130 Unit 5

A client admitted with a non-life-threatening illness says, "I was asked to fill out an advance directive when I was admitted, but I was too stressed. What was it all about?" How does the nurse respond? "Advance directives are only for those individuals who are severely ill." "Advance directives allow a client to convey his or her wishes about health care ahead of time." "Most Americans have an advance directive in place; you will need to see a lawyer." "You should have completed the paperwork before you were admitted."

"Advance directives allow a client to convey his or her wishes about health care ahead of time." (The nurse responds by stating that advanced directives allow a client to convey his or her wishes about health care ahead of time. This best addresses the client's comments.Most advance directives are in place before the client becomes severely ill. Many Americans do not have advance directives in place. Legal assistance is not necessary to complete them. Although completing paperwork pertaining to advance directives before admission would be ideal, any time is a good to do this.)

A client with hypertension is started on verapamil (Calan). What teaching does the nurse provide for this client? "Consume foods high in potassium." "Monitor for irregular pulse." "Monitor for muscle cramping." "Avoid grapefruit juice."

"Avoid grapefruit juice." (The nurse teaches the client who is taking verapamil to avoid grapefruit juice. Grapefruit juice must be avoided with calcium channel blockers, such as verapamil, because it can enhance the action of the drug.Foods high in potassium would be encouraged for clients taking diuretics, not calcium channel blockers such as verapamil. Bradycardia, not irregular pulse, is a typical side effect of verapamil. Muscle cramping may occur with statins, not with calcium channel blockers.)

A patient tells the nurse, "I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial nursing response? "Why not start by learning to meditate? That technique will cover everything." "In cases like yours, physical exercise works to elevate mood and reduce anxiety." "Reading about stress and how to manage it might be a good place to start." "Let's talk about what is going on in your life and then look at possible options."

"Let's talk about what is going on in your life and then look at possible options." (In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. As a result, further assessment is indicated before potential solutions can be explored. Suggesting further exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.)

A dying patient says to the nurse, "I am afraid to die. I did a lot of wrong things in my life." How does the nurse respond? "Tell me more about that." "Why? What did you do wrong?" "Don't worry, God will forgive you." "I'm sure it is nothing to worry about."

"Tell me more about that." (A response such as, "Tell me more about that," acknowledges the patient's spiritual pain and encourages verbalization. "Don't worry, God will forgive you" assumes that the patient is religious and minimizes the patient's concerns; it gives false reassurance and is a nontherapeutic response. Saying that it's nothing to worry about minimizes the patient's concerns and is a nontherapeutic response; it shuts the patient off from expressing his or her concerns. Asking why the patient is afraid and what he or she did wrong assumes that the patient did something wrong, which may not be the case. "Why" questions are never considered to be therapeutic because they place patients on defense; they often stop communication.)

What decrease in blood pressure (BP) defines diagnostic criteria for orthostatic hypertension? 5 mm Hg systolic and/or 15 mm Hg diastolic 15 mm Hg systolic and/or 5 mm Hg diastolic 10 mm Hg systolic and/or 20 mm Hg diastolic 20 mm Hg systolic and/or 10 mm Hg diastolic

20 mm Hg systolic and/or 10 mm Hg diastolic (Orthostatic hypotension is a decrease in BP of 20 mm Hg systolic and/or 10 mm Hg diastolic when the patient changes position from lying to sitting. Decreases of 5 mm Hg systolic and/or 15 mm Hg diastolic, 15 mm Hg systolic and/or 5 mm Hg diastolic, or 10 mm Hg systolic and/or 20 mm Hg diastolic do not meet diagnostic criteria for orthostatic hypertension.)

Arrange in order the pathophysiological events that take place during the dying process. 1. Cardiac arrest 2. Multiple organ failure 3. Occurrence of anaerobic metabolism 4. Inadequate blood supply to body tissues 5. Release of toxic metabolites in vital organs

4. Inadequate blood supply to body tissues 3. Occurrence of anaerobic metabolism 5. Release of toxic metabolites in vital organs 2. Multiple organ failure 1. Cardiac arrest (Inadequate blood supply to body tissues leads to unmet oxygen demand. It stimulates anaerobic metabolism leading to acidosis, hyperkalemia, and tissue ischemia. This results in release of toxic metabolites in the vital organs such as the kidneys and the liver, which may result in organ failure causing cardiac arrest.)

The nurse working on an inpatient hospice unit has received the change-of-shift report. Which client does the nurse assess first? A 26-year-old with metastatic breast cancer who is experiencing pain rated at 10 (0-to-10 scale) and anxiety A 30-year-old with AIDS-associated dementia and agitation who is asking for assistance with calling family members A 62-year-old with lung cancer who has cool, clammy, dusky skin, and blood pressure of 64/20 mm Hg A 70-year-old with cancer of the colon who has a respiratory rate of 8 with loud, wet-sounding respirations

A 26-year-old with metastatic breast cancer who is experiencing pain rated at 10 (0-to-10 scale) and anxiety (Management of discomfort is the priority goal for hospice care, so decreasing this client's pain and anxiety should be the first action.The client with AIDS needs rapid assistance, but is the second priority for the nurse in this scenario. The client with lung cancer and the client with colon cancer are exhibiting normal signs and symptoms associated with dying.)

