Palliative and End-of-Life Care
Solved Exam Questions
Course Introduction
Palliative and End-of-Life Care explores the principles and practices involved in caring for individuals with life-limiting illnesses and their families. The course covers the assessment and management of physical, emotional, social, and spiritual needs, emphasizing patient-centered, compassionate approaches to improve quality of life. Ethical and legal considerations, communication strategies for difficult conversations, and interdisciplinary teamwork are also examined, preparing students to deliver holistic and culturally sensitive care during advanced illness, dying, and bereavement.
Recommended Textbook
Ebersole and Hess Gerontological Nursing and Healthy Aging in Canada 2nd Edition by Theris A.
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26 Chapters
314 Verified Questions
314 Flashcards
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2
Chapter 1: Introduction to Healthy Aging
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17 Verified Questions
17 Flashcards
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Sample Questions
Q1) Mrs.McCloud, 70 years old, lives in Attawapiskat and speaks mostly Cree.She is transferred to a hospital in a larger city in Ontario for hemodialysis.While Mrs.M.is in hospital, what should the nurse take into account when developing nursing interventions based on health promotion?
A)Instruct the older person to monitor her fluid intake on an hourly basis.
B)Demonstrate, through pictures, how to eat a healthy, well-balanced diet.
C)Ask the older person about her home and how she accesses health care.
D)Ask the older person why she did not seek help sooner, to prevent the need for hemodialysis.
Answer: C
Q2) Historical influences that have shaped the lives of the majority of the middle-old in Canada today include which of the following?
A)Influenza epidemic of 1918
B)Immigration from Communist Europe
C)Child-rearing during the Depression
D)World War II
Answer: D
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Page 3
Chapter 2: Gerontological Nursing History, Education, and Roles
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Sample Questions
Q1) Leadership in long-term care settings requires balancing the needs of the residents with the well-being of the staff.The turnover rate of Health Care Aides (HCAs) in long-term care facilities is almost 100%.You are working in a long-term care facility and have identified that whenever a particular HCA is unhappy with an assignment, the entire unit has a bad day.Which action should the unit nurse take first to correct this situation?
A)Meet with the HCA to find out why the HCA is so unhappy.
B)Place the HCA on probation for the negative behaviour.
C)Discuss with the HCA the perceived attitude and the way it affects the unit.
D)Suspend the HCA until the behaviour improves.
Answer: C
Q2) What was the first formal action taken by the Canadian Gerontological Nursing Association (CGNA) in relation to gerontological nursing?
A)The CGNA established the first provincial gerontological nursing association.
B)The CGNA established gerontological nursing standards.
C)The CGNA created the Canadian Association of Older Adults.
D)The CGNA formed the Canadian Association of Gerontology.
Answer: B
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Chapter 3: Communicating With Older Persons
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Sample Questions
Q1) An older male person who wears a hearing aid waits in the radiology department.The department is busy and noisy, so the nurse asks the patient if he wants to wait or reschedule the appointment.Which of the following is the most important strategy for the nurse to implement for effective communication with this man?
A)Face the man while sitting at his level.
B)Speak with him in a private, quiet setting.
C)Verify that the information is understood.
D)Ask if hearing is better in one ear or another.
Answer: B
Q2) Dysarthria is defined by which of the following descriptions?
A)Dysarthria is difficulty in coming up with the correct word.
B)Dysarthria is difficulty in physically producing the sounds of speech.
C)Dysarthria is difficulty in speaking when the person is thinking about what to say.
D)Dysarthria is difficulty in understanding speech.
Answer: B
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Chapter 4: Culture, Ethnicity, and Aging
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Sample Questions
Q1) The health care provider discusses the need for surgery with an older person and her family.Which information about the older person's culture is important for the nurse to collect before this discussion to facilitate the process of informed consent?
A)Attitudes about caregiving
B)Process of decision making
C)Rituals for death and dying
D)Experience with discomfort
Q2) Which of the following statements is true about differing health belief systems?
A)Personalistic or magicoreligious beliefs have been replaced in Western minds by biomedical principles.
