwhelmed
d. Hopelessness related to knowledge deficit about cancer - ANSWERSANS: a.
Ineffective coping related to lack of grieving
The spouses 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 overwhelmed, hopeless, or anxious.
As the nurse admits a patient with end-stage kidney disease to the hospital, the patient
tells the nurse, If my heart or breathing stops, I do not want to be resuscitated. Which
action is best for the nurse to take?
a. Ask if these wishes have been discussed with the health care provider.
b. Place a Do Not Resuscitate (DNR) notation in the patient's care plan.
c. Inform the patient that a notarized advance directive must be included in the record or
resuscitation must be performed.