In which newly admitted client situations does the nurse initiate a conversation about advance directives? Select all that apply. A client with a non-life-threatening illness A person who currently has advance directives The client with end-stage kidney disease The comatose client who was injured in an automobile crash The laboring mother expecting her first child

A client with a non-life-threatening illness A person who currently has advance directives The client with end-stage kidney disease The laboring mother expecting her first child (All clients who are hospitalized need to be asked about advance directives by the nurse when they are admitted to a hospital. This is a requirement of the Patient Self-Determination Act. Many nurses feel uncomfortable discussing advance directives with "healthy" clients, but the circumstances of admission do not relieve the nurse of this responsibility. The client with preexisting advance directives still needs to be questioned; it is possible that the client's wishes have changed since the documents were established. Clients who have potentially life-threatening diseases or conditions should establish advance directives while they are able to do so.The comatose client is not considered capable of making decisions about his or her wishes concerning advance directives.)

A dying client exhibits signs of agitation. The Foley catheter has drained 100 mL in the last 3 hours, and the client's last bowel movement was yesterday evening. What does the nurse do first? Administer an analgesic. Arrange for a consultation with a bereavement counselor. Assess the client for impaction. Change the Foley catheter to ensure adequate drainage.

Administer an analgesic. (The first action taken by the nurse is to administer an analgesic. Agitation may be indicative of pain, which must be addressed in the dying client.Arranging for a consultation with a counselor is not the priority in this situation. The dying client's metabolism has slowed, so assessing for impaction may not be necessary since the client had a bowel movement the evening before. The Foley catheter should not be changed, but the tubing should be assessed to ensure that there are no kinks.)

The nurse manager for home health and hospice is scheduling daily client visits. Which client is appropriate for the nursing assistant to visit? Advanced cirrhosis of the liver and just called the hospice agency reporting nausea Aggressive brain tumor and needs daily assistance with ambulation and bathing Inoperable lung cancer and considering whether to have radiation and chemotherapy Prostate cancer and bone metastases and has new-onset leg weakness and tingling

Aggressive brain tumor and needs daily assistance with ambulation and bathing (Assisting clients with activities of daily living such as ambulation and bathing is a common role for nursing assistants working in home health or hospice agencies.Assessing and acting upon a new symptom (nausea), helping clients make decisions, and evaluating a new-onset symptom all require more complex assessment skills and interventions, which are within the RN scope of practice.)

A patient has died after a long hospital stay. The family was present at the time of the patient's death. Which postmortem action does the nurse implement? Asks the family to leave Removes dentures and any prosthetics Asks the family if they wish to help wash the patient Raises the head of the bed and opens the patient's eyes

Asks the family if they wish to help wash the patient (The nurse may ask the family if they wish to be involved in washing the patient after the patient's death. The family should be allowed to grieve at the bedside of the patient. The head of the bed should be flat and the patient's eyes closed. The patient's dentures and prosthetics should be replaced, not removed.)

A dying client is having difficulty swallowing oral medications. Which intervention does the nurse implement for this client? Asks the pharmacy to substitute intramuscular (IM) equivalents for the medications Asks the provider if the medications can be discontinued or substituted Crushes the pills, opens the sustained-release capsules, and mixes them with a spoonful of applesauce Does not give the medications and documents: "Unable to swallow"

Asks the provider if the medications can be discontinued or substituted (The nurse contacts the provider to ask if the medications can be discontinued or substituted. Since the client is in the dying process, he or she may no longer require some of the medications prescribed, and other routes may be available for medications that will promote comfort.The IM route is almost never used for clients at the end of life because this method is invasive and painful, and can cause infection. Although some pills may be crushed, sustained-release capsules should not be taken apart and their contents administered directly. The client may still need the medications prescribed for comfort; withholding them could cause discomfort throughout the dying process.)

The nurse is conducting a patient assessment. The patient tells the nurse that he has smoked two packs of cigarettes per day for 27 years. The nurse may find which data upon assessment? Blood pressure above the normal range Bounding pedal pulses Night blindness Reflux disease

Blood pressure above the normal range (Smokers have a constriction of the blood vessels due to the tar and nicotine in cigarettes. This constriction may lead to hypertension. Bounding pulses, night blindness, and reflux disease do not have a direct link to smoking.)

The nurse recognizes signs and symptoms of delirium in an 80-year-old client who is dying from metastatic breast cancer. What does the nurse do initially for this client? Requests an order for an antipsychotic medication to control these symptoms Collaborates with the end-of-life (EOL) care team to evaluate possible medication-induced causes Discontinues all medications that have central nervous system adverse effects Assures the client's family that this terminal delirium indicates that death is imminent

Collaborates with the end-of-life (EOL) care team to evaluate possible medication-induced causes (The nurse would initially collaborate with the end-of-life (EOL) care team to evaluate possible medication-induced causes. Terminal delirium occurs in the last few weeks of life and its causes, including medication-induced causes, should be assessed and treated with the collaboration of the EOL care team and the client's physician.Antipsychotic medications are only used to treat psychosis symptoms of hallucinations and delusions. Medications may only need to be reduced. Discontinuation or reduction of medication would be decided by the health care provider. Reassuring the family does not address the symptoms.)

How does essential hypertension lead to body organ damage? Continuous BP elevation causes pressure on body organs, resulting in tissue damage. Continuous BP elevation leads to specific disease states that are damaging to body organs. Continuous BP elevation causes body organs to work harder to compensate for the decreased perfusion. Continuous BP elevation causes medial hyperplasia of arterioles, perfusion decreases, and body organs are damaged.

Continuous BP elevation causes medial hyperplasia of arterioles, perfusion decreases, and body organs are damaged. (Continuous blood pressure (BP) elevation causes medial hyperplasia of arterioles, perfusion decreases, and body organs are damaged. Essential hypertension does not lead to body organ damage as a result of pressure on body organs causing tissue damage, specific disease states that are damaging to body organs, or causing body organs to work harder to compensate for the decreased perfusion.)

