NCLEX-Style Review Questions

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NCLEX-Style Review Questions

QUESTION 1: A nurse is caring for a client diagnosed with carcinoma of the prostate along with metastatic infiltration to other parts of the body. Which signs of approaching death does the nurse notice in the client? Select all that apply.Correct Response: Bladder and bowel control is lost. Extremities may feel cold to touch. Breathing may gradually become noisy.Explanation: Clients in the end-of-life stage exhibit loss of control over the bladder and bowels as a result of the loss of neurologic control in the client’s brain.The client’s extremities may feel cold to touch because of the slowing of circulation and the deviation of blood flow to the core of the client’s body. The client’s breathing may gradually become noisy as a result of the collection of secretions in the mouth and lungs. The client’s mouth may become dry, and thick secretions may begin to accumulate in the back of the throat because of the decrease in the client’s swallow and gag reflex. Occasionally, clients in their end-of-life stage exhibit sudden restlessness because of oxygen hunger.

QUESTION 2: A client involved in a motor vehicle accident is declared dead on admission to the healthcare facility. The client’s driver’s license indicates a wish to be an eye donor.Which nursing measure should the nurse perform when caring for the client’s body?Correct Response: Obtain legal written permission from the client’s next of kin.Explanation: It is mandatory for the nurse to obtain written approval from the client’s next of kin or legal guardian before harvesting the eyes for donation. Even though the client had self-designated as the eye donor, the family

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members gain custody of the body at death and must now give written permission.Placing the client’s body on a ventilator is often recommended only for preserving organs such as the heart and kidneys; this procedure is not necessary for preserving the eyes. It is the duty of the nurse to assist the client’s family members and guide them through this time of decision making, and this responsibility should not be transferred to another nurse or healthcare provider unless absolutely necessary. The client’s eyes must not be harvested based solely on the client’s advance directive for donation without informing and obtaining permission from a surviving spouse or next of kin.

QUESTION 3: An older adult client is admitted to the healthcare facility with severe respiratory failure and infections. Which nursing measure must the nurse perform when caring for this client?

Correct Response: Assist the client to be as active as possible.

Explanation: Assisting the client to be as active as possible is an important part of end- of-life care because it helps in maintaining the circulation to the peripheral parts of the body and also helps in preventing bedsores and other circulatory complications in the client. Providing a bed shampoo with water can be too strenuous for the client; therefore, a shampoo cap is often used for hair care in the client. The nurse should not ask the client to lie on the back for long because it may cause secretions to pool in the back of the client’s throat, leading to choking or aspiration into the lungs.Milk is usually avoided in the final stages of life because it leads to formation of a coating or membrane-like mucus in the throat and interferes with breathing.

QUESTION 4: A nurse is providing end-of-life care to an older adult client at a healthcare facility.The client reports frequent nausea and vomiting. Which nursing considerations must the nurse employ when caring for the client? Select all that apply.Correct Response: Encourage client/family to place a damp cloth on the forehead. Offer dry foods such as soda crackers.

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Explanation: If the client complains of nausea and vomiting, the family members and the client are taught to place a cool, damp cloth on the client’s forehead. The nurse should assist the client to lie on the side and not supine, to prevent aspiration of the contents of the stomach into the client’s

respiratory tract when vomiting. Clients are asked to take slow, deep breaths rather than rapid, shallow ones. Milk is contraindicated in clients during end-of-life care because it usually forms a coating or membrane- like mucus in the client’s throat and could interfere with breathing. Dry food such as soda crackers can be helpful in relieving nausea and vomiting.

QUESTION 5: A nurse is caring for an older adult client who is dying. What interventions should the nurse perform with regard to mouth care for this client?

Correct Response: Apply mineral oil to the client’s lips.

Explanation: The nurse should apply mineral oil to the client’s lips to prevent the lips from cracking. The nurse should swab the client’s mouth with mouthwash often to prevent a foul taste and bad breath, rather than ask the client to rinse with mouthwash, as the dying client may not be able to rinse his mouth with mouthwash himself. If the client’s tongue is dry, the nurse should moisten it with saline swabs or water-soluble lubricant in extreme cases to prevent it from sticking to the roof of the mouth. The tongue is not moistened with mineral oil. The nurse should provide clear, cold liquids, such as gelatin or juice often, rather than hot liquids or solids to the client.

QUESTION 6: A nurse is working with a client who has just been diagnosed as having terminal cancer. The client is visibly agitated and keeps asking staff members at the hospital, “I have tried to do the right thing all my life, and now this…I don’t understand why I have to go through this.” Which stage of dying would the nurse note for this client?

Correct Response: Anger and rage

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Explanation: The client appears to be in the second stage of Kübler-Ross’ stages of dying, which is anger and rage. In this stage, people tend to ask questions such as, “Why is this happening to me?” The first stage is denial and isolation, when people say or think, “This isn’t happening to me!” The third stage is bargaining and developing awareness, when people say or think, “I promise I will be a better person if only...” The fourth stage is depression, when people say or think, “I don’t care any more.” The fifth stage is acceptance and peace, when people say or think, “I’m ready for whatever happens.” The sixth and final stage is detachment, when the person withdraws from life.

QUESTION 7: The nurse is caring for a terminally ill client who has a “DNI” order on the chart.The nurse notes equipment at the bedside to assist in caring for the client. Which equipment, if noted, would alert the nurse to verify the order and speak to a supervisor?

Correct Response: An intubation tube

Explanation: The code DNI stands for “do not intubate” so an intubation tube would be a concern and a potential violation of the provider’s order and the client wishes. This concern should be discussed with the supervisor and the order clarified. The other equipment is appropriate for a terminally ill client.

QUESTION 8: The nurse is working with a client who is in end-of-life care. The nurse is primarily providing the client with palliative care. Which is an example of palliative care?Correct Response: Applying mineral oil to the client’s lips to prevent them from cracking Explanation: Palliative care emphasizes comfort and pain control, so it encompasses nursing care and medical treatments that relieve or reduce symptoms of a disease or illness.Applying mineral oil to a client’s lips to prevent cracking is an example of palliative care, as it is intended to comfort the client.Chemotherapy, antibiotics, and surgery to remove a cancerous tumor are not palliative care, as they are not primarily focused on providing comfort or pain control to the client but are directed at attacking the cause of the disease.