End of Life Issues

The patient with a terminal illness wishes not to receive heroic measures to prolong her life should her heart stop beating. The nurse encourages the patient to sign which document to ensure her wishes are followed?

A patient with stage IV breast cancer is admitted for palliative radiation. Which of the following is the most appropriate goal of treatment for this patient?

The nurse is assessing an elderly patient for possible mild cognitive impairment (MCI). Which of the following is the most efficient screening tool for MCI?

Which term refers to the legal document that grants another person the right to make health care decisions for a person if they lack the ability to make the decisions themselves?

The nurse is assessing an elderly patient whose husband died 9 months ago. Which indicates ineffective coping with his death?

The nurse is planning to have a discussion with a patient regarding their terminal illness and end of life issues. Which of the following is the most appropriate setting in which to have this discussion?

The terminally-ill patient with chronic obstructive pulmonary disease (COPD) is in a hospice. He says to the nurse, “I know I will die soon. I would feel at peace knowing my organs and tissues will be able to help other people after I’m gone. Which response by the nurse is most appropriate?

The nurse is performing a psychosocial assessment on an 84-year-old male in a hospice. The patient says, “I have had a good life. My children are grown and successful, and I was a successful businessman.” How does the nurse document this patient’s psychosocial development?

An unconscious patient presents to the emergency department following a benzodiazepine overdose and is noted to have the words, “Do Not Resuscitate,” tattooed across the chest. Which action by the medical team is most appropriate?

A terminally ill patient has attempted to commit suicide by swallowing an entire bottle of opioid pain medication.The patient is brought to the emergency department and found to have a “Do Not Resuscitate” tattoo on her chest along with a handwritten note that states that she is tired of suffering and wishes her life to end. Which next step by the medical team is most appropriate?

The nurse is assessing the 75-year-old female patient whose spouse died unexpectedly six months ago. Which statement by the patient reflects ineffective coping mechanisms?

Following a motor vehicle accident, the patient is unable to make his wishes known and is close to death without immediate and extensive treatment. The patient’s girlfriend, who he has been living with for the last five years, wants the medical team to do everything possible to save him. The patient’s wife, who he left when he moved in with his girlfriend, states she would not like any lifesaving measures and will sign the Do-Not-Resuscitate (DNR) paperwork. The medical team looks to which entity for decision-making?

A nurse is assigned to care for a terminally ill patient who is of the orthodox Jewish faith. The nurse anticipates the patient will have which opinion of organ donation?

The patient who is admitted for surgery for resection of a malignant lung tumor has a living will. In addition to making sure a copy of the living will is included with the patient’s electronic medical record, which action does the nurse take?

The patient requiring mechanical ventilation is dying of tuberculosis and is responsive only to tactile and painful stimulation. The family would like to give him holy water to drink in order to have peace in the afterlife. Which response by the nurse is most appropriate?

The family of a patient who is dying expresses a desire to feed him a traditional fruit and herb paste to ensure that his soul can have peace in the afterlife in accordance with their religious beliefs. The patient is NPO due to the risk of aspiration and is unable to make his wishes known due to decreased cognition. Which action by the nurse is most appropriate?

A patient with a documented Do Not Resuscitate (DNR) order suddenly develops pulseless ventricular tachycardia. Which intervention by the nurse is most appropriate?

A patient with a signed Do Not Resuscitate (DNR) order suddenly becomes unresponsive and goes into cardiac arrest. His wife, who is his healthcare power of attorney, starts yelling hysterically, “Do everything you can! Save him! I don’t care that he didn’t want to be resuscitated, he would want to live for me!” Which action by the nurse is best?

The patient’s family requests a second opinion after being told the patient will never regain consciousness following a motor vehicle accident. The family is exhibiting which of the Kubler-Ross stages of grief?

The older adult patient is brought to the emergency department with sudden onset confusion, agitation, and hallucinations. The patient's past medical history is significant for type 2 diabetes managed with glyburide, anxiety managed with lorazepam, and insomnia managed with zolpidem. Upon assessment, the patient's heart rate and rhythm are regular, lungs are clear to auscultation, and bowel sounds are present. Vital signs are normal, with exception of a slightly elevated heart rate. Which is the most likely cause of the patient's symptoms?