What are the intended purposes of massage therapy for the dying patient? Select all that apply. Decrease pain Enhance dignity Decrease nausea Promote relaxation Reduce the need for analgesics

Decrease pain Enhance dignity Promote relaxation (Massage is a popular complementary therapy for patients at end of life. Massage decreases pain in patients with cancer. Daily massage helps the patient feel well and enhances dignity. Patients are relaxed and find peace when massage is incorporated into the palliative plan of care. Massage does not decrease nausea or reduce the need for analgesics. Pain medication is given to the patient round the clock for pain relief.)

What is the classification of carvedilol (Coreg)? Beta blocker ACE inhibitor Alpha₂ blocker Dual-action alpha₁ and beta receptor blocker

Dual-action alpha₁ and beta receptor blocker (Carvedilol blocks both the alpha₁ and beta receptors of the adrenergic nervous system.)

What is the most common type of hypertension? Essential Malignant Secondary Nonessential

Essential (Essential hypertension is the most common type of hypertension and is not caused by an existing health problem. Malignant hypertension is a severe type of elevated blood pressure (BP) that rapidly progresses; it is not as common. Specific disease states and drugs can increase a person's susceptibility to hypertension. A person with this type of elevation in BP has secondary hypertension. Hypertension is not typically referred to as nonessential.)

A client diagnosed with lung cancer 6 months ago is now ventilator-dependent and unresponsive. The family wants to remove the ventilator and stop antibiotics and IV fluids. What does the nurse do next? Facilitates a meeting between the family and health care team Removes the interventions, per the family's wishes Tells the family that removing the interventions is illegal Waits to obtain information on the client's wishes

Facilitates a meeting between the family and health care team (The nurse's next action would be to facilitate a meeting between the family and the health care team. Withdrawing or withholding life-sustaining therapy involves discontinuing one or more therapies that might prolong the life of a person who cannot be cured by the therapy. To do this, a meeting is required between the family and the health care team.Withdrawing life support requires more than simply following the family's wishes. Removal of life-sustaining therapy is not illegal except in cases of active euthanasia or physician-assisted euthanasia. The client most likely will not regain consciousness. The client's wishes should have been determined and documented earlier in the course of his or her disease (advance directives, living will, etc.).)

The nurse is coordinating interdisciplinary palliative care interventions for the dying client. Which goal is the nurse seeking to meet? Avoiding symptoms of client distress Ensuring an expedited death Meeting all of the client's needs Facilitating a peaceful death for the client

Facilitating a peaceful death for the client (Facilitating a peaceful death for the client is one of the goals of palliative care.Symptoms of distress cannot be avoided but can be controlled. Expedited death is not a goal of palliative care. Identifying client needs is a goal of palliative care, but it is not always possible to meet all of the client's needs (e.g., to prevent death or lengthen life).)

Which class of medication can cause secondary hypertension in a patient? Diuretics Renin inhibitors Glucocorticoids Calcium channel blockers

Glucocorticoids (One side effect of glucocorticoids is fluid retention that can lead to secondary hypertension. Diuretics, renin inhibitors, and calcium channel blockers are used to treat hypertension.)

A Christian client is struggling with a diagnosis of cancer and says, "Why is life so unfair?" What health care team member does the nurse ask to provide support? Client's family Physician Hospital chaplain Psychiatrist

Hospital chaplain (The nurse requests assistance from the chaplain. Chaplains are the most able to provide support and have the time and expertise to manage spiritual distress, no matter what the client's religious preference.The family is not a member of the health care team. Asking the physician to provide support is inappropriate. Asking the psychiatrist for support might make sense, but is not the best answer.)

The nurse should question a prescription for a calcium channel blocker in a patient with which condition? Dysrhythmia Hypotension Angina pectoris Increased intracranial pressure

Hypotension (Calcium channel blockers cause smooth muscle vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.)

A nurse who is skilled in complementary and alternative medicine (CAM) therapies works on a cancer unit with patients who are terminally ill. For which patient symptom does the nurse use these therapies? Constipation Memory loss Increased pain Cool extremities

Increased pain (CAM can help relieve pain and agitation, minimizing the need for increased opioids. CAM is not typically used for constipation or to deal with cool extremities. Memory loss is not a symptom that should receive priority in the dying patient.)

The clinical findings of a patient with hypertension show elevated levels of serum creatinine and blood urea nitrogen. What may be a cause of secondary hypertension? Encephalitis Kidney disease Cushing's disease Pheochromocytoma

Kidney disease (The clinical finding of the patient show increased blood levels of creatinine and blood urea nitrogen (BUN). These findings may be associated with kidney disease. Conditions such as encephalitis, pheochromocytoma, and Cushing's disease may not be associated with elevated level of proteins and RBC in urine and increased blood levels of creatinine and BUN.)

Which condition, when assessed in a dying client, requires that the nurse take action? Alternating apnea and rapid breathing Anorexia Cool extremities Moaning

Moaning (Moaning indicates pain and requires pain medication.Alternating apnea and rapid breathing, anorexia, and cool extremities are normal assessment findings in the dying client.)

A client with terminal pancreatic cancer is near death and reports increasing shortness of breath with associated anxiety. Which hospice protocol order does the nurse implement first? Albuterol (Proventil) 0.5% solution per nebulizer Morphine sulfate (Roxanol) 5 to 10 mg sublingually as needed Oxygen 2 to 6 L/min per nasal cannula Prednisone (Deltasone) elixir 10 mg orally

Morphine sulfate (Roxanol) 5 to 10 mg sublingually as needed (Morphine sulfate is the standard treatment for the dyspneic client who is near death.Albuterol (Proventil), oxygen, and steroids may be useful, but should be used as adjuncts to therapy with morphine.)

