Gerontological Nurse Test End-of-Life Care and Palliative Nursing 1 — Questions and Answers
Question 1: Which document allows an older adult to designate a person to make healthcare decisions on their behalf if they become incapacitated?
- Living will
- Durable power of attorney for healthcare (healthcare proxy) (Correct answer)
- Do Not Resuscitate (DNR) order
- POLST form
Correct answer: Durable power of attorney for healthcare (healthcare proxy)
A durable power of attorney for healthcare designates a specific individual as the healthcare proxy to make medical decisions when the patient lacks decision-making capacity.
Question 2: The primary goal of hospice care for an older adult with a terminal illness is to:
- Aggressively treat the underlying disease to extend life
- Provide comfort-focused care to maximize quality of life (Correct answer)
- Ensure the patient dies in a hospital setting
- Limit family involvement to reduce emotional distress
Correct answer: Provide comfort-focused care to maximize quality of life
Hospice care is a philosophy and service that focuses on comfort, symptom management, and quality of life rather than curative treatment, supporting both patient and family.
Question 3: An older adult patient with terminal cancer rates their pain as 8/10. The nurse administers the ordered PRN morphine. This action reflects which principle of palliative care?
- Autonomy in decision-making
- Aggressive symptom management to promote comfort (Correct answer)
- Hastening death to relieve suffering
- Limiting opioid use due to addiction risk in older adults
Correct answer: Aggressive symptom management to promote comfort
In palliative care, effective and timely symptom management—including adequate analgesia—is a core ethical obligation to maintain patient comfort and dignity.
Question 4: A nurse is discussing advance directives with an older adult patient. The POLST (Physician Orders for Life-Sustaining Treatment) form differs from a living will in that POLST:
- Is a legal document requiring a notary
- Is a physician order that is actionable across all healthcare settings (Correct answer)
- Can only be completed by patients with dementia
- Designates a healthcare proxy for decision-making
Correct answer: Is a physician order that is actionable across all healthcare settings
POLST is a physician order that translates patient wishes into actionable medical orders honored across all care settings, unlike a living will which is a legal directive that must be interpreted.
Question 5: Which symptom is most common and distressing for older adults in the final days of life that requires active nursing management?
- Hypertension
- Pain and dyspnea (Correct answer)
- Hyperglycemia
- Increased appetite
Correct answer: Pain and dyspnea
Pain and dyspnea are the most prevalent and distressing symptoms at end of life, and their proactive management is a central nursing responsibility in end-of-life care.
Question 6: The nurse notes that a dying patient's respirations have become irregular with periods of apnea. The nurse recognizes this pattern as:
- Kussmaul respirations indicating metabolic acidosis
- Cheyne-Stokes respirations, a normal end-of-life change (Correct answer)
- Biot's respirations indicating neurological emergency
- Tachypnea requiring immediate oxygen therapy
Correct answer: Cheyne-Stokes respirations, a normal end-of-life change
Cheyne-Stokes respirations—cyclic periods of increasing then decreasing breathing depth with apneic episodes—are a normal physiologic sign of imminent death as brain stem regulation declines.
Gerontological Nurse Test End-of-Life Care and Palliative Nursing 1
Which document allows an older adult to designate a person to make healthcare decisions on their behalf if they become incapacitated?