B)In most cultures, older persons are likely to treat themselves using traditional methods before turning to biomedical professionals.
C)Ayurvedic medicine is another name for traditional Aboriginal medicine.
D)The belief that health depends on maintaining a balance among opposite qualities is characteristic of a magicoreligious belief system.
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Chapter 5: Nursing Documentation
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Sample Questions
Q1) Which of the following is a true statement about documentation?
A)Nurses should keep records of patients' wishes.
B)Patients do not have access to their own medical records.
C)The DARE approach is a complete record of the health status of a patient.
D)The nurse is responsible for completing all of the Minimum Data Set (MDS).
Q2) Mrs.Smadu, who is 80 years of age, was recently admitted to a long-term care setting.Over the past month, Mrs.Smadu appears to be deteriorating.She does not wish to eat, sleeps all the time, and is not able to participate in any of her activities of daily living.Which of the following assessment tools will help inform and guide comprehensive care and planning for this older person?
A)Clinical Assessment Protocols (CAPs)
B)Continuing Care Reporting System (CCRS)
C)Resident Assessment Instrument (RAI)
D)Utilization Guide (UG)
Q3) In Canada, advance directives (advanced care planning) falls under which jurisdiction?
A)Federal
B)Provincial/territorial
C)Municipal
D)Health care agency/provider
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Chapter 6: Biological Theories and Physical Changes of Aging
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Sample Questions
Q1) The nurse cares for an older person who appears to be malnourished and short of breath and has an infection in a large wound on his coccyx.Which intervention is the nurse's priority?
A)Monitor temperature and leukocytes.
B)Provide assistance with meal planning.
C)Provide high-quality protein in the diet.
D)Maintain oxygen saturation above 95%.
Q2) Which theory of aging suggests that the adverse physical effects of aging result from gradual loss of control mechanisms in the pituitary and hypothalamus?
A)Free radical theory
B)Programmed theory
C)Stochastic theory
D)Neuroendocrine theory
Q3) Which change in the skin is abnormal in an older person?
A)Thinner and more fragile skin
B)A tear in the skin after being assisted with transferring from the bed
C)Mottled pigmentation and greater number of freckles
D)Loss of hair on the extremities
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Chapter 7: Social, Psychological, Spiritual, and Cognitive Aspects of Aging
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Sample Questions
Q1) The nurse observes older female adults learning advanced knitting techniques.The nurse concludes that this is a suitable learning activity for these women because it accomplishes which goal?
A)It helps to maintain joint flexibility.
B)It improves the group's cohesiveness.
C)It provides a needed social opportunity.
D)It adds to their existing knowledge base.
Q2) Which alterations in roles are most likely to have a significant effect on the type of aging process experienced by the older person?
A)Being a grandparent and church member
B)Losing employment or a spouse
C)Being a friend and patient
D)Being a parent and volunteer
Q3) Crystallized intelligence consists of:
A)Memories created more than 20 years ago.
B)Knowledge and abilities that the person acquires through education and life.
C)Skills that are biologically determined.
D)Education acquired through post-secondary education.
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Chapter 8: Nutritional Needs
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Sample Questions
Q1) The nurse is trying to improve the nutritional status of older persons in a nursing home.Which one of the following recommendations should the nurse implement?
A)Develop a seating chart for the main dining room, based on unit, to facilitate a more organized and efficient meal delivery.
B)Replace the fluorescent lighting with candles at every table, to create a cozier, restaurant-like atmosphere.
C)Provide nutritious food according to the older persons' expressed food preferences, with liberal use of seasonings.
D)Distribute "nutritional liquid supplements" such as Ensure.
Q2) The following nursing interventions represent the four steps of a nutritional assessment.Which one would be the final step in the nutritional assessment?
A)Measure the midpoint of the upper arm.
B)Obtain blood for biochemical serum examination.
C)Examine the lips, gums, oral cavity, and skin turgor.
D)Obtain a detailed weight history.
