End of Life Care

The nurse is caring for an unresponsive terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing. Which action would the nurse take?

Document the patient‘s respiratory pattern.

The nurse is caring for a dying adolescent patient who is comatose. The patient‘s parents are interested in organ donation and ask the nurse how the health care providers determine brain death. Which response by the nurse accurately describes brain death determination?

“Brain death has occurred if there is not any breathing or brainstem reflexes.”

A patient in hospice is manifesting a decrease in all body system functions except for a heart rate of 124 beats/min and a respiratory rate of 28 breaths/min. Which statement would be accurate for the nurse to make to the patient‘s family?

“These vital signs are an expected response now but will slow down later.”

A patient who has been diagnosed with inoperable lung cancer and has a poor prognosis plans a trip across the country “to settle some issues with family members.” The nurse recognizes that the patient is manifesting which psychosocial response?

Anxiety about unfinished business

A patient with terminal cancer is being admitted to a family-centered inpatient hospice. The patient‘s spouse visits daily and cheerfully talks with the patient about wedding anniversary plans for the next year. When the nurse asks about any concerns, the spouse says, “I‘m busy at work, but otherwise things are fine.” Which issue would the nurse identify as a concern in working with the patient‘s spouse?

Difficulty coping

As the nurse admits a patient in end-stage renal disease to the hospital, the patient tells the nurse, “If my heart or breathing stop, I do not want to be resuscitated.” Which action should the nurse take first?

Ask if the decision has been discussed with the patient‘s health care provider.

A young adult patient with metastatic cancer who is very close to death appears restless. The patient keeps repeating, “I am not ready to die.” Which action by the nurse would show respect for the patient?

Sit at the bedside and ask if there is anything the patient needs.

The nurse is caring for a terminally ill patient who is experiencing continuous and severe pain. How would the nurse schedule the administration of opioid pain medications?

Plan around-the-clock routine administration of prescribed analgesics.

The nurse is caring for a patient with lung cancer in a home hospice program. Which action would the nurse implement?

Encourage the patient to discuss past life events and their meanings.

A hospice nurse who has become close to a terminally ill patient is present in the home when the patient dies and feels saddened and tearful as the family members begin to cry. Which action would the nurse take at this time?

Cry along with the patient‘s family members.

A middle-aged patient tells the nurse, “My mother died 2 months ago. I have been thinking about all the good times we shared together every day.” Which type of grief is the patient describing?

Adaptive grief

The son of a dying patient tells the nurse, “Mother doesn‘t respond any more when I visit. I don‘t think she knows that I am here.” Which response would the nurse provide?

“Withdrawal can be a normal response in the process of dying.”

Which patient would the nurse refer for hospice care?

A 40-yr-old patient with AIDS-related dementia who needs pain management

The nurse admits a terminally ill patient to the hospital. Which action would the nurse plan to complete first?

Determine the patient‘s wishes about end-of-life care.

Which action would the nurse take first when admitting an alert, terminally ill patient who is from a different culture than the nurse?

Ask the patient and family about their preferences for care during this time.