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Five end-of-life questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
A nurse is caring for a client who is terminally ill and is inquiring about physician-assisted suicide. Which statement if made by the nurse would correctly inform the client of this practice?
A. The health care provider administers an analgesic at a level that renders the client unconscious.'
B. The health care provider provides the means for the clients to take their life.'
C. The health care provider provides the means and the nurse assists the client in ending their life.'
D. The health care provider provides the means for suicide to clients who require palliative care.'
Show answer and rationale
Correct answer: B — The health care provider provides the means for the clients to take their life.'
Physician-assisted suicide is the practice of providing a means by which a client can end their life. Much controversy exists concerning the practice. California, Vermont, Oregon, Washington, and Montana are the only states that permit physician-assisted suicide. Administering analgesics at a level that renders the client unconscious is referred to as passive euthanasia as it is believed to facilitate death by letting 'nature take its course.' It is different than a provider providing the means for the client to take their own life. The health care provider may provide the means for the client to end their life, but the nurse does not assist the client in the act. Nurse practice prohibit nurses from assisting clients to die. Health care provider-assisted suicide is not considered part of palliative care. Palliative care is an approach that improves the quality of life of those at the end of life. It neither hastens nor postpones death; it provides relief from pain and discomfort, addresses spiritual needs, and provides emotional support to the client and family.
Question 2
A client with appendicitis has had an appendectomy. After surgery, what type of pain does the nurse anticipate the client will have?
A. Acute pain
B. Chronic pain
C. Neuropathic pain
D. Referred pain
Show answer and rationale
Correct answer: A — Acute pain
Acute pain is a discomfort that has a short duration (from a few seconds to less than 6 months). It is associated with tissue trauma, including surgery, or some other recent identifiable etiology. The characteristics of chronic pain, discomfort that lasts longer than 6 months, are almost totally opposite from those of acute pain. An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Referred pain is a term used to describe discomfort that is perceived in a general area of the body, but not in the exact site where an organ is anatomically located.
Question 3
A client comes to the outpatient clinic to receive cortisone injections in the neck for pain that has been occurring consistently for 8 months. What type of pain is this client experiencing?
A. Referred pain
B. Neuropathic pain
C. Acute pain
D. Chronic pain
Show answer and rationale
Correct answer: D — Chronic pain
The characteristics of chronic pain, discomfort that lasts longer than 6 months, are almost totally opposite from those of acute pain. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located. An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Acute pain is a discomfort that has a short duration (from a few seconds to less than 6 months). It is associated with tissue trauma, including surgery, or some other recent identifiable etiology.
Question 4
You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first?
A. Ask if he would like you to sit with him while he collects his thoughts.
B. Tell him that you will leave for now but will be back shortly.
C. Offer to call pastoral care or a member of his chosen clergy.
D. Reassure him that you can understand how he is feeling.
Show answer and rationale
Correct answer: A — Ask if he would like you to sit with him while he collects his thoughts.
The most important intervention the nurse can provide is listening empathetically. Seriously ill patients and their families need time and support to cope with the changes brought about by serious illness and the prospect of impending death. The nurse who is able to listen without judging and without trying to solve the patients and familys problems provides an invaluable intervention. The patient needs to feel that people are concerned with his situation. Leaving him does not show acceptance of his feelings. Offering to call pastoral care may be helpful for some patients, but should be done after you have spent time with the patient. Telling the patient that you understand how he is feeling is inappropriate because it does not help him express his feelings.
Question 5
The nurse asks the client about a reddened area on the left arm. The client reports having been bitten by an insect, and the bite area burned briefly. What type of pain does the nurse document this as?
A. Superficial somatic pain
B. Visceral pain
C. Deeper somatic pain
D. Neuropathic pain
Show answer and rationale
Correct answer: A — Superficial somatic pain
Superficial somatic pain, also known as cutaneous pain (such as that from an insect bite or a paper cut), is perceived as sharp or burning discomfort. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Causes for visceral pain are varied and include ischemia, compression of an organ, intestinal distention with gas, or contraction as occurs with gallbladder or kidney stones. Deeper somatic pain is caused by trauma and produces localized sensations that are sharp, throbbing, and intense. Neuropathic pain is processed abnormally by the nervous system and results from damage to either the pain pathways in peripheral nerves or pain-processing centers in the brain.
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Question 6
You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit?
A. Teach the family the theory of pain management and the use of alternative therapies.
B. Provide psychosocial family support during this emotional experience.
C. Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
D. Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.
Correct answer:
If PCA is to be used in the patients home, the patient and family are taught about the operation of the pump as well as the side effects of the medication and strategies to manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could endanger the patient. Teaching the family the theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication administered by PCA.
Which of the following nursing interventions contributes to achieving a client's pain relief?
A. Minimize the client's description of pain or need for pain relief.
B. Collaborate with the client to set a goal for a level of pain relief.
C. Use all forms of available pain management techniques.
D. Prevent the client from self-administering analgesics.
Correct answer:
The nurse should collaborate with each client to set a goal for a level of pain relief; this helps implement interventions for achieving the goal. The client's description of pain or need for pain relief should never doubted or minimized. The client need not refrain from self-administering analgesics; providing a client with equipment to self-administer analgesics promotes a more consistent level of pain relief. The nurse should also inform the client of available pain management techniques and incorporate any preferences or objections to interventions for pain management that the client may have when establishing a plan of care; using all forms of available pain management techniques is not necessary.
You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patients subsequent care?