The patient who recently lost her young child to acute lymphoblastic leukemia (ALL) tells the nurse that she is having trouble handling the grief and feels like she is to blame for her child’s death. Which response by the nurse is most appropriate? 

The man who lost his wife and child to a drunk driving accident one year ago is receiving care in a behavioral health unit. The patient tells the nurse that he has begun to feel better and feels like he is ready for release. Which statement indicates the patient should remain in the unit?

The older adult patient with dementia wants her eldest son to make healthcare decisions on her behalf when her condition worsens. The nurse instructs the patient to complete which form? 

The nurse is admitting an 89-year-old man with end stage liver disease. He declines a palliative care consult saying, “I’m not dying today.” Which responses by the nurse are appropriate to counsel the patient? Select all that apply.

The nurse receives report that the patient will undergo brain death testing and is aware the patient must meet which criteria to be diagnosed with brain death? Select all that apply.

The extremely low birth weight neonate born at 22 weeks gestation is not expected to live through the night. The family has described to the nurse the importance of their church and Christian faith. Which action by the nurse demonstrates the nurse's ability to recognize and address the family's grief? 

The patient with terminal cancer was placed on hospice care; although he has deteriorated, he is still alive after 6 months. How is the patient’s hospice care affected?

The patient receiving hospice care reports constant, severe dry mouth. Which interventions does the nurse include in the patient's care plan? Select all that apply.

The patient with dementia has experienced unintentional weight loss of 20 pounds due to decreased food intake. The patient's caregiver asks the nurse about nutritional drinks and shakes. Which response by the nurse is most appropriate?

The nurse is sitting with a family whose matriarch died within the last hour. The family is exhibiting which form of grief?

When is palliative care most appropriate?

Which patients are seen first in the hospital following a mass casualty event?

The nurse is discussing palliative care with the patient with metastatic colorectal cancer. The patient responds, "I'm not ready to give up. I want to keep fighting this disease." Which response from the nurse is most appropriate? 

The grown child of an elderly woman with dementia is trying to provide his mother with in-home hospice. The caregiver providing in-home hospice for the elderly patient with dementia reports nearly constant verbal and physical abuse at the hands of the patient including degrading talk, biting, and scratching. How does the nurse manage this situation?

The nurse is caring for a patient who was just pronounced dead. The patient’s adult children are with the patient. Which is the best response by the nurse to the family?

The nurse is caring for a patient transitioning to hospice care and completing his admission assessment. Which question will help the nurse most effectively attend to his spiritual needs?

The nurse is evaluating the arterial blood gas results of the patient on hospice with the following respiratory pattern: The patient’s PaCO₂ is 62 mm Hg, which is 20 mm Hg higher than the previous ABG. The nurse understands the patient’s blood gas was drawn at which period in the patient’s respiratory cycle?

The patient in the intensive care unit who was intubated with a central venous catheter, peripheral arterial catheter, and chest tube has expired. Which question by the nurse who enters the room to assist the patient care nurse is most appropriate?

The nurse is providing post-mortem care to a patient on hospice after being treated for stage 4 colon cancer that metastasized to the bladder. Which action by the nurse is most appropriate?

A bodybuilder is brought to the emergency room after being found unresponsive. The patient is found to have no brain activity due to hypoxia caused by a massive myocardial infarction. Care is withdrawn and the patient passes away. Which statements does the nurse make to the nursing student who is assisting in providing post-mortem care? Select all that apply.

The family of the dying Buddhist patient requests to burn incense in the patient’s hospital room for a religious ceremony. Which response by the nurse is most appropriate?

The nurse caring for a dying patient of the Buddhist faith approaches the charge nurse in distress to state, “My patient is going to die at any time and the family is nowhere near him. I’m not sure what to do to ensure he is not alone as he passes.” Which response by the charge nurse is most appropriate?

The baby born at 23-weeks-gestation is 6 hours old when a pneumothorax develops and the patient decompensates rapidly. Despite stabilization of the airway and evacuation of the pneumothorax, the baby is not responding to chest compressions and intravenous epinephrine and is deemed unlikely to survive. The parents request the baby to be baptized before life-saving interventions are ceased. The chaplain is called but is unable to make it to the hospital immediately. Which action by the nurse is most appropriate?