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Chapter 9: Hydration and Continence
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Sample Questions
Q1) Which one of the following signs and symptoms is characteristic of a urinary tract infection (UTI) in an older person?
A)Fever
B)Dysuria
C)Anorexia
D)Flank pain
Q2) Which one of the following is part of a program for addressing bowel incontinence in an older person?
A)Place the older person on the toilet or commode first thing upon wakening.
B)Provide a diet containing 2 g of fibre and 1000 mL of water each day.
C)Expect a rapid and full recovery of continence of the bowel.
D)Provide patient teaching about exercises to strengthen abdominal and pelvic floor muscles.
Q3) Which one of the following increases the risk for chronic dehydration in older persons?
A)Overuse of diuretics
B)Poor cognitive function
C)Dry mucous membranes
D)Fluid loss from vomiting
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11
Chapter 10: Rest, Sleep, and Activity
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Sample Questions
Q1) Which of the following is important to include in the initial assessment for older persons who are frail and are beginning an exercise program?
A)Exercise tolerance testing (ETT)
B)The older person's financial ability to pay for training sessions
C)A medical history and physical examination
D)Pulmonary function tests (PFTs)
Q2) Which of the following statements is true about sleep in older persons?
A)The time spent in bed increases, but the time spent asleep decreases.
B)The amount of leg movement during sleep remains steady throughout life.
C)Rapid-eye-movement (REM) sleep increases with age.
D)The amount of stage III sleep increases steadily throughout life.
Q3) Which factor contributes to sleep problems in older persons?
A)Excessive napping
B)Daily exercise
C)Lethargy
D)Rapid eye movement (REM)
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Chapter 11: Promoting Healthy Skin and Feet
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Sample Questions
Q1) Which of the following topical agents is safe to apply?
A)Corn starch, to absorb moisture in the groin area
B)Betadine, to disinfect a healing pressure ulcer
C)An over-the-counter preparation, to dissolve a corn
D)Zinc oxide ointment to an area of excoriation
Q2) The nurse monitors for which of the following clinical indicators when an older person complains of pruritus?
A)Dry, flaky skin
B)Brown macule
C)Brownish skin
D)Regional edema
Q3) Which of the following statements is true about foot care for older persons with diabetes?
A)A health care aide is qualified to care for the feet of a diabetic patient, including trimming the patient's nails.
B)Onychomycosis is eradicated quickly with antifungal creams or powders.
C)Toenails should be cut to give a smooth, rounded edge.
D)Tinea pedis is treated with topical application of antifungal powders.
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Chapter 12: Maintaining Mobility and Environmental Safety
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Sample Questions
Q1) Driving cessation has been associated with which of the following?
A)Decreased social integration
B)Decreased income
C)Increase in falls
D)More prescription medications
Q2) An older male adult was oriented and responded correctly in the hospital, but he is disoriented and confused in his home after discharge.Which is the first issue the home nurse should examine to determine if an environmental issue is contributing to the patient's condition at home?
A)Complaints of shivering
B)Temperature of the household
C)Types of food preparation
D)Patient indicators of injury
Q3) The nurse is assessing an older person in order to plan for fall screening prevention.What information should the nurse gather for the plan of care?
A)Information about the environment in hospital and at home
B)The patient's emotional status
C)The patient's financial status
D)The patient's occupational history
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Chapter 13: Assessment Tools in Gerontological Nursing
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Sample Questions
Q1) The nurse assesses an older female adult in midmorning and, in a normal-toned voice, asks her, "Do you walk to the library to borrow books?" How should this nurse improve an assessment of an older person?
A)Assess her earlier in the day.
B)Get this data from the family.
C)Use a soft voice for questions.
D)Ask her how she obtains books.
Q2) Why should a new nurse use a standardized assessment tool?
A)It allows for electronic data collection and analysis.
B)It increases the likelihood of collecting the most accurate data.
C)It is a substitute for possessing refined interviewing skills.
D)It provides an automated means of choosing nursing diagnoses.
Q3) Which assessment tool is the most comprehensive exam of an older person's functional status?
