End-Of-Life Care, Family Support - NCLEX Pn
- What is the nurse's priority if an advance directive is found in the chart?
- Ensure the care plan aligns with the documented wishes. Advance directives guide care to respect patient values, preventing conflicts and ensuring ethical practice.
- What is the best nursing action to relieve dry mouth in a dying patient?
- Provide frequent oral care and moisten lips and mucosa. Dry mouth in dying patients results from dehydration or medications, and regular hydration and care prevent discomfort and complications.
- Which medication class is commonly used to reduce terminal secretions?
- Anticholinergics (for example, glycopyrrolate or scopolamine). Anticholinergics dry up excessive secretions by blocking acetylcholine, commonly used to manage noisy breathing in terminal phases.
- Which treatment is still appropriate for a patient with a DNR order?
- Comfort measures and medically indicated treatments not involving CPR. DNR orders limit only resuscitation, allowing other interventions to maintain comfort and treat symptoms.
- What is the primary goal of hospice care for a terminally ill patient?
- Comfort-focused care when cure is not expected. Hospice emphasizes symptom management and emotional support for patients with limited life expectancy, shifting from aggressive treatments to comfort.
- What is the nurse's best action immediately after a patient is pronounced dead?
- Provide privacy, support the family, and begin postmortem care per policy. Post-death actions prioritize dignity, family support, and adherence to institutional protocols for care.
- What does a Do-Not-Resuscitate (DNR) order direct the nurse to withhold?
- CPR and advanced resuscitation if cardiac or respiratory arrest occurs. A DNR order specifies withholding resuscitative efforts to align with patient wishes against prolonging suffering.
- Which option best defines anticipatory grief for family members?
- Grief experienced before the actual death occurs. Anticipatory grief allows family members to process emotions in advance, often triggered by the impending loss of a loved one.
- Which action best supports patient autonomy when discussing end-of-life choices?
- Provide clear information and honor the patient's informed decisions. Autonomy respects the patient's right to self-determination, ensuring decisions are based on accurate information and consent.
- Which option best defines palliative care in end-of-life nursing?
- Care focused on comfort and quality of life; may occur with curative care. Palliative care aims to alleviate suffering and improve well-being for patients with serious illnesses, integrating with curative treatments when appropriate.
- Which statement best reflects therapeutic communication with a grieving family?
- Use silence and open-ended prompts; acknowledge feelings. Therapeutic communication fosters emotional expression and validation, aiding families in processing grief.
- Which sign most strongly suggests decreased perfusion in the actively dying patient?
- Mottling and cool extremities. Mottling and coolness indicate circulatory shutdown as the body prioritizes vital organs in the dying process.
- Which response is best when a family member says, "This is all my fault"?
- "You are feeling guilty. Tell me more about what you are thinking." Acknowledging guilt encourages exploration of emotions, promoting coping and reducing isolation in grief.
- Which opioid adverse effect requires routine prevention in end-of-life care?
- Constipation. Opioids commonly cause constipation due to slowed gastrointestinal motility, necessitating prophylactic measures like stool softeners.
- Which change in breathing pattern is common near death and may include apnea?
- Cheyne–Stokes respirations. Cheyne-Stokes breathing reflects central nervous system changes near death, characterized by cycles of deep breaths and apnea.
- What is the best nursing response to the "death rattle" in a dying patient?
- Reposition and provide oral suction only if secretions are in the mouth. The death rattle is caused by accumulated secretions; interventions minimize distress without invasive measures unless necessary.
- What is the nurse's first action when a family asks to stop life support?
- Clarify goals and verify the patient's wishes and legal decision-maker. Withdrawing life support requires ethical and legal confirmation of patient directives and surrogate authority.
- Which term describes grief that lasts longer and impairs functioning?
- Complicated grief. Complicated grief involves intense, persistent symptoms that disrupt daily life, requiring professional intervention beyond normal grieving.
- Which document names a health care proxy to make decisions if the patient cannot?
- Durable power of attorney for health care. This legal instrument appoints a surrogate to advocate for the patient's preferences when they lack capacity.
- Which intervention is most appropriate for dyspnea at end of life?
- Position upright and give prescribed opioids and oxygen as ordered. Dyspnea management focuses on reducing air hunger through positioning and pharmacological support to enhance comfort.
- Which finding requires reporting before postmortem care due to legal implications?
- Unexplained injury or death that may require medical examiner notification. Legal requirements mandate reporting suspicious circumstances to ensure investigation and prevent oversight.
- Which finding is most consistent with disenfranchised grief?
- Grief not socially recognized or supported. Disenfranchised grief occurs when societal norms minimize the loss, leading to isolation and unsupported mourning.