Free Hospice and Palliative Nurse Questions and Answers — Questions and Answers
Question 1: What traits are connected to Alzheimer's disease?
- A more accelerated decline in older patients
- Slow, irreversible organ failure
- Pre-clinical and symptomatic phases (Correct answer)
- Lewy body deposits
Correct answer: Pre-clinical and symptomatic phases
One kind of dementia called Alzheimer's disease has a known pre-clinical stage during which pathophysiologic alterations start to take place. This stage is followed by a symptomatic stage during which cognitive and functional deterioration becomes apparent. Only Lewy body dementia is linked to lewy body deposits in the brain. The rate of dementia progression is frequently influenced by underlying variables, while some data points to a faster rate of advancement in Alzheimer's patients with early start. The most typical symptoms are discomfort, constipation, and behavioral abnormalities; irreversible organ failure is not one of these symptoms.
Question 2: You are the nurse on call when a continuous care nurse calls to inform you that her patient's wife is quite worried since her patient has started to have "rattling" secretions. You are aware that the patient is actually dying because of the report. What would be the best course of action?
- Suction the patient
- Order oxygen for the patient
- Administer furosemide
- Reposition patient on his side (Correct answer)
Correct answer: Reposition patient on his side
The term "terminal secretions" refers to the noisy, congested breathing that occurs frequently as a person is dying; this breathing is also referred to as the "death rattle". They typically do not bother the patient, but they can be extremely upsetting to family members. To reduce the noise caused by this condition, the patient can be repositioned by being turned on his side. Anticholinergics can also be provided, however their effectiveness is often constrained once the secretions begin.
Question 3: What traits are most frequently linked to end-stage renal disease?
- 10% or less of normal renal function exists; consequence of diabetes (Correct answer)
- Affects Hispanic population disproportionately; symptoms include polyuria
- 20% or less of normal renal function exists; consequence of coronary artery disease
- Consequence of alcohol misuse; only treatment is dialysis
Correct answer: 10% or less of normal renal function exists; consequence of diabetes
Diagnosis of end-stage renal disease (ESRD), which frequently results from diabetes or hypertension, occurs when there is less than 10% of normal renal function. Alcohol abuse or comorbidities like starvation or peripheral vascular disease may be present, but they are not the main causes of the condition. Dialysis and kidney transplantation are both options for treatment. African Americans are more commonly impacted by ESRD than Hispanic ones. Oliguria rather than polyuria is a sign of ESRD.
Question 4: Doris is a 73-year-old patient who has been diagnosed with emphysema and has smoked for 50 years. She has a barrel chest, is quite slender, and occasionally experiences both resting and exertional dyspnea as well as supraclavicular retractions. What non-pharmacologic treatment would most likely help this patient's dyspnea?
- Guided imagery
- Lowering the head of the bed
- Positioning in the tripod position (Correct answer)
- Slow, deep meditative breathing through the nose
Correct answer: Positioning in the tripod position
Due to the extended tension-state of the diaphragm in this position, patients with emphysema may get some relief from dyspnea by leaning forward while sitting and crossing their arms over a table (the "tripod position"). Lowering the head of the bed would probably make dyspnea worse; pursed mouth breathing would be more helpful in reducing dyspnea than deep nose breathing; and although guided imagery may elevate mood, there is no proof that it directly affects dyspnea.
Question 5: Mason is a brand-new heart failure hospice patient. Mason claims to have put on six pounds since being released from the hospital three days ago. Mason reports feeling sick to his stomach and having a bad appetite, and the nurse observes that he has dependent peripheral edema 2+. What is the pathogenesis of Mason's heart disease in light of these findings?
- Decreased ejection fraction
- Generalized organ perfusion failure
- Systolic dysfunction, with poor cardiac output
- Diastolic dysfunction, with poor ventricle filling (Correct answer)
Correct answer: Diastolic dysfunction, with poor ventricle filling
Mason suffers from right-sided (diastolic) heart failure, which causes a widespread edema of the limbs and the hepatic system as a result of inadequate ventricular filling. Nausea, anorexia, peripheral edema, ascites, weakness, and weight gain are signs of right-sided failure. Left-sided heart failure is indicated by poor cardiac output, a reduced ejection fraction, and organ perfusion failure.
Question 6: The first time a nurse encounters a patient. The nurse mentions a number of signs that are alarming for an acute stroke when introducing himself. What signs and symptoms point to an acute stroke?
- Vomiting and dyspnea
- Generalized weakness and dysphagia
- Hyperventilation and bowel incontinence
- Difficulty understanding speech and blurry vision (Correct answer)
Correct answer: Difficulty understanding speech and blurry vision
Aphasia, or the inability to hear or express speech verbally, ataxia, limb or facial paralysis, vision abnormalities, and headaches that may cause vomiting are all symptoms of acute stroke. The additional symptoms don't resemble acute stroke symptoms.