A)Katz Index
B)Fulmer SPICES
C)The Functional APGAR Evaluation Tool
D)The Older Americans Resources and Services (OARS) instrument
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Chapter 14: Safe Medication Use for Older Persons
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Sample Questions
Q1) The relationship of biological rhythms to variations in the body's response to drugs is known as chronopharmacology.When caring for an older person with asthma, what information would help guide the nurse in planning the time to administer medication to the patient?
A)The asthma is most distressing before bedtime.
B)The asthma is most distressing at midday.
C)The asthma is most distressing between 0400 and 0500 hours.
D)The asthma is most distressing after performing activities of daily living.
Q2) Which of the following processes is not increased in the early morning?
A)Fibrinolytic activity
B)Osteoarthritis pain
C)Asthma symptoms
D)Rheumatoid arthritis pain
Q3) In speaking with an older person, which question is likely to elicit the most accurate information about the individual's adherence to the medication plan?
A)"You take digoxin (Lanoxin) at the correct time, don't you?"
B)"Why didn't you take all of your digoxin (Lanoxin) last month?"
C)"How many doses of digoxin (Lanoxin) do you think you missed?"
D)"You have never missed a dose of digoxin (Lanoxin), have you?"
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Page 16
Chapter 15: Living With Chronic Illness
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Sample Questions
Q1) Which one of the following describes the nurse's role for an older patient with a chronic illness?
A)Implement an individualized therapeutic regimen that brings about a cure.
B)Focus on potential rather than on limitations.
C)Suggest that the patient accept eventual death to reduce burdens on the patient's family.
D)Encourage the patient to minimize the utilization of services to control costs.
Q2) Which one of the following descriptors represents a phase of the chronic illness trajectory (CIT)?
A)Caring
B)Stable
C)Bargaining
D)Rehabilitation
Q3) Which of the following qualities does the nurse need to provide caring?
A)Sensitivity to the needs of other nurses
B)Longing to help others live a healthy life
C)Desire to have a stable career and income
D)Ability to create a trusting environment
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Chapter 16: Pain and Comfort
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Sample Questions
Q1) The nurse admits an older male patient who had abdominal surgery.Admission vital signs are P 73, R 20, BP 136/84 mm Hg.He is receiving intravenous (IV) fluids but has not requested pain medication since surgery.Seven hours later, his vital signs are P 98, R 26, BP 164/90 mm Hg, and he denies pain.Which intervention should the nurse implement?
A)Administer an opioid medication by IV route.
B)Check the surgical dressing for bleeding.
C)Report the vital signs to the health care provider.
D)Ask him about discomfort at the surgical site.
Q2) Which one of the following pain management techniques is an example of a cognitive behavioural approach?
A)Bio
B)Opioid medication
C)Massage
D)Anxiety medication
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18
Chapter 17: Diabetes Mellitus
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Sample Questions
Q1) An older person with type 2 diabetes mellitus has a sensory impairment and unstable blood sugars.Which alteration in sensory function does the nurse address in the plan of care for stabilizing his blood sugar?
A)The older person requires reading glasses at 2.0 strength.
B)The older person has difficulty hearing in crowded rooms.
C)The older person enjoys spicy food more than bland food.
D)The older person awakens with periodic left-foot numbness.
Q2) The nurse assists an older male adult with type 2 diabetes mellitus to improve his glucose control.What does the nurse instruct this individual to do when he plans to walk more than usual in one day?
A)Omit antidiabetic medication.
B)Wear sturdy open-toed shoes.
C)Supplement his caloric intake.
D)Prepare to administer insulin.
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19
Chapter 18: Bone and Joint Health
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Sample Questions
Q1) An osteoporosis-related fall necessitated hip-replacement surgery for an older female adult who is entering a rehabilitation facility.Which of the following goals is the nurse's priority during this woman's rehabilitation?
A)Tell the patient to eat whole grains, fruits, and vegetables.
B)Recapture the patient's preoperative mobility status.
C)Keep the patient's surgical wound clean and dry.
