Preview Extract
Chapter 17
1. Several visitors are in the room of a terminally ill patient. The health care provider enters
the room to discuss the plan of care for the patient. Which of the following should be done to
ensure the patient’s privacy?
1. Ask the patient which individuals he or she would like to have stay in the room.
2. Sit down next to the patient and discuss the plan.
3. Ask the other patient in the room to increase the volume of the television.
4. Stand at the foot of the patient’s bed and tell all present the best course of action.
Answer: Ask the patient which individuals he or she would like to have stay in the room.
Rationale:
The health care provider should ask the patient which individuals he or she would like to
have stay in the room. Individuals have a right to privacy, and caregivers have a duty to
respect the confidentiality of patient information. Any discussion regarding the patient’s
diagnoses, consultation, examination, and treatment should be conducted discreetly. The
health care provider should not assume that everyone in the room is supposed to hear the plan
of care, nor should the health care provider ask the patient’s roommate to increase the volume
of the television to drown out the discussion. Sitting next to the patient does not necessarily
ensure privacy.
2. A nurse recognizes that the purpose of palliative care is to provide comprehensive care
focused on:
1. Alleviating suffering and promoting quality of life.
2. Decreasing pain and prevention of medical complications.
3. Controlling side effects of illness while postponing death.
4. Withdrawing all medical care to allow natural death.
Answer: Alleviating suffering and promoting quality of life.
Rationale:
The purpose of palliative care is to provide comprehensive care focused on alleviating
suffering and promoting quality of life. Medical complications can be controlled but not
prevented. The purpose is not specifically to postpone death. Withdrawing all medical care
would be inappropriate, as it would cause more suffering.
3. A terminal patient with a fulminating leg wound needs surgery, yet there is no guarantee
the patient will survive the procedure. The nurse realizes that which of the following actions
would support the ethical principle of beneficence?
1. Do not conduct the surgery and determine other treatment approaches.
2. Conduct the surgery.
3. Explain that the surgery is needed and every effort will be done to keep the patient alive.
4. Tell the patient that offering surgery was an error and that treatment will be done with
medications and therapy.
Answer: Do not conduct the surgery and determine other treatment approaches.
Rationale:
Beneficence means to do or promote good. It is different from nonmaleficence, or the duty to
not inflict harm. It is sometimes difficult when caring for patients to distinguish between
preventing harm and providing benefit. The surgery should not be conducted and other
treatment options should be determined; when the duty not to inflict harm conflicts with the
duty to provide benefit, there is support for the view that the obligation not to injure others is
greater than the obligation to benefit them. Patients at the end of their lives may be vulnerable
to harm when they receive unwanted or unnecessary interventions, are overtreated with
technological interventions that serve only to prolong dying, and when treatments are
withdrawn without their consent or agreement. The surgery should not be done with the
promise of keeping the patient alive. The statement that the offer of surgery was a mistake
should not be made to the patient.
4. A patient tells the nurse that he has a paper that outlines everything that he does and does
not want to be done regarding his health should he be unable to make his own health care
decisions. The nurse realizes this patient is describing:
1. Advance directives.
2. A will.
3. A durable power of attorney.
4. A care plan.
Answer: Advance directives.
Rationale:
Advance directives are a part of the Patient Self-Determination Act and provide directives
and directions regarding the amount and degree of care the patient would want in the event he
is unable to communicate. A will is created to direct survivors as to what to do with the
person’s possessions after death. A durable power of attorney is a mechanism for the patient
to appoint an individual who is responsible for making health care decisions for the patient if
the patient is incapacitated. A care plan identifies care that the patient is to receive.
5. The family of an incapacitated patient desires one course of treatment that is against the
decisions of the person with durable power of attorney. What should the nurse do?
1. Provide care according to the decisions of the person with durable power of attorney.
2. Ask the physician to talk with the family and the person with durable power of attorney.
3. Follow the family’s desires.
4. Tell the person with durable power of attorney that he has to get the family’s consent.
Answer: Provide care according to the decisions of the person with durable power of
attorney.
Rationale:
The nurse should provide care according to the decisions of the person with durable power of
attorney. A durable power of attorney for health care allows the patient to appoint a decision
maker in the case of future incapacity. The durable power of attorney specifically states
which powers the patient gives to the surrogate decision maker, and those decisions are to be
followed even when in conflict with family members’ desires. The appointed person
responsible for making medical decisions does not need consent from other family members
or friends.