ACE inhibitors and ARBs both work to decrease blood pressure by which action? Enhance sodium and water resorption Increase the breakdown of bradykinin Prevent the formation of angiotensin II Prevent aldosterone secretion

Prevent aldosterone secretion (Whereas ACE inhibitors block the formation of angiotensin II, ARBs allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone secretion is inhibited, preventing the reabsorption of sodium and water.)

A client dying of cancer is receiving high doses of opioids. In addition, which intervention is the most effective for this client? Classical music Deep muscle massage More pain medication Short, light massage

Short, light massage (Massage has been shown to decrease pain in individuals with cancer. Light, short episodes of pressure are best. Deep or intense pressure should be avoided.Although music therapy may be effective, the type of music played should be the client's choice, and does not assume that the client wants to hear classical music. The dying client who is frail may not tolerate an extensive deep massage. The client is already receiving high doses of opioids. Complementary or alternative therapy can replace the need for increased pain medication.)

Which are risk factors for primary hypertension? Select all that apply. Smoking Pregnancy Kidney disease Hyperlipidemia Oral contraceptive use

Smoking Hyperlipidemia (Risk factors for primary hypertension include smoking and hyperlipidemia. Risk factors for secondary hypertension include pregnancy, kidney disease, and oral contraceptive use.)

A hospice client becomes too weak to swallow. What does the nurse do initially to increase the client's comfort? Administers nutrition and fluids through a nasogastric tube Explains to the family that aspiration may be a concern Obtains a physician order to initiate an IV line Teaches the family how to provide oral care

Teaches the family how to provide oral care (Because the oral mucosa will become dry, the initial action taken by the nurse would be to teach the family members how to moisten the lips and mouth.Although fluids can be given through a nasogastric tube and through an IV line, these are generally considered to increase discomfort by prolonging the client's suffering. Aspiration is not a concern in terminally ill clients, because fluids are not given orally to clients with decreased swallowing.)

What are the typical causes of nausea and vomiting in a terminally ill patient in the last week of life? Select all that apply. Uremia Hypocalcemia Stool impaction Bowel obstruction Reduced cranial pressure

Uremia Stool impaction Bowel obstruction (Increased serum urea nitrogen (uremia) often causes nausea and vomiting in the terminally ill patient. Stool impaction and bowel obstruction also may cause nausea and vomiting. A biphosphate enema or mineral oil enema followed by gentle disimpaction may help to relieve the patient's distress. The patient generally has hypercalcemia and increased cranial pressure in the last days, which lead to nausea and vomiting.)

A nurse is caring for a client who is terminally ill. The client's spouse states, "I am concerned because he does not want to eat." How should the nurse respond? a. "Let him know that food is available if he wants it, but do not insist that he eat." b. "A feeding tube can be placed in the nose to provide important nutrients." c. "Force him to eat even if he does not feel hungry, or he will die sooner." d. "He is getting all the nutrients he needs through his intravenous catheter."

a. "Let him know that food is available if he wants it, but do not insist that he eat." (When family members understand that the client is not suffering from hunger and is not "starving to death," they may allow the client to determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the family.)

A nurse discusses inpatient hospice with a client and the client's family. A family member expresses concern that her loved one will receive only custodial care. How should the nurse respond? a. "The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left." b. "Palliative care will release you from the burden of having to care for someone in the home. It does not mean that curative treatment will stop." c. "A palliative care facility is like a nursing home and costs less than a hospital because only pain medications are given." d. "Your relative is unaware of her surroundings and will not notice the difference between her home and a palliative care facility."

a. "The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left." (Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is on pain control and helping the relative die with dignity.)

A nurse admits an older adult client to the hospital. Which criterion should the nurse use to determine if the client can make his own medical decisions? (Select all that apply.) a. Can communicate his treatment preferences b. Is able to read and write at an eighth-grade level c. Is oriented enough to understand information provided d. Can evaluate and deliberate information e. Has completed an advance directive

a. Can communicate his treatment preferences c. Is oriented enough to understand information provided d. Can evaluate and deliberate information (To have decision-making ability, a person must be able to perform three tasks: receive information (but not necessarily oriented); evaluate, deliberate, and mentally manipulate information; and communicate a treatment preference. The client does not have to read or write at a specific level. Education can be provided at the client's level so that he can make the necessary decisions. The client does not need to complete an advance directive to make his own medical decisions. An advance directive will be necessary if he wants to designate someone to make medical decisions when he is unable to.)

A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse question? a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5 b. Albuterol (Proventil) metered dose inhaler every 4 hours PRN for wheezes c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions d. Sodium biphosphate (Fleet) enema once a day PRN for impacted stool

a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5 (Pain medications should be scheduled around the clock to maintain comfort and prevent reoccurrence of pain. The other medications are appropriate for this client.)