D)Tell the patient to take two steps into the walker.
Q2) An older female adult with osteoarthritis is seen by the nurse.She has a low-grade fever, and she tells the nurse that her pain is changing: it is worse at night and in her shoulder muscles.What should the nurse do to determine if the older person is now experiencing polymyalgia rheumatica (PMR) rather than an exacerbation of her osteoarthritis?
A)Assess the patient's joints for swelling and redness.
B)Obtain blood specimens for blood cultures.
C)Direct the patient to report pain in the neck and upper arms, possibly evolving to the pelvic and pectoral girdles.
D)Tell the patient to apply moist heat for 20 minutes.
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Chapter 19: Visual and Auditory Changes
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Sample Questions
Q1) The children of an older male adult feel that his vision may be impaired and they are worried about him driving a car.Which sign/behaviour has research shown to indicate that there may be vision problems in this patient?
A)This older person has complained of squinting and a greater sensitivity to light.
B)This older person recently began taking a prescription medication for high blood pressure.
C)This older person has decreased his socialization with his bridge group.
D)This older person has shown decreased interest in making meals.
Q2) Which disease creates pressure within the eye and potential optic nerve damage in the older person?
A)Glaucoma
B)Presbyopia
C)Cataract
D)Macular degeneration
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21
Chapter 20: Cardio-Vascular and Respiratory Disorders
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Sample Questions
Q1) An older female adult who has chronic obstructive pulmonary disease (COPD) wants to perform self-care activities.Which instruction should the nurse include in patient teaching to help this older person achieve this goal?
A)Bathe and eat slowly, with periodic rest.
B)Walk short distances without oxygen.
C)Perform all activities of daily living (ADLs) together, and then rest.
D)Bathe right after eating and then rest.
Q2) The exercise tolerance of an older person is impaired after a myocardial infarction (MI) because of a low ejection fraction.Which of the following primary interventions should the nurse use to assist this individual to restore baseline functional status?
A)Provide a well-balanced diet.
B)Assist with range of motion.
C)Instruct the older person to sit up in a chair four times daily.
D)Keep O2 saturation above 95%.
Q3) Which of the following statements about heart disease in older persons is true?
A)More women than men die from myocardial infarctions.
B)Cardiac care for men and women is equally aggressive.
C)Cardiac medications have been tested on men and women equally.
D)Women generally receive less aggressive treatment than men do.
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Page 22
Chapter 21: Cognitive Impairment and Neurological Disorders
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Q1) At 2200 hours, an older male resident is attempting to climb over the bedrails.Which intervention should the nurse implement first?
A)Gently question the resident about his behaviour.
B)Call the physician and ask for sedation.
C)Apply a vest restraint to the resident.
D)Get a companion to keep the older person in the bed.
Q2) An older female adult has a wound infection five days after having undergone a below-the-knee amputation brought about by diabetes mellitus.What is the nurse's priority intervention to prevent cognitive dysfunction and postoperative complications in this older person?
A)Remove invasive devices as soon as possible.
B)Minimize administration of opioid analgesics.
C)Allow for self-care and independent activities.
D)Administer short-acting benzodiazepines as needed (PRN).
Q3) An older person who has had a TIA should be assessed for which of the following?
A)Age, race, gender, income
B)Vital signs, speech, gender, race
C)Age, income, coordination, sensation
D)Vital signs, speech, coordination, sensation
Page 23
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Chapter 22: Economic and Legal Issues
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Q1) The nurse distrusts the male caregiver, the son of an older female adult, and collaborates with social services about potential resources for abused older persons.Which characteristics of the caregiver does the nurse report to social services as indicators of potential elder abuse?
A)The caregiver collects unemployment benefits.
B)The caregiver keeps his mother isolated from other family members and services.
C)The caregiver takes frequent breaks for smoking.
D)The caregiver sits at the patient's bedside for hours daily.