6. A competent terminally ill client has completed a living will that expresses the desire to
avoid resuscitation and heroic life support measures. The family members are not supportive
of this directive. Which of the following actions by the nursing staff is most appropriate when
family members share with staff that they are not supportive of the client’s decision?
1. Facilitate a discussion regarding the directives between the client and family.
2. Contact the social services department to revisit the issue with the client.
3. Clarify the legality of the document with the hospital attorney.
4. Explain to the family that the conflict with the client’s wishes could invalidate the
document.
Answer: Facilitate a discussion regarding the directives between the client and family.
Rationale:
Facilitating a discussion regarding the directives between the client and family is the correct
option since it allows for discussion of the client’s wishes with all interested parties being
present. The client is competent, so his or her directives will take priority. It is not necessary
to contact social services or the attorney. The client’s living will is not invalidated by a
conflict with the family’s concerns.
7. A nurse is providing an in-service on do-not-resuscitate (DNR) orders to a group of newly
hired graduate nurses. Which of the following statements made by one of the group members
indicates to the nurse a need for further teaching?
1. “Do-not-resuscitate orders are a form of euthanasia.”
2. “My nursing license is safe as long as I follow facility polices regarding a DNR.”
3. “A do-not-resuscitate order is an example of a client’s right to autonomy.”
4. “Do-not-resuscitate orders may be rescinded if the client wishes.”
Answer: “Do-not-resuscitate orders are a form of euthanasia.”
Rationale:
Do-not-resuscitate orders are not a form of euthanasia, and this statement would indicate the
need for follow-up by the nurse conducting the in-service. The other responses indicate an
understanding of DNR orders.
8. A dying patient is having a build-up of carbon dioxide in the blood. Which of the following
interventions would help make this patient more comfortable?
1. Allow the build-up of carbon dioxide to continue.
2. Provide oxygen.
3. Raise the head of the bed.
4. Place the patient in a side-lying position.
Answer: Allow the build-up of carbon dioxide to continue.
Rationale:
Allowing hypoxia is the fastest path to unconsciousness with the least amount of agitation.
Withdrawal of some treatments may actually assist the patient to be more comfortable. The
patient should not be provided with oxygen nor should the head of the bed be elevated.
Placing the patient in a side-lying position may or may not help with the patient’s comfort.
9. The nurse is preparing an analgesic infusion for a cancer patient who is in pain and is
nearing the end of life. Which of the following should the nurse do to ensure this patient’s
comfort?
1. Titrate the medication to help with pain relief and not hasten the dying process.
2. Use Meperidine for the infusion.
3. Contact the pharmacy for the correct dose to provide the patient.
4. Limit the amount of medication infused.
Answer: Titrate the medication to help with pain relief and not hasten the dying process.
Rationale:
The nurse should titrate the medication to reduce the patient’s pain but not hasten the dying
process. Meperidine is not recommended for pain because it could cause seizures. The patient
may have been receiving pain medication for cancer treatment and may have some tolerance
to the medication. There is no set dosage for pain medications at the end of life.
10. A patient is experiencing delirium. Which of the following groups of medication should
the nurse consider administering to help decrease delirium?
1. Neuroleptics
2. Opioids
3. Benzodiazapines
4. NSAIDs (nonsteroidal anti-inflammatory drugs)
Answer: Neuroleptics
Rationale:
Neuroleptics such as Haldol help decrease symptoms of delirium. Opioids and
benzodiazepines can worsen signs of delirium. NSAIDs are helpful to treat inflammation,
pain, and fever rather than delirium.
11. A patient of the Jewish faith died on a Friday evening. The nurse realizes this patient most
likely will be buried:
1. On Sunday.
2. On Saturday.
3. After 2 or 3 days.
4. Only after the completion of the autopsy.
Answer: On Sunday.
Rationale:In the Jewish faith, the Sabbath is observed from sundown on Friday until sundown
on Saturday. Since the patient died on Friday, the first available day to bury the patient will be
on Sunday. A requirement to wait 2 or 3 days to bury the patient is not a part of the Jewish
faith. Autopsy is forbidden in the Jewish faith. If an autopsy is required, it should be limited
to essential organs or systems. All body parts must be returned for burial.
12. The family of a Vietnamese patient is grieving after the death of their family member.
Which of the following will the family most likely plan to do at the time of the patient’s
death?
1. Wash the body of the deceased family member.
2. Shout at the nurse to leave them alone to grieve.
3. Stare at anyone who comes into the patient’s room.
4. Place a special amulet on the patient’s body.
Answer: Wash the body of the deceased family member.