A hospice nurse plans care for a client who is experiencing pain. Which complementary therapies should the nurse incorporate in this client's pain management plan? (Select all that apply.) a. Play music that the client enjoys. b. Massage tissue that is tender from radiation therapy. c. Rub lavender lotion on the client's feet. d. Ambulate the client in the hall twice a day. e. Administer intravenous morphine.

a. Play music that the client enjoys. c. Rub lavender lotion on the client's feet. (Complementary therapies for pain management include massage therapy, music therapy, Therapeutic Touch, and aromatherapy. Nurses should not massage over sites of tissue damage from radiation therapy. Ambulation and intravenous morphine are not complementary therapies for pain management.)

hospice nurse is caring for a dying client and her family members. Which interventions should the nurse implement? (Select all that apply.) a. Teach family members about physical signs of impending death. b. Encourage the management of adverse symptoms. c. Assist family members by offering an explanation for their loss. d. Encourage reminiscence by both client and family members. e. Avoid spirituality because the client's and the nurse's beliefs may not be congruent.

a. Teach family members about physical signs of impending death. b. Encourage the management of adverse symptoms. d. Encourage reminiscence by both client and family members. (The nurse should teach family members about the physical signs of death, because family members often become upset when they see physiologic changes in their loved one. Palliative care includes management of symptoms so that the peaceful death of the client is facilitated. Reminiscence will help both the client and family members cope with the dying process. The nurse is not expected to explain why this is happening to the family's loved one. The nurse can encourage spirituality if the client is agreeable, regardless of whether the client's religion is the same.)

A nurse plans care for a client who is nearing end of life. Which question should the nurse ask when developing this client's plan of care? a. "Is your advance directive up to date and notarized?" b. "Do you want to be at home at the end of your life?" c. "Would you like a physical therapist to assist you with range-of-motion activities?" d. "Have your children discussed resuscitation with your health care provider?"

b. "Do you want to be at home at the end of your life?" (When developing a plan of care for a dying client, consideration should be given for where the client wants to die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status should be the client's decision, not the family's decision.)

A nurse teaches a client who is considering being admitted to hospice. Which statement should the nurse include in this client's teaching? a. "Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge." b. "Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms." c. "Hospice care will not help with your symptoms of depression. I will refer you to the facility's counseling services instead." d. "You seem to be experiencing some difficulty with this stage of the grieving process. Let's talk about your feelings."

b. "Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms." (As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.)

The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client's anxiety and restlessness. Which statement made by the family member indicates understanding of the nurse's teaching? a. "Maybe we should just hire an around-the-clock sitter to stay with Grandmother." b. "I have some of her favorite hymns on a CD that I could bring for music therapy." c. "I don't think that she'll need pain medication along with her herbal treatments." d. "I will burn therapeutic incense in the room so we can stop the anxiety pills."

b. "I have some of her favorite hymns on a CD that I could bring for music therapy." (Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client's inner restlessness. Hiring an around-the-clock sitter does not demonstrate that the client's family understands complementary therapies. Complementary therapies are used in conjunction with traditional therapy. Complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications.)

A nurse is caring for a terminally ill client who has just died in a hospital setting with family members at the bedside. Which action should the nurse take first? a. Call for emergency assistance so that resuscitation procedures can begin. b. Ask family members if they would like to spend time alone with the client. c. Ensure that a death certificate has been completed by the physician. d. Request family members to prepare the client's body for the funeral home.

b. Ask family members if they would like to spend time alone with the client. (Before moving the client's body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The client's family should not be expected to prepare the body for the funeral home.)

A nurse cares for a dying client. Which manifestation of dying should the nurse treat first? a. Anorexia b. Pain c. Nausea d. Hair loss

b. Pain (Only symptoms that cause distress for a dying client should be treated. Such symptoms include pain, nausea and vomiting, dyspnea, and agitation. These problems interfere with the client's comfort. Even when symptoms, such as anorexia or hair loss, disturb the family, they should be treated only if the client is distressed by their presence. The nurse should treat the client's pain first.)

A nurse assesses a client who is dying. Which manifestation of a dying client should the nurse assess to determine whether the client is near death? a. Level of consciousness b. Respiratory rate c. Bowel sounds d. Pain level on a 0-to-10 scale

b. Respiratory rate (Although all of these assessments should be performed during the dying process, periods of apnea and Cheyne-Strokes respirations indicate death is near. As peripheral circulation decreases, the client's level of consciousness and bowel sounds decrease, and the client would be unable to provide a numeric number on a pain scale. Even with these other symptoms, the nurse should continue to assess respiratory rate throughout the dying process. As the rate drops significantly and breathing becomes agonal, death is near.)

After teaching a client about advance directives, a nurse assesses the client's understanding. Which statement indicates the client correctly understands the teaching? a. "An advance directive will keep my children from selling my home when I'm old." b. "An advance directive will be completed as soon as I'm incapacitated and can't think for myself." c. "An advance directive will specify what I want done when I can no longer make decisions about health care." d. "An advance directive will allow me to keep my money out of the reach of my family."

c. "An advance directive will specify what I want done when I can no longer make decisions about health care." (An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client's residence or financial matters.)

An intensive care nurse discusses withdrawal of care with a client's family. The family expresses concerns related to discontinuation of therapy. How should the nurse respond? a. "I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia." b. "You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support." c. "I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death." d. "There is no need to worry. Most religious organizations support the client's decision to stop medical treatment."

c. "I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death." (The nurse should validate the family's concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about their purpose. If the client's family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics.)

A hospice nurse is caring for a variety of clients who are dying. Which end-of-life and death ritual is paired with the correct religion? a. Roman Catholic - Autopsies are not allowed except under special circumstances. b. Christian - Upon death, a religious leader should perform rituals of bathing and wrapping the body in cloth. c. Judaism - A person who is extremely ill and dying should not be left alone. d. Islam - An ill or dying person should receive the Sacrament of the Sick.

c. Judaism - A person who is extremely ill and dying should not be left alone. (According to Jewish law, a person who is extremely ill or dying should not be left alone. Orthodox Jews do not allow autopsies except under special circumstances. The Islamic faith requires a religious leader to perform rituals of bathing and wrapping the body in cloth upon death. A Catholic priest performs the Sacrament of the Sick for ill or dying people.)

A nurse is caring for a dying client. The client's spouse states, "I think he is choking to death." How should the nurse respond? a. "Do not worry. The choking sound is normal during the dying process." b. "I will administer more morphine to keep your husband comfortable." c. "I can ask the respiratory therapist to suction secretions out through his nose." d. "I will have another nurse assist me to turn your husband on his side."

d. "I will have another nurse assist me to turn your husband on his side." (The choking sound or "death rattle" is common in dying clients. The nurse should acknowledge the spouse's concerns and provide interventions that will reduce the choking sounds. Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention. The nurse should not minimize the spouse's concerns. Morphine will assist with comfort but will not decrease the choking sounds. Nasotracheal suctioning is not appropriate in a dying client.)

A client tells the nurse that, even though it has been 4 months since her sister's death, she frequently finds herself crying uncontrollably. How should the nurse respond? a. "Most people move on within a few months. You should see a grief counselor." b. "Whenever you start to cry, distract yourself from thoughts of your sister." c. "You should try not to cry. I'm sure your sister is in a better place now." d. "Your feelings are completely normal and may continue for a long time."

d. "Your feelings are completely normal and may continue for a long time." (Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be grieving after a few months. The other responses are not as therapeutic because they justify or minimize the client's response.)

A nurse teaches a client's family members about signs and symptoms of approaching death. Which manifestations should the nurse include in this teaching? (Select all that apply.) a. Warm and flushed extremities b. Long periods of insomnia c. Increased respiratory rate d. Decreased appetite e. Congestion and gurgling

d. Decreased appetite e. Congestion and gurgling (Common physical signs and symptoms of approaching death including coolness of extremities, increased sleeping, irregular and slowed breathing rate, a decrease in fluid and food intake, congestion and gurgling, incontinence, disorientation, and restlessness.)

A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response? a. "This therapy will take about 3 months." b. "This therapy will take about a year." c. "This therapy will go on until your symptoms disappear." d. "Therapy for high blood pressure is usually lifelong."

d. "Therapy for high blood pressure is usually lifelong." (There is no cure for the disease, and treatment will be lifelong. The other answers are not appropriate.)

Which are risk factors for secondary hypertension? Select all that apply. Smoking Pregnancy Kidney disease Hyperlipidemia Oral contraceptive use

Pregnancy Kidney disease Oral contraceptive use (Risk factors for secondary hypertension include pregnancy, kidney disease, and oral contraceptive use. Risk factors for primary hypertension include smoking and hyperlipidemia.)

A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient? a. He should take the diuretic with his evening meal. b. He should skip the diuretic dose if he plans to leave the house. c. If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. d. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

d. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls. (Caution must be exercised in the administration of diuretics to the older adults because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber.)

The caregiver of a terminally ill patient reports that the patient sleeps through the day and avoids eating and drinking. The nurse finds that the patient has cold extremities. The nurse teaches care management to the patient's caregiver. Which caregiver's statement indicates effective learning? "I should not force the patient to eat." "I should encourage the patient to stay awake during the day." "I should position the patient on his or her back while sleeping." "I should cover the patient with an electric blanket to provide warmth."

"I should not force the patient to eat." (Cool extremities, increased sleeping, and reduced hunger are the physical signs and symptoms of approaching death in a terminally ill patient. In such a situation, the patient should not be forced to drink or eat, nor stay awake. The patient should be positioned on his or her side to allow easy breathing and to cough up secretions. A terminally ill patient may have impaired skin integrity. Therefore, the nurse should not cover the patient with blankets or a heating pad.)

The nurse is teaching the family members about end-of-life care for a terminally ill patient. Which caregiver statement indicates a need for further teaching? "I can sit quietly beside the patient." "I should spend as much time as possible with the patient." "I should wake up the patient if he or she sleeps continuously." "I should talk to the patient normally even if there is no response."

"I should wake up the patient if he or she sleeps continuously." (A family caring for a terminally ill patient should let him or her sleep without waking him or her up. The other statements indicate understanding. They should spend as much time as possible with the patient by sitting quietly beside them. They should talk to the patient normally even when there is no response.)

A registered nurse is teaching a nursing student about hospice care. Which statements made by the nursing student regarding hospice care are true? Select all that apply. "It is not limited to a specific time period." "It is provided to the patient in any stage of a serious illness." "It can be provided to a cancer patient when curative treatment is discontinued." "It includes registered nurses, social workers, chaplains, and volunteers who participate in the caring process." "It is provided when patients have a prognosis of six months or less to live."

"It can be provided to a cancer patient when curative treatment is discontinued." "It includes registered nurses, social workers, chaplains, and volunteers who participate in the caring process." "It is provided when patients have a prognosis of six months or less to live." (Hospice care can be provided to a patient when curative treatment, such as chemotherapy, is stopped. Registered nurses, social workers, chaplains, and volunteers all participate in providing hospice care. Hospice care is provided to patients who have a prognosis of six months or less to live. Palliative care, not hospice care, is not limited to any specific time periods. Palliative care, not hospice care, is provided to a patient in any stage of serious illness.)

The nurse is teaching the family members about providing care to a patient with a terminal illness whose sleep is increased. Which teaching by the nurse is appropriate? "Eliminate having people in the room." "Spend time sitting quietly with the patient." "Play loud music while the patient is sleeping." "Prompt the patient to talk to keep him or her awake."

