End Of Life Medications Flashcards
Atropine 1% Opthalmic (PO, SL)
Dilate pupils before eye exams; tx for amblyopia
Atropine injection (IV, SQ, IM)
Given before anesthesia to decrease mucus secretions, like saliva
Scopolamine (Transdermal patch)
Prevent NV post-anesthesia, narcotic pain, medicines and surgery
Lorazepam (PO, IV)
Treat anxiety and sleeping problems
Morphine (PO, IV)
Pain relief, moderate to severe
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
D. Demographic changes in the population
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
D. Ability of technology to prolong life beyond meaningful quality of life
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
A. The patient may be trying to protect loved ones from the emotional effects of the illness
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
A. Administering a lethal dose of medication to a patient whose death is imminent
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
A. To improve the patient’s and family’s quality of life
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
A. Families needs for information and support often go unmet
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
A. The patient and family should be viewed as a single unit of care
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
A. Actual
B. Perceived
C. Psychological
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
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
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
C. Unresolved grief
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
A. Acceptance
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?”
B. “It does seem unfair. Tell me more about how you are feeling.”
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.”
B. “What seems to be concerning you the most?”
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
B. Durable power of attorney for health care
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.”
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.
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
A. Comfort measures only
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
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
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
C. Caregiver role strain
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
B. The nurse sits on the side of the bed of a dying patient, holding the patient’s hand, and crying with the patient
