EXEMPLAR 3.B END OF LIFE CARE TEST
QUESTIONS AND ANSWERS
The nurse is taking care of a client with terminal lung cancer who is
showing signs of imminent death. What change should the nurse most
expect the client to exhibit first?
A) Decreased blood pressure
B) Blurry vision
C) Confusion
D) Irregular pulse rate
A) Decreased blood pressure
Low blood pressure, or hypotension, occurs as a client's body begins to
near death. This is often accompanied by cool skin and an irregular
pulse rate. Hypotension can lead to blurry vision, as well as confusion
and dizziness; however, etiologies other than low blood pressure may
also be the source of these symptoms. The nurse should most expect
hypotension, potentially presenting with the other signs and symptoms.
A competent older adult client has a living will that expresses the client's
desire to avoid resuscitation and heroic life support measures. The
family members are not supportive of this directive and plan to contest
the living will. Which nursing action is the most appropriate?
A) Place the document on the chart.
B) Contact the Social Services department.
C) Explain to the client that the conflict could invalidate the document.
D) Notify the hospital attorney.
A) Place the document on the chart.
The client is competent. The wishes of the client must take priority. The
document should first be placed on the chart and the provider notified. If
there are concerns about the authenticity of the document, the Social
Services department or the unit supervisor will need to be contacted.
There is no need to notify the hospital attorney at this time. A lack of
support by the family, or a plan to contest, does not invalidate the
document legally.
, The nurse is caring for a client who has suffered a massive cerebral
haemorrhage and is not expected to survive. The client's mother
indicates the client is Catholic. Which intervention is most appropriate?
A) If the nurse is not Catholic, then finding a Catholic nurse to continue
care for the client is necessary.
B) The nurse should contact a priest and ask him what must be done for
the client.
C) The nurse should assume the client's desires based on the nurse's
existing understanding of the Catholic faith.
D) The nurse should ask the client or the client's family what they want in
terms of religious rituals.
D) The nurse should ask the client or the client's family what they want in
terms of religious rituals.
Cultural and religious beliefs and traditions are often of paramount
importance for end-of-life clients and their families. Nurses should work
to facilitate requests to every extent possible. Contacting a priest may be
necessary for the client to receive the Anointing of the Sick, but the
nurse should follow the client's or family's request in this matter. The
nurse doesn't need to find a Catholic nurse to continue care and should
not simply assume what the client wants in this regard.
The nurse is caring for the family of a terminally ill client. The family
members have been tearful and sad since the diagnosis was given.
What is the best nursing diagnosis for this family?
A) Grieving
B) Hopelessness
C) Compromised Family Coping
D) Caregiver Role Strain
A) Grieving
Grieving prior to the actual loss is termed anticipatory grieving. There
are no assessment findings that indicate compromised family coping or
hopelessness. This reaction is typical of family members, so there is no
indication that the family is exhibiting caregiver role strain.
An older adult client with terminal lung cancer is not breathing well and
has cold and mottled skin. The client has a living will and requests
comfort measures only. What should the nurse do to help this client?
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