Gerontological Nurse Test End-of-Life Care and Palliative Nursing 2 — Questions and Answers
Question 1: A family member asks the nurse why their dying parent is no longer accepting food or water. The most accurate and therapeutic response is:
- 'We need to start IV fluids immediately to prevent dehydration.'
- 'Decreased intake is a natural part of the dying process and does not cause suffering.' (Correct answer)
- 'Your parent is giving up on life and we must encourage them to eat.'
- 'This is a sign that death is weeks away and you should prepare.'
Correct answer: 'Decreased intake is a natural part of the dying process and does not cause suffering.'
Decreased appetite and fluid intake in the active dying phase are normal physiologic changes; the body no longer needs nutrition and forced feeding can increase discomfort.
Question 2: Which pharmacological intervention is most commonly used to manage the death rattle (noisy breathing) in the final hours of life?
- Nebulized albuterol
- Glycopyrrolate (Robinul) or hyoscine (scopolamine) (Correct answer)
- Oral antihistamines
- High-dose diuretics
Correct answer: Glycopyrrolate (Robinul) or hyoscine (scopolamine)
Anticholinergic agents such as glycopyrrolate or scopolamine reduce secretions causing the death rattle, improving comfort for the patient and reducing distress for families present.
Question 3: A patient at end of life expresses spiritual distress and asks the nurse, 'Why is God doing this to me?' The nurse's most therapeutic response is to:
- Offer a theological explanation of suffering
- Listen attentively, acknowledge the distress, and offer to arrange a chaplain visit (Correct answer)
- Reassure the patient that God has a plan
- Change the subject to discuss physical symptoms
Correct answer: Listen attentively, acknowledge the distress, and offer to arrange a chaplain visit
Acknowledging spiritual distress and facilitating access to chaplaincy is within nursing scope; imposing theological interpretations or dismissing the concern is inappropriate.
Question 4: Under the Medicare Hospice Benefit in the United States, a patient must have a life expectancy of how long to qualify for hospice enrollment?
- 3 months or less
- 6 months or less if the disease runs its natural course (Correct answer)
- 1 year or less
- 2 years or less
Correct answer: 6 months or less if the disease runs its natural course
Medicare Hospice Benefit requires physician certification that the patient has a life expectancy of 6 months or less if the terminal illness follows its normal course.
Question 5: The nurse understands that providing adequate opioid analgesia to a dying patient may secondarily hasten death. This ethical concept is known as:
- Active euthanasia
- The principle of double effect (Correct answer)
- Physician-assisted suicide
- Beneficent deception
Correct answer: The principle of double effect
The doctrine of double effect justifies an action with a good intended outcome (pain relief) even if a foreseeable but unintended secondary effect (hastened death) may result.
Question 6: Which physical sign indicates that death is likely within hours for an older adult patient receiving end-of-life care?
- Mild confusion in the morning that resolves by afternoon
- Mottling of the knees and lower extremities with cool, clammy skin (Correct answer)
- Decreased appetite for 24 hours
- A request to speak with family members
Correct answer: Mottling of the knees and lower extremities with cool, clammy skin
Mottling (livedo reticularis) of the extremities with cool, clammy skin reflects circulatory shutdown and peripheral vasoconstriction, indicating death is imminent within hours.
Gerontological Nurse Test End-of-Life Care and Palliative Nursing 2
A family member asks the nurse why their dying parent is no longer accepting food or water.
The most accurate and therapeutic response is: