End Of Life Medications

Question 1

Atropine 1% Opthalmic (PO, SL)

Answer 1

Dilate pupils before eye exams; tx for amblyopia

Question 2

Atropine injection (IV, SQ, IM)

Answer 2

Given before anesthesia to decrease mucus secretions, like saliva

Question 3

Scopolamine (Transdermal patch)

Answer 3

Prevent NV post-anesthesia, narcotic pain, medicines and surgery

Question 4

Lorazepam (PO, IV)

Answer 4

Treat anxiety and sleeping problems

Question 5

Morphine (PO, IV)

Answer 5

Pain relief, moderate to severe

Question 6

In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying?

A. Increased incidence of infections and acute illnesses
B. Increased focus of health care providers on disease prevention
C. Larger numbers of people dying in hospital settings
D. Demographic changes in the population

Answer 6

D. Demographic changes in the population

Question 7

A nurse who works in the speciality of palliative care frequently encounters issues and situation that constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the context of palliative care?

A. The increase in cultural diversity in the US
B. Staffing shortages in health care and questions concerning quality of care
C. Increased costs of health care coupled with inequalities in access
D. Ability of technology to prolong life beyond meaningful quality of life

Answer 7

D. Ability of technology to prolong life beyond meaningful quality of life

Question 8

The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patient’s strategy?

A. The patient may be trying to protect loved ones from the emotional effects of the illness
B. The patient is being noncompliant in order to assert power over caregivers
C. The patient may be skeptical of the benefits of the Western biomedical model of health
D. The patient thinks that treatment does not provide him comfort

Answer 8

A. The patient may be trying to protect loved ones from the emotional effects of the illness

Question 9

A nurse who sits on the hospitals ethics committee is reviewing a complex case that has many of the hallmarks of assisted suicide. Which of the following would be an example of assisted suicide?

A. Administering a lethal dose of medication to a patient whose death is imminent
B. Administering a morphine infusion without assessing for respiratory depression
C. Granting a patients request not to initiate enteral feeding when the patient is unable to eat
D. Neglecting to resuscitate a patient with a do not resuscitate order

Answer 9

A. Administering a lethal dose of medication to a patient whose death is imminent

Question 10

A medical nurse is providing palliative care to a patient with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse’s care?

A. To improve the patients and family’s quality of life
B. To support aggressive and innovative treatments for cure
C. To provide physical support for the patient
D. To help the patient develop a separate plan with each discipline of the health care team

Answer 10

A. To improve the patient’s and family’s quality of life

Question 11

After contributing to the care of several patients who died in the hospital, the nurse has identified some lapses in the care that many of these patients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings?

A. Families needs for information and support often go unmet
B. Patient’s are too sedated to achieve adequate pain control
C. Patient’s are not given opportunities to communicate with caregivers
D. Patients are ignored by the care team toward the end of life

Answer 11

A. Families needs for information and support often go unmet

Question 12

An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?

A. The patient and family should be viewed as a single unit of care.
B. Persistent symptoms of terminal illness should not be treated
C. Each member of the interdisciplinary team should develop an individual plan of care
D. Terminally ill patients should die in the hospital whenever possible

Answer 12

A. The patient and family should be viewed as a single unit of care

Question 13

A nurse midwife is assisting a patient who is firmly committed to natural childbirth to deliver a full-term baby. A cesarean delivery becomes necessary when the fetus displays signs of distress. Inconsolable, the patient cries and calls herself a failure as a mother. The nurse notes that the patient is experiencing what type of loss? SATA.

A. Actual
B. Perceived
C. Psychological
D. Anticipatory
E. Physical
F. Maturational

Answer 13

A. Actual
B. Perceived
C. Psychological

Question 14

A nurse who cared for a dying patient and his family documents that the family is experiencing a period of mourning. Which behaviors would the nurse expect to see at this stage? SATA.