Q2) The National Advisory Committee on Aging (NACA) has raised an important issue of "under-subscription," that is, people who are eligible for the GIS, the Allowance, Old Age Security (OAS), or the Allowance for the Survivor, but who do not receive it because they have not applied or reapplied for the benefits.Which of the following groups constitutes the majority of those who do not subscribe or apply for OAS benefits?
A)Canadians who do not speak English or French, or who have low literacy
B)Canadians who live in remote regions
C)Canadians who are homeless
D)Canadians who are older women
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Chapter 23: Relationships, Roles, and Transitions
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Q1) Which of the following statements is true about caregiving?
A)Dementia in an older person can cause grief in the caregiver, comparable to the grief from the older person's death.
B)Middle-aged adults and older parents reverse lifelong caregiving roles with increasing age.
C)Older persons should relocate to the caregiver's home when long distances separate the two.
D)Increasing numbers of adult children who are developmentally disabled become caregivers for their older parents.
Q2) Which older person will have the highest economic risk at the beginning of retirement?
A)An older divorced female who has lived in this country for eight years
B)An older male veteran, who is an above-the-knee amputee, and who was a teacher
C)An older female, who is a widow and a primary care nurse practitioner
D)An older male, who immigrated from China, and designs computer software
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25
Chapter 24: Mental Health and Wellness in Later Life
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Q1) An older female adult fell at home while trying to get to the bathroom in time to prevent urinary leakage.What is the priority nursing intervention to prevent patient injury at home in the future?
A)Discharge the patient to home while she is attending an alcohol prevention program.
B)Perform a home safety inspection to identify modifiable safety hazards.
C)Instruct the patient on pelvic floor exercises and other incontinence strategies.
D)Explore and assess for depression, alcohol abuse, and physiological contributors to falls.
Q2) An older male adult who had radical surgery for oral cancer is refusing to see visitors and is losing weight, despite aggressive nutrition therapy.The nurse assesses this older person and recognizes that he is not coping well and appears to be grieving.What is the most important patient outcome, in light of this nursing assessment?
A)The patient discusses how his coping mechanisms are overwhelmed.
B)The patient performs self-feedings through gastrostomy tube daily.
C)The patient uses nonverbal forms of communication effectively.
D)The patient exhibits self-confidence in regaining a sense of control.
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Chapter 25: Loss, Death, and Palliative Care
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Q1) Which of the following statements about loss, dying, and death for older persons is TRUE?
A)Those at special risk for significantly adverse effects of grief are younger to middle-aged spouses because these partners are at the beginning of their life journey.
B)Visions, hallucinations, and an inability to communicate in a logical, sustained manner are not normal grief reactions for someone who has lost a spouse and should be regarded as signs of underlying health issues.
C)Pathological grief begins with normal grief responses whose evolution toward adjustment and the re-establishment of equilibrium is blocked by some obstacle.
D)Bereaved persons regain their normal capability about six months after loss, and regressive behaviour after that time should be examined by a therapist.
Q2) Which of the following characteristics is associated with acute grief?
A)Waves of grief or distressing emotion
B)Prolonged inability to sleep after a loss
C)Exacerbations of grief on specific dates
D)Change in attitude toward the future loss
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Chapter 26: Care Across the Continuum
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Q1) A resident of a long-term care facility in Ontario has been asking to have the drain in the bathroom sink repaired for two months.The nurse responds by saying that when they move to the new building, the sinks will work very well.Which right of a resident of a long-term care facility has the nurse violated?
A)The right to be free of all forms of abuse
B)The right to be transferred for appropriate reasons
C)The right to voice concerns or recommend changes in policies and services and have them remedied
D)The right to information about conditions and treatments
Q2) An older female resident in a residential facility keeps a large collection of personal items and photos of her late husband on her bedside table, but the personal support worker (PSW) and the resident argue about this frequently.Why should the nurse intervene between the resident and the PSW?
A)The resident is attempting to maintain her sense of personal space.
B)The resident needs to accept the reality of her spouse's death.
C)The resident's argumentative nature can indicate early dementia.
D)The clutter from all the personal items is a safety and liability risk.
To view all questions and flashcards with answers, click on the resource link above.
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