A. The patient may want to investigate new alternative pain management options that are outside the United States.
B. The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.
C. The patient may want to increase his exercise and activities significantly to create distractions.
D. The patient may want to relocate to long-term care in order to have his ADL needs met.
Correct answer:
In some situations, especially with long-term severe intractable pain, usual pharmacologic and nonpharmacologic methods of pain relief are ineffective. In those situations, neurologic and neurosurgical approaches to pain management may be considered. Investigating new alternative painmanagement options that are outside the United States is unrealistic and may even be dangerous advice. Increasing his exercise and activities to create distractions is unrealistic when a patient is in intractable pain and this recommendation conveys the attitude that the pain is not real. Moving into a nursing home so others may care for him is an intervention that does not address the issue of pain.
A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, reports pain in the left lower extremity. What type of pain is the client experiencing?
A. Breakthrough pain
B. Neuropathic pain
C. Visceral pain
D. Referred pain
Correct answer:
An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Chronic pain sufferers may have periods of acute pain, which is referred to as breakthrough pain. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located.
A nurse is caring for a client whose death is imminent. The family asks the nurse why there is a rattling in their loved one's chest. What information about this process should the nurse convey?
A. The client's peripheral circulation is impaired, which causes an accumulation of fluid in the lungs.
B. Decreased perfusion to the kidneys causes the body to retain fluid, which builds up in the lungs.
C. There is an accumulation of fluid in the pulmonary circulation and secretions throughout the respiratory tract.
D. Aspiration of oral fluids can cause noisy respirations.
Correct answer:
Failure of the heart's pumping function causes fluid to collect in the pulmonary circulation. Also, there is an accumulation of secretions in the respiratory tract. Both account for noisy respirations or what is called the 'death rattle.' The client's impaired peripheral circulation causes pallor and cold extremities, not fluid accumulation in the lungs. Decreased perfusion to the kidneys causes urine volume to diminish and toxic waste products to accumulate. It does not cause fluid accumulation in the lungs. Aspiration of oral fluids can occur if the client is able to take fluids. However, a client whose death is imminent is not taking oral fluids.
The nurse is caring for a client in the hospital who has been taking an analgesic for pain related to a chronic illness and has developed a tolerance to the medication. What is the appropriate action by the nurse?
A. Inform the client that they will not be able to receive more medication than the health care provider has prescribed.
B. Suggest a consultation with a psychiatrist to treat the client's addiction.
C. Tell the client the nurse will ask the health care provider to prescribe a non-narcotic analgesic.
D. Consult with the prescriber regarding the need for an increased dose of the drug and not to reduce the frequency of administration.
Correct answer:
The most appropriate action by the nurse would be to consult with the physician regarding the need for an increased dose of the drug and not to reduce its frequency of administration. As a rule of thumb, an ineffective dose should be increased by 25% to 50%. Informing the client that they will not be able to receive more medication is not acting as a client advocate nor acting in the best interest of the client. Suggesting a psychiatrist consultation would not be an appropriate action because the client has a chronic illness that requires medication. Taking a non-narcotic analgesic would not provide the client with the pain relief needed.
The nurse caring for a 79-year-old man who has just returned to the medicalsurgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurses management of the patients pain?
A. The elderly may require lower doses of medication and are easily confused with new medications.
B. The elderly may have altered absorption and metabolism, which prohibits the use of opioids.
C. The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication.
D. The elderly may require a higher initial dose of pain medication followed by a tapered dose.
Correct answer:
The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and, therefore, the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors like environment. Opioids are not absolutely contraindicated and confusion following surgery is never normal. Medication should begin at a low dose and slowly increase until the pain is managed.
The client will be using transcutaneous electrical nerve stimulation (TENS) for the treatment of lower back pain. What does the nurse explain to the client that this will do for the back pain?
A. Deliver a burst of electricity to the skin and underlying nerves, decreasing pain
B. Causes decrease in vasodilation to decrease swelling
C. Applies heat to the skin and subcutaneous tissues
D. Interrupts the pain pathways in the spinal cord
Correct answer:
TENS is a pain management technique that delivers bursts of electricity to the skin and underlying nerves. It is safe for managing acute and chronic pain and does not produce systemic side effects or addiction. The electricity is delivered from a battery-operated TENS unit through electrode patches that are placed at appropriate sites, such as directly over the affected area, at areas along a nerve pathway, or at points distal to the painful area. Cold compresses cause decrease in vasodilation. Warm compresses cause heat to the skin and subcutaneous tissues. A cordotomy interrupts the pain pathways in the spinal cord.
A 52-year-old female patient is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the patients pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain?
A. Cancer pain is often related to the stress of the patient knowing she has cancer and requires relatively low dosages of pain medications along with a high dose of anti-anxiety medications.
B. Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention.
C. Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
D. Cancer pain is often misreported by patients because of confusion related to their disease process.
Correct answer:
Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so ubiquitous that when cancer patients are asked about possible outcomes, pain is reported to be the most feared outcome. Higher doses of pain medication are usually needed with cancer patients, especially with metastasis. Cancer pain is not treated with anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction may help, but higher doses of pain medications are usually the best intervention. No research indicates cancer patients misreport pain because of confusion related to their disease process.
A patients rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this patients care, the nurse should identify what primary aim?
A. To prioritize emotional needs
B. To prevent and relieve suffering
C. To bridge between curative care and hospice care
D. To provide care while there is still hope
Correct answer:
Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care goes beyond simple prioritization of emotional needs; these are always considered and addressed. Palliative care is considered a bridge, but it is not limited to just hospice care. Hope is something patients and families have even while the patient is actively dying.
About these Nursing textbooks end-of-life questions
Nursing textbooks end-of-life practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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