A. The family arranges for a funeral for their loved one
B. The family arranges for a memorial scholarship for their loved one
C. The coroner pronounces the patient’s death
D. The family arranges for hospice for their loved one
E. The patient is diagnosed with terminal cancer
F. The patient’s daughter writes a poem expressing her sorrow

Answer 14

A. The family arranges for a funeral for their loved one
B. The family arranges for a memorial scholarship for their loved one
F. The patient’s daughter writes a poem expressing her sorrow

Question 15

A nurse interviews an 82-year-old resident of a long-term care facility who says that she has never gotten over the death of her son 20 years ago. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. What type of grief is this woman experiencing?

A. Somatic grief
B. Anticipatory grief
C. Unresolved grief
D. Inhibited grief

Answer 15

C. Unresolved grief

Question 16

A home health care nurse has been visiting a patient with AIDS who says, “I’m no longer afraid of dying. I think I’ve made my peace with everyone, and I’m actually read to move on.” This reflects the patient’s progress to which stage of death and dying?

A. Acceptance
B. Anger
C. Bargaining
D. Denial

Answer 16

A. Acceptance

Question 17

A nurse is visiting a patient with pancreatic cancer who is dying at home. During the visit, he breaks down and cries, and tells the nurse that it is unfair that he should have to die now when he’s finally made peace with his family. Which response by the nurse would be most appropriate?

A. “You can’t be feeling this way. You know you are going to die.”
B. “It does seem unfair. Tell me more about how you are feeling.”
C. “You’ll be all right; who knows how much time any of us has.”
D. “Tell me about your pain. Did it keep you awake last night?”

Answer 17

B. “It does seem unfair. Tell me more about how you are feeling.”

Question 18

A nurse is caring for a terminally ill patient during the 11 pm to 7 am shift. The patient says, “I just can’t sleep. I keep thinking about what my family will do when I am gone.” What response by the nurse would be most appropriate?

A. “Oh, don’t worry about that now. You need to sleep.”
B. “What seems to be concerning you the most?”
C. “I have talked to your wife and she told me she will be fine.”
D. “I’m not qualified to advise you, I suggest you discuss this with your wife.”

Answer 18

B. “What seems to be concerning you the most?”

Question 19

A patient tells a nurse that he would like to appoint his daughter to make decisions for him should he become incapacitated. What should the nurse suggest he prepare?

A. POLST form
B. Durable power of attorney for health care
C. Living will
D. Allow natural death (AND) form

Answer 19

B. Durable power of attorney for health care

Question 20

A hospice nurse is caring for a patient who is terminally ill and who is on a ventilator. After a restless sight, the patient hands the nurse a note with the request: “Please help me end my suffering.” Which response by a nurse would best reflect adherence to the position of the American Nurses Association (ANA) regarding assisted suicide?

A. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient’s death.
B. The nurse tells the patient that under no condition can he be removed from the ventilator because this is active euthanasia and is expressly forbidden by the Code for Nurses.
C. After exhausting every intervention to keep a dying patient comfortable, the nurse says, “I think you are now at a point where I’m prepared to do what you’ve been asking me. Let’s talk about when and how you want to die.”
D. The nurse responds: “I’m personally opposed to assisted suicide, but I’ll find you a colleague who can help you.”

Answer 20

A. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient’s death.

Question 21

A patient diagnosed with breast cancer who is in the end stages of her illness has been in the medical intensive care unit for 3 weeks. Her husband tells the nurse that he and his wife often talked about the end of her life and that she was very clear about not wanting aggressive treatment that would merely prolong her dying. The nurse could suggest that the husband speak to his wife’s health care provider about which type of order?

A. Comfort measures only
B. Do not hospitalize
C. Do not resuscitate
D. Slow code only

Answer 21

A. Comfort measures only

Question 22

A nurse is preparing a family for a terminal weaning of a loved one. Which nursing actions would facilitate this process? SATA.

A. Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support.
B. Explain to the family what will happen at each phase of the weaning and offer support.
C. Check the orders for sedation and analgesia, making sure that the anticipated death is comfortable and dignified
D. Tell the family that death will occur almost immediately after the patient is removed from the ventilator
E. Tell the family that the decision for terminal weaning of a patient must be made by the PCP
F. Set up mandatory counseling sessions for the patient and family to assist them in making this end-of-life decision

Answer 22

A. Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support.
B. Explain to the family what will happen at each phase of the weaning and offer support.
C. Check the orders for sedation and analgesia, making sure that the anticipated death is comfortable and dignified

Question 23

A premature infant with serious respiratory problems has been in the NICU for the last 3 months. The infant’s parents also have a 22-month-old son at home. The nurse’s assessment data for the parents include chronic fatigue and decreased energy, guilt about neglecting the son at home, shortness of temper with one another, and apprehension about their continued ability to go on this way. What human response would be appropriate for the nurse to document?

A. Grieving
B. Ineffective coping
C. Caregiver role strain
D. Powerlessness

Answer 23

C. Caregiver role strain

Question 24

A nurse is caring for a terminally ill patients in a hospital setting. Which nursing action describes appropriate end-of-life care?

A. To eliminate confusion, the nurse takes care not to speak too much when caring for a comatose patient
B. The nurse sits on the side of the bed of a dying patient, holding the patient’s hand, and crying with the patient
C. The nurse refers to a counselor the daughter of a dying patient who is complaining about the care associate with articulacy feeding her father
D. The nurse tells a dying patient to sit back and relax and performs patient hygiene for the patient because it is easier than having the patient help

Answer 24

B. The nurse sits on the side of the bed of a dying patient, holding the patient’s hand, and crying with the patient

Question 25

A nurse is providing postmortem care. Which nursing action violates the standards of caring for the body after a patient has been pronounced dead and is not scheduled for an autopsy?

A. The nurse leaves the patient in the sitting position while the family visits
B. The nurse places identification tags on both the shroud and the ankle
C. The nurse removes soiled dressings and tubes
D. The nurse makes sure a death certificate is issued and signed

Answer 25

A. The nurse leaves the patient in the sitting position while the family visits

Question 26

The family of a patient who has just died asks to be alone with the body and asks for supplies to wash the body. The nurse providing care knows the mortician usually washes the body. Which response would be most appropriate?

A. Inform the family that there is no need for them to wash the body since the mortician typically does this
B. Explain that hospital policy forbids their being alone with the deceased patient and that hospital supplies are to be used only by hospital personnel
C. Give the supplies to the family but maintain a watchful eye to make sure that nothing unusual happens
D. Provide the requested supplies, checking if this request is linked to their religious or cultural customs and asking if there is anything else you can do to help

Answer 26

D. Provide the requested supplies, checking if this request is linked to their religious or cultural customs and asking if there is anything else you can do to help

Question 27

A 70-year old patient who has had a number of strokes refuses further life-sustaining interventions, including artificial nutrition and hydration. She did competent, understands he consequences of her actions, is not depressed, and persists in refusing treatment. Her health care provider is adamant that she cannot be allowed to die this way, and her daughter agrees. An ethics consult has been initiated. Who would be the appropriate decision maker?

A. The patient
B. The patient’s daughter
C. The patient’s health care provider
D. The ethics consult team

Answer 27

A. The patient

Question 28

The nurse cares for a client from/who practices Jehova witness, who is a minor on hospice care. What statement by the client would cause concern?

A. “I am not ready to die, why can’t I choose to be treated?”
B. “This is God’s plan for me”
C. “I am at peace”

Answer 28

A. “I am not ready to die, why can’t I choose to be treated?”

Question 29

A charge nurse observes a newly hired nurse performing postmortem care. Which observation requires the nurse to intervene?

A. Keep foley in the patient when bagging
B. Removes all drains and tubes before bagging
C. Labels and bags all patient belongings
D. Places patient supine in anatomical position in body bag

Answer 29

A. Keep foley in the patient when bagging

Question 30

A patient arrives to ER post MVA, with severe head trauma. Nurse anticipates critical care, when should the nurse ask the family about an Advance Directive?

A. After physician evaluated patient
B. Before surgical procedures
C. Upon admission
D. Before discharge

Answer 30

C. Upon admission

Question 31

The nurse cares for a client who is experiencing the anger stage of grief. What statement by the patient would indicate they are in this stage?