"Spend time sitting quietly with the patient." (The older patient who has increased sleep at the end of life should be provided proper care. Family members should spend time with the patient sitting quietly. Family members can talk to the patient in a normal way, even if the patient does not respond. It is not required to reduce the number of people in the room; this would help if the patient was restless. Family members should not play loud music; however, soft music may be soothing to the patient. The patient should not be forced to talk to stay awake.)

The family of an unconscious dying patient realizes that their mother will die soon. The patient's children are having a difficult time letting go. How does the nurse respond to the needs of this family? "This must be difficult for you." "She will soon be in a better place." "Things will be fine, try not to worry so much." "Don't be upset; she wouldn't want it that way."

"This must be difficult for you." (Accept whatever the grieving person says about the situation. Remain present, be ready to listen attentively, and guide gently. In this way, the nurse can help the bereaved prepare for the necessary reminiscence and integration of the loss. The patient's or family member's pain of loss should never be minimized. Trite assurances such as saying, "Things will be fine" or "Don't be upset; she wouldn't want it that way," should be avoided. Such comments can actually be barriers to demonstrating care and concern. Never try to explain a patient's death or impending death in philosophic or religious terms; such statements are not helpful when the bereaved person has yet to express feelings of anguish or anger.)

The nurse is assisting a patient's family members who are grieving and mourning. Which statement made by the nurse indicates effective communication with the family members? 1"Things will be fine, don't cry." "In a year, you will have forgotten." "This must be very difficult for you." "Don't be upset. She wouldn't want it that way."

"This must be very difficult for you." (The statement, "This must be very difficult for you," is appropriate for communicating with the patient's family during grieving process. This is an example of therapeutic communication. The other three statements, "Things will be fine," "In a year, you will have forgotten," and "Don't be upset, she wouldn't want it that way" give false assurance to the family members and should be avoided.)

Which priority question should the nurse ask when beginning a spiritual assessment? "With which religion do you identify?" "Do you have an advanced directive?" "What gives you meaning in your life?" "Are there any specific rituals that you want to continue?"

"What gives you meaning in your life?" (Perform a spiritual assessment to identify the patient's spiritual needs and to facilitate open expression of his or her beliefs and needs. A spiritual assessment starts with an open-ended, general question like "What gives you meaning or purpose in your life?" While asking about advanced directives, religion, and rituals are important, these questions can follow the broader question in order to inform the tone of the rest of the conversation.)

The nurse is performing a spiritual assessment on a dying client. Which question provides the most accurate data on this aspect of the client's life? "Do you believe in God?" "Tell me about the history of religion in your life." "What gives you purpose and meaning in your life?" "Where have you been attending church for the past several years?"

"What gives you purpose and meaning in your life?" (The most accurate data about the client's spirituality would come from the question, "What gives you purpose and meaning in your life?" Spirituality arises from whatever or whoever provides the client ultimate purpose and meaning. It is not necessarily God, but it could be. It could be the client's definition of a higher power.The client may not believe in God and may find an inquiry about believing in God offensive and judgmental. Religion is considered by many people to be affiliation or membership in a faith community. Members of such a community may be supportive of the client if the client is a member, but this is not the best way to determine what the client's spirituality is. Church attendance is one way that some individuals express their religion, but it does not necessarily define a person's spirituality; asking about church could place the client on the defensive.)

The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? "I will move slowly from a sitting to standing position." "Blood pressure drugs can cause changes in sexual functioning." "When my blood pressure is over 140/90, I will take my medication." "I will wear a medical alert bracelet."

"When my blood pressure is over 140/90, I will take my medication." (Patients must adhere to prescribed antihypertensive regimen to prevent end-organ damage. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, but the medication may produce unwanted adverse effects. Patient teaching is essential.)

The nurse is caring for a 37-year-old patient diagnosed with end-stage renal failure. The patient is a single parent and has two young children to care for. Which nursing statement most meets the spiritual needs when the patient expresses concern about the children's upbringing? "Things will be fine. Don't cry." "This must be very difficult for you." "Would you like me to arrange for you to talk with a trained professional?" "Let's write a letter together that your children can read when they are older."

"Would you like me to arrange for you to talk with a trained professional?" (Patients with terminal diseases often have spiritual or existential distress. If the patient prefers, the nurse can arrange for counselling with a trained professional; this can help meet the spiritual needs of the patient. "Things will be fine. Don't cry" is a trite assurance and is not something the nurse should say as it dismisses the patient's pain. The nurse may say "This must be difficult for you" as this acknowledges the legitimacy of the patient's pain of the impending loss. While it is empathetic, it does not necessarily meet the patient's spiritual needs. Encouraging the patient to write letters for her children to read when they are older promotes storytelling through reminiscence and assists during the grieving process, but the patient might not wish to do this.)

What instruction should the nurse include while teaching dietary modifications to the patient who is prescribed verapamil after being diagnosed with hypertension? "You should strictly avoid apple juice in your diet." "You should strictly avoid orange juice in your diet." "You should strictly avoid grapefruit juice in your diet." "You should strictly avoid strawberry juice in your diet."

"You should strictly avoid grapefruit juice in your diet." (The patient should strictly avoid grapefruit juice while taking verapamil. Verapamil is a calcium channel blocker, and grapefruit juice enhances the action of drug. This enhancement may result in organ dysfunctioning or even death. The other fruit juices such as apple, strawberry, and orange can be included in the patient's diet. They don't have an effect on drug action.)

The daughter of a dying patient says, "I don't want my father to be uncomfortable." How does the nurse respond? "Your father will be kept sedated." "Do you want to talk to the bereavement nurse?" "We will send him to hospice when the time comes." "Your father will be closely monitored and cared for."