Rationale:
The family may want to wash the body of the deceased person because the body is highly
respected. In the Vietnamese culture, a loud voice is a sign of disrespect, and avoiding eye
contact is a sign of respect. The Chinese place special amulets or cloths on the body of a
deceased person.
13. A client of American Indian descent suffers a massive cerebral hemorrhage and is not
expected to survive. Which of the following interventions by the nursing staff would be
appropriate when attempting to observe this client’s religious and cultural traditions?
1. Provide the family’s spiritual healer with privacy for death rituals.
2. Offer the family unlimited access to their dying family member.
3. Discuss the possibility of transferring the client home for the death.
4. Make it possible for the family to assist in the care of the dying family member.
Answer: Provide the family’s spiritual healer with privacy for death rituals.
Rationale:
Providing the family’s spiritual healer with privacy for death rituals is appropriate since
American Indian end-of-life practices are often guided by these tribal members. The
remaining options do not reflect traditional American Indian death practices.
14. A patient tells the nurse that he has to go home to die because he cannot afford to pay for
the hospital care. The nurse realizes this patient would benefit from the aid of which of the
following providers?
1. Social worker
2. Physician
3. Spiritual advisor
4. Pharmacist
Answer: Social worker
Rationale:
Interdisciplinary collaboration means the knowledge and expertise of health care providers,
nurses, social workers, spiritual counselors, dietitians, aides, and volunteers are all brought
together to help meet the patient’s and family’s needs. The patient is concerned with financial
arrangements, which could best be addressed by the social worker.
15. A terminally ill patient has been discharged to go home, but the patient lives alone and has
limited resources. Which of the following is the most appropriate action by the nurse?
1. Coordinate a meeting with the physician, social worker, and other health professionals to
facilitate the postdischarge care for this patient.
2. Suggest to the health care provider that the patient stay in the hospital.
3. Instruct the patient to return to the emergency department at the first sign of distress.
4. Locate a skilled nursing facility that could accept the patient.
Answer: Coordinate a meeting with the health care provider, social worker, and other health
professionals to facilitate the postdischarge care for this patient.
Rationale:
Interdisciplinary collaboration means the knowledge and expertise of health care providers,
nurses, social workers, spiritual counselors, dietitians, aides, and volunteers are all brought
together to help meet the patient’s needs. The patient lives alone and is terminally ill and will
need assistance with coordination of care and resources. Due to the patient’s financial
concerns, the nurse should not plan to transfer the patient to a skilled facility nor suggest that
the patient be kept in the hospital. The nurse should not simply discharge the patient with the
instructions to return to the emergency department if in distress.
16. A client hospitalized for diagnostic cancer testing reports an intense fear of dying from
cancer. Which of the following responses by the nurse would be most appropriate?
1. “What has your doctor told you about your condition?”
2. “There is no indication from the testing that you are going to die.”
3. “Most forms of cancer are treatable and have good recovery rates.”
4. “What makes you feel that you are going to die now?”
Answer: “What has your doctor told you about your condition?”
Rationale:
Asking the client, “What has your doctor told you about your condition?” is the correct
option because it facilitates an opportunity for the nurse to have a discussion with the client
related to the client’s concerns. Until the nurse understands the client’s knowledge of his or
her condition, the other responses are premature.
17. The brother of a terminally ill client states, “I’ll donate a million dollars to the hospital if
they cure my brother.” The nurse realizes this statement is indicative of which phase of
Kubler-Ross’s loss stages?
1. Bargaining
2. Denial
3. Anger
4. Acceptance
Answer: Bargaining
Rationale:
Bargaining is an attempt to postpone or in some way affect the reality of the loss. The brother
is not expressing denial or acceptance and does not appear to be angry.
18. A client who is a recent widow states, “I wanted to ask him for a divorce and then he
died.” The nurse realizes this client is at risk for:
1. A dysfunctional grief reaction.
2. Accelerated grief reaction.
3. A typical grief reaction process.
4. Psychosomatic disorders.
Answer: A dysfunctional grief reaction.
Rationale:
A dysfunctional grief reaction is one that is affected by factors that interfere with a successful
grieving reaction, such as an ambivalent relationship with the deceased.
The client’s comment is not indicative of either a typical grief reaction process or an
accelerated grief reaction. There is no indication the client is at risk for a psychosomatic
disorder.