Question 7: Which of the following best represents the suffering that is a "breakthrough"?
- Can occur as end-of-dose failure (Correct answer)
- An aspect of opioid pseudo-addiction
- Associated with pathological fractures
- Refers to a new psychological or spiritual insight
Correct answer: Can occur as end-of-dose failure
Patients with chronic pain may experience brief periods of breakthrough pain. This kind of pain may be brought on by a specific activity, be idiopathic, or result from the failure of a painkiller to provide adequate analgesia. Once a dose requirement is identified, opioid regimens for pain management in hospice and palliative care settings should contain both a long-acting agent and a short-acting agent to treat episodes of breakthrough pain.
Question 8: When a patient is diagnosed with renal cell carcinoma that has metastasized to the liver and is surgically unresectable, which of the following is prescribed?
- Nilotinib
- Temsirolimus (Correct answer)
- Cetuximab
- Fluorouracil
Correct answer: Temsirolimus
Advanced renal cell carcinoma patients are treated with temsirolimus.
Question 9: Michelle is terminally ill from metastatic cancer of the head and neck. Her niece looks after her at home. She has been more agitated and restless during the past 24 hours, often trying to get out of bed and yelling for help. Which category of interventions would Michelle fit into the best right now?
- Dim the lights in Michelle's room; administer haloperidol. (Correct answer)
- Transfer Michelle from home to an inpatient hospice unit; begin IV morphine.
- Raise the head of Michelle's bed; obtain a 24-hour sitter.
- Confine Michelle to bed; discontinue her neuroleptics.
Correct answer: Dim the lights in Michelle's room; administer haloperidol.
Michelle is exhibiting hyperkinetic delirium, which is frequently observed near the end of life, right before unconsciousness. Michelle might feel more at ease and less stimulated by the lights if they are dimmed. For this symptom, haloperidol is frequently used and usually works well. Michelle's symptoms would probably worsen if she was transferred right away; morphine, while sedative, is not the best medication for these symptoms. Michelle shouldn't be confined; stopping her present meds will make her symptoms worse. Michelle may be at danger for falls, thus a sitter is a suitable solution; nevertheless, increasing the head of the bed won't help with these symptoms.
Question 10: As she nears the end of her life, Heidi is receiving care from her spouse and grown children. She has been sleeping 16 to 20 hours a day for the past week, and she is only drinking small amounts of juice and water. Concerned that Heidi has suddenly become aware and made it plain that she needs to get up and line up with those who are waiting for her outside, her daughter contacts the nurse. The family is offended by Heidi's remarks, but Heidi finds solace in them. What kind of intervention would be best for this family?
- Instruct the family to increase the pain medication dose that Heidi is receiving, as this is an indicator of pain
- Instruct the family that speaking in metaphors when patients near end of life is common, and that Heidi may be trying to communicate that she is ready to die. (Correct answer)
- Instruct the family to increase the pain medication dose that Heidi is receiving, as this is an indicator of pain
- Encourage the family to clearly state to Heidi that there are no people outside waiting for her
Correct answer: Instruct the family that speaking in metaphors when patients near end of life is common, and that Heidi may be trying to communicate that she is ready to die.
Describing visions or conversations with others, patients may utilize allegory or metaphors to express end-of-life events. They may also make anticipatory statements about packing, getting ready for a journey, seeing old friends and family, or waiting in line. Although it's plausible that Heidi is experiencing delirium, her behavior and statement do not support raising her pain medication; similarly, disregarding her claims would probably hurt Heidi without yielding any positive results.
Question 11: Ayaan's wife and grown children take care of him at home as he suffers from metastatic pancreatic cancer. At a recent visit, the nurse observes that he is getting closer to the end of his life and that his symptoms have significantly gotten worse. The nurse is aware that discussing death is taboo and is seen as "giving up" by the family according to their spiritual beliefs. After the nurse's evaluation, Ayaan's wife inquires about her husband's condition and joyfully informs the nurse that she believes he is "improving". What would be the nurse's best course of action?
- "Let's call the medical director to give you an update."
- "It's time to begin talking about Ayaan's death."
- "You are not helping Ayaan by avoiding the facts."
- "I wish that I had better news to tell you." (Correct answer)
Correct answer: "I wish that I had better news to tell you."
Expressions like "I wish" and "I had hoped" honor the family's spiritual wishes to avoid having a direct conversation about death while acknowledging the evident changes. It devalues their beliefs about death to confront the wife and accuse her of not being helpful or prepared to talk about death; sending the conversation to the medical director might be beneficial, but it's not the best course of action.
Free Hospice and Palliative Nurse Questions and Answers
What traits are connected to Alzheimer's disease?