ALS
This progressive neurological disease affects motor neurons in the brain and spinal cord, leading to muscle weakness while leaving cognitive function intact. You must know the whole name.
“What is Amyotrophic Lateral Sclerosis (ALS)?
This late-manifesting symptom of pancreatic cancer occurs when the tumor obstructs the bile duct, leading to yellowing of the skin and sclera.
What is jaundice?
(Rationale: Tumor compression of the common bile duct leads to bilirubin buildup and characteristic yellow discoloration.)
A nurse explains death to a 6-year-old with a terminal illness. The nurse remembers that school-age children typically view death in this way.
What is understanding that death is permanent but may believe it happens to others and not themselves?
(Rationale: School-age children begin to comprehend the finality of death but may not personalize it.)
During the final stage of life in an elderly patient, the nurse expects this normal physical change as the body begins to shut down.
What is decreased circulation leading to cool, mottled extremities and weak pulse?
(Rationale: Peripheral circulation decreases near death, resulting in cyanosis and cool skin — a normal finding.)
This type of care focuses on comfort rather than cure, providing physical, emotional, and spiritual support for patients with a life expectancy of six months or less.
What is hospice care?
(Rationale: Hospice is for patients at the end of life who are no longer pursuing curative treatments.)
As ALS progresses, the nurse monitors for signs of respiratory failure. The most important nursing assessment to identify early respiratory compromise is this.
What is monitoring respiratory rate and assessing for use of accessory muscles or decreased vital capacity?
(Rationale: ALS causes progressive diaphragmatic weakness; respiratory monitoring is a priority.)
Because pancreatic cancer often causes severe abdominal and back pain, this nursing intervention is a priority in end-of-life care.
What is administering prescribed opioid analgesics around-the-clock with additional doses for breakthrough pain?
(Rationale: Continuous pain control maintains comfort and prevents pain escalation.)
When managing pain in a terminally ill child, the priority nursing principle is this.
What is administering pain medication on a regular schedule, regardless of risk for dependence?
(Rationale: Comfort is the top priority; the goal is relief, not prevention of addiction in end-of-life care.)
When providing end-of-life pain management for an older adult with multiple comorbidities, the nurse should use this principle to ensure safe care.
What is starting opioid analgesics at a lower dose and titrating slowly while monitoring for side effects?
(Rationale: Aging alters metabolism and drug clearance; titration minimizes sedation and respiratory depression.)
The nurse correctly explains that palliative care differs from hospice care in this key way.
What is palliative care can be provided at any stage of a serious illness, alongside curative treatment?
(Rationale: Palliative care focuses on symptom relief and quality of life — not limited to terminal stages.)
Because ALS often leads to dysarthria (impaired speech), nurses should prioritize providing this type of communication device early in the disease process.
What is an augmentative or alternative communication device (e.g., communication board or eye-tracking system)?
(Rationale: Promotes autonomy and reduces frustration as verbal ability declines.)
Due to malabsorption and early satiety in pancreatic cancer, the nurse should recommend this dietary approach to maintain comfort and nutrition.
What is offering small, frequent, high-calorie, high-protein meals and pancreatic enzyme replacement as ordered?
(Rationale: Pancreatic insufficiency and anorexia are common; small meals prevent discomfort and aid digestion.)
A child with end-stage cancer is nearing death. The parents want to stay at the bedside. The nurse’s best action is this.
What is support the parents’ presence and offer privacy, allowing them to participate in care as desired?
(Rationale: Family presence and involvement promote coping and healthy grieving.)
An elderly patient expresses fear of dying alone. The nurse’s most therapeutic intervention is this.
What is offering to stay with the patient and facilitating presence of family or spiritual support?
(Rationale: Presence reduces anxiety and promotes emotional comfort at end-of-life.)
A patient in hospice care develops terminal restlessness and agitation. The nurse anticipates administering medications from this class to promote comfort.
What are benzodiazepines or antipsychotics (e.g., lorazepam, haloperidol)?
(Rationale: These reduce anxiety, agitation, and restlessness in the dying process.)
When caring for a patient with ALS who has difficulty swallowing and excessive salivation, this medication class may be prescribed to improve comfort and reduce aspiration risk.
What are anticholinergic medications (e.g., atropine drops, glycopyrrolate)?
(Rationale: Reduces drooling and helps manage secretions near end-of-life.)
A patient with end-stage pancreatic cancer develops dyspnea and anxiety. The nurse knows the most appropriate intervention is this.
What is administering low-dose morphine to ease dyspnea and reduce the sensation of air hunger?
(Rationale: Morphine decreases the respiratory drive and perception of breathlessness — a palliative measure, not euthanasia.)
Parents of a terminally ill child request “no heroic measures.” The nurse ensures that this preference is documented as this type of medical order.
What is a Do-Not-Resuscitate (DNR) order?
(Rationale: A DNR formalizes the family’s and healthcare team’s decision to avoid resuscitative efforts in end-of-life care.)
Before initiating or discontinuing life-sustaining treatments in an elderly patient, the nurse should first verify the existence of this document.
What is an advance directive or living will?
(Rationale: Guides decisions based on the patient’s prior wishes regarding end-of-life care.)
When a family member asks, “Is my loved one dying?” the nurse’s most therapeutic response is this.
What is responding honestly and compassionately, describing the physical signs of approaching death in clear, simple terms?
(Rationale: Honest, empathetic communication helps families prepare emotionally and spiritually.)
A patient with ALS decides to discontinue mechanical ventilation. The nurse’s priority action is to do this.
What is ensure the patient’s decision is informed, voluntary, and documented, and provide palliative measures for comfort?
(Rationale: Respect for autonomy and focus on comfort aligns with ethical principles of end-of-life care.)
When a patient with terminal pancreatic cancer expresses fear of death and concern for family, the nurse’s best therapeutic response is this.
What is acknowledging the patient’s feelings and encouraging open discussion about end-of-life wishes and emotional concerns?
(Rationale: Supports emotional and spiritual well-being, aligns with therapeutic communication principles.)
A dying child asks, “Am I going to die?” The nurse’s most therapeutic response is this.
What is responding honestly and simply, using age-appropriate language, and encouraging the child to express feelings?
(Rationale: Honest, compassionate communication fosters trust and emotional support.)
After an older adult passes away, the nurse’s priority action to support the family is this.
What is allowing the family time to be with the body and express grief before postmortem care?
(Rationale: Respectful support of mourning facilitates healthy grieving and closure.)
The hospice nurse’s primary goal when caring for a dying patient and family is this.
What is promoting comfort, dignity, and quality of life for the patient and supporting the family’s coping process?
(Rationale: Hospice care is holistic — addressing physical comfort and emotional, psychosocial, and spiritual needs.)