A. “Why me? I quit smoking and ate healthy”
B. “This is not the correct diagnosis, check again!”
C. “I lived this long and I never had a child”
D. “I can go in peace now that I called my family”

Answer 31

A. “Why me? I quit smoking and ate healthy”

Question 32

The nurse assesses a client who has been in the hospital for 72-hours with multiple comorbidities and was just pronounced dead. What is the priority nursing action?

A. Call family
B. Contact the coroner
C. Call the morgue
D. Contact the social worker

Answer 32

B. Contact the coroner

Question 33

The nurse instructs a newly hired nurse about Advance Directives. Which statement by the new hire indicates additional teaching is needed?

A. Advance Directive must always be notarized
B. Advance Directives can designate alternate agents
C. SNF patient requires a special witness

Answer 33

A. Advance Directive must always be notarized

Question 34

The nurse evaluates a client’s response to morphine. What should the nurse consider as the priority assessment?

A. Respiratory status
B. Pain level
C. Temperature
D. Heart rate

Answer 34

B. Pain level

Question 35

Which of the following assessments would indicate a bad/poor death?

A. Advance Directive was followed by healthcare team
B. Family was not called
C. 0/10 pain
D. Support and teaching was given to the family

Answer 35

B. Family was not called

Question 36

Which patient would require a coroners investigation?

A. 15-year old who died in the ER
B. 87-year old who died in hospice care
C. 65-year old who died after battling cancer for 5 years
D. 97-year old who died…

Answer 36

A. 15-year old who died in the ER

Question 37

An end-of-life patient’s family member voices concern about the patient’s increase in rattling, gurgling, and breathing. What is the best medication to administer?

A. Morphine
B. Atropine
C. Lorazepam
D. Haloperidol

Answer 37

B. Atropine

Question 38

The nurse assesses a client’s Glasgow Coma Score of 15. How should the nurse document this finding?

A. Patient is asleep and unresponsive
B. Patient needs to be intubated right away
C. Patient is alert, responsive and cooperative
D. Patient responds to sounds only

Answer 38

C. Patient is alert, responsive and cooperative

Question 39

The nurse cares for a client who is experiencing the second stage of grief. What statement by the client is represented by this stage?

A. “Why is this happening to me?”
B. “Maybe the physician mixed up my results”

Answer 39

A. “Why is this happening to me?”

Question 40

The nurse prepares to administer a prescribed dose of morphine to a client with hospice care only orders. In which situation would the nurse hold the medication?

A. Respirations below 12
B. Heart rate below 60
C. Difficulty breathing
D. Do not hold, administer medication

Answer 40

D. Do not hold, administer medication

Question 41

A nurse is assessing the understanding of a POLST. Which statement is correct?

A. Patient states, “DNR means I will be intubated”
B. Both my PCP and I must sign this correct?
C. This POLST form replaces my advance directive
D. This form expires in 1 year

Answer 41

B. Both my PCP and I must sign this correct?

Question 42

The nurse reviews newly written prescriptions for a client admitted on hospice. Which prescription should the nurse question?

A. Atropine 1-2 drops PO sublingual Q4H PRN
B. Scopolamine transdermal patch daily
C. Heparin 20,000 units SQ daily
D. Morphine IVP 0.2 mg/kg Q4H PRN

Answer 42

C. Heparin 20,000 units SQ daily

Question 43

The nurse is treating a client who has been diagnosed and admitted to hospice with terminal diagnosis of metastasized cancer and has 1 month left to live. What is the priority intervention for this patient?

A. To only provide relief of symptoms associated with their disease and the dying process
B. To improve the patient and family’s quality of life
C. To help the patient develop a separate plan with each discipline of the health care team
D. To encourage the patient to engage in aggressive and innovative treatment for a cure

Answer 43

A. To only provide relief of symptoms associated with their disease and the dying process

Question 44

The nurse prepares to teach a client with terminal cancer about the POLST document. Which statement by the client causes concern?

A. I don’t want to sign something that I can’t change later on
B. I am going to sign this form with my PCP
C. I am voluntarily signing this form
D. I can change my decisions regarding this document verbally or written

Answer 44

A. I don’t want to sign something that I can’t change later on