"Your father will be closely monitored and cared for." (Telling the daughter that her father will be closely monitored and cared for provides support and comfort. The daughter's comment does not require the expertise of a bereavement nurse. Also, asking if the daughter wants to talk to a bereavement nurse is a yes or no question and a nontherapeutic response; it shuts off the dialog. The dying patient is not typically kept sedated; patients are kept comfortable with as little or as much pain medication as needed. A goal is to keep him or her alert and able to communicate. Telling the daughter that her father will be sent to hospice when the time comes does not address the daughter's concern about her father's comfort; it closes the dialog.)

Which patient has the highest risk for hypertension? 50-year-old male 70-year-old male 45-year-old female 65-year-old female

65-year-old female (The 65-year-old female has the highest risk for hypertension. Men are at a higher risk until age 45, so the 50- and 70-year-old males are at a lower risk than the 65-year-old female. From ages 45-64, women and men have a similar risk for hypertension. After age 64, women have a higher risk than men, so the 65-year-old female is therefore at a higher risk than the 45-year-old female as well.)

The nurse is providing education for a diabetic patient prescribed lisinopril who is newly diagnosed with hypertension. In what instance does the nurse instruct the patient to notify the health care provider? An increase in blood glucose Fatigue and sexual dysfunction A 20-mm Hg decrease in systolic pressure The occurrence of dizziness when standing

A 20-mm Hg decrease in systolic pressure (The patient should notify the health care provider if there is a 20 mm Hg-decrease in systolic pressure. Hypotension places the patient at risk for injury. Loop and thiazide diuretics can affect blood glucose levels. Fatigue and sexual dysfunction are adverse effects of beta-blockers, not lisinopril. Dizziness is expected to occur with the initial use of an ACE inhibitor, so the patient should be instructed to get out of bed slowly. It is unnecessary to notify the health care provider of this.)

The nurse is caring for a patient near death who has loud, wet respirations. Which interventions would be most appropriate for the patient to relieve dyspnea? Select all that apply. Monitor vitals to assess for infections. Administer atropine solution 1% sublingually. Place a small towel under the patient's mouth. Re-position the patient to one side on the hospital bed. Perform oropharyngeal suctioning to clear the secretions.

Administer atropine solution 1% sublingually. Place a small towel under the patient's mouth. Re-position the patient to one side on the hospital bed. (Atropine solution should be administered sublingually every 4 hours to a patient with loud, wet respirations. Atropine helps to dry up secretions. A small towel should be placed under the patient's mouth to collect secretions. The patient should be re-positioned to one side on the bed to reduce gurgling. Assessing for infections in a patient near death would not be a priority action. Oropharyngeal suctioning should not be performed in a patient with loud, wet respirations as it is often not effective and it may result in agitation.)

A client with terminal lung cancer is receiving hospice care at home. Which nursing action does the RN manager ask the LPN/LVN to do? Administer prescribed medications to relieve the client's pain, shortness of breath, and nausea. Clarify family members' feelings about the meaning of client behaviors and symptoms. Develop a plan for care after assessing the needs and feelings of both the client and the family. Teach the family to recognize signs of client discomfort such as restlessness or grimacing.

Administer prescribed medications to relieve the client's pain, shortness of breath, and nausea. (LPN/LVNs are educated to administer medications and monitor clients for therapeutic and adverse medication effects; the administration of prescribed medications to the client for pain, shortness of breath, and nausea is appropriate to delegate to the LPN/LVN.Clarifying family members' feelings, developing a plan of care, and teaching the family to recognize signs of discomfort all require broader education and are appropriate for the RN practice level.)

A patient died in an acute care facility while being treated for acute pneumonia. What is the most appropriate nursing action? Determine the cause of death Ask the family to notify the medical examiner Bathe the body and prepare it for transfer to the funeral home Ask the family about their cultural and/or spiritual preferences for body preparation

Ask the family about their cultural and/or spiritual preferences for body preparation (The most appropriate action in such a situation is to ask the family about their cultural and/or spiritual preferences for body preparation. The medical examiner may be called if the death was unexpected or suspicious, but this is not the family's job. The nurse may eventually bathe and prepare the body for transfer to the funeral home but should ask the family about cultural/spiritual preferences before assuming that this is what they wish to have done. The health care provider will determine the cause of death.)

The nurse is providing education for a patient prescribed losartan and metroprolol for hypertension management. What is essential for the nurse to include in the patient education? Avoid grapefruit juice. Avoid foods high in potassium. Report a persistent dry cough. Consume foods high in potassium and magnesium.

Avoid foods high in potassium. (Education for the patient taking losartan should include avoiding foods high in potassium. Losartan is an angiotensin II receptor blocker, which can cause hyperkalemia, especially when combined with other hypertensive agents such as metroprolol (beta blocker). Grapefruit and grapefruit juice should be avoided when taking calcium channel blockers. A persistent dry cough may occur when taking angiotensin-converting enzyme (ACE) inhibitors. Loop and thiazide diuretics cause potassium and magnesium excretion and may necessitate a diet rich in these nutrients.)

A patient who is prescribed tamsulosin (Flomax) does not have a history of hypertension. The nurse knows this medication is also used for what condition? Migraine headache Pulmonary emboli Subarachnoid hemorrhage Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) (Alpha₁ blockers have beneficial in the treatment of BPH. The blocking of alpha₁-adrenergic receptors decreases the urine outflow obstruction related to BPH by preventing smooth muscle contractions in the bladder neck and urethra.)

When assessing the patient for hypertension, the nurse understands that systemic arterial blood pressure (BP) is a product of which factors? Fluid intake and urine output Stroke volume and heart rate BP in