19. A patient asks the nurse what it means to have hospice care at home. Which of the
following is the most correct response to this patient?
1. “Hospice makes sure that you are comfortable at home.”
2. “Hospice care helps cure your illness.”
3. “Hospice care is for patients who will be sick for longer than a year.”
4. “Hospice care means your physical needs will be met.”
Answer: “Hospice makes sure that you are comfortable at home.”
Rationale:
Hospice care focuses on comfort care versus curative care. Hospice care includes an
interdisciplinary team of health care providers including physicians, nurses, social workers,
spiritual counselors, dieticians, home health aides, and volunteers. The care plan includes
both the patient and family/caregiver as the unit of care, and the care plan is written to meet
their values and goals. Patients receiving hospice care are generally defined as those patients
who have a prognosis of 6 months or less if their terminal disease runs a normal course.
20. A dying patient tells the nurse that he is disappointed in how his life has gone and is
anxious about dying. Which of the following would be beneficial for this patient?
1. Determine if this patient is eligible for hospice care.
2. Ask the physician for an increase in pain medication.
3. Facilitate an earlier discharge to home.
4. Discuss options to transfer this patient to a skilled facility.
Answer: Determine if this patient is eligible for hospice care.
Rationale:
This patient is demonstrating existential suffering, which includes hopelessness,
disappointment, remorse, and death anxiety. Hospice addresses suffering at all levels and
realizes that relieving suffering is critical to achieving a “good death.” There is no evidence
to suggest this patient would benefit from an increase in pain medication. This patient may or
may not be stable enough to return to home. There is no evidence to suggest this patient
needs to be admitted to a skilled facility.
21. While discussing the discharge of a terminally ill client, the client’s wife asks for
information concerning arranging for hospice care. What initial action by the nurse is most
appropriate?
1. Provide the client’s wife with a list of contact numbers for hospice agencies.
2. Assist the family with making contact with a hospice prior to discharge.
3. Determine the client’s life expectancy to decide when contact with hospice is appropriate.
4. Explain to the wife that hospice care is effective only when death is imminent.
Answer: Provide the client’s wife with a list of contact numbers for hospice agencies.
Rationale:
Providing the client’s wife with a list of contact numbers for hospice agencies is the correct
option because it initiates the process of identifying the most appropriate care agency, and
may lead to assisting the family in making contact with the agency. It is not necessary to
determine life expectancy before providing the contact information the wife has requested.
Hospice care is effective prior to imminent death.
22. A patient with a chronic illness asks the nurse if the new medication is going to cure his
disease. Which of the following is the nurse’s best response?
1. “It will help you be more comfortable. I don’t think it’s going to cure the disease.”
2. “Of course it’s going to cure the disease.”
3. “If you believe it will cure the disease, then it will.”
4. “I don’t think it’s going to help or hurt at this time.”
Answer: “It will help you be more comfortable. I don’t think it’s going to cure the disease.”
Rationale:
In palliative care, the nurse needs to be honest with the patient and therefore explain that the
medication will help with comfort, but will not cure. The nurse should not approach care as
curative, as this could rob the patient of time and closure at the end of life. The nurse has no
way of knowing the effect of the medication as far as helping or hurting the patient’s illness.
23. The nurse is planning palliative care for a patient with severe atherosclerotic disease.
Which of the following would be of the highest priority for this patient?
1. Pain and symptom management
2. Financial resource utilization
3. Tolerance of physical activity
4. Redesign of the patient’s home to support assistive devices
Answer: Pain and symptom management
Rationale:
When providing care to patients in a palliative care program, targeted interventions are
common and include pain and symptom management, end-of-life care planning, and
interventions to support the patient’s psychosocial and spiritual needs. Finances, physical
activity, and home environment are not a high priority at this time.
24. Which of the following nursing interventions follows the principles of palliative care?
1. Talk to the patient about plans for funeral arrangements.
2. Encourage physical therapy to restore prior level of functioning.
3. Talk to the patient about the possibility of becoming an organ donor.
4. Facilitate a consult to promote weight gain.
Answer: Talk to the patient about plans for funeral arrangements.
Rationale:
Palliative care needs focus on pain and symptom management, end-of-life planning, and
psychosocial as well as spiritual needs. Encouraging end-of-life planning such as funeral
plans would be very appropriate. Encouraging weight gain is not necessary, and attempting to
return to a prior level of functioning is not the goal. Organ donation is only possible when a
patient experiences brain death on life support. This is also not the goal in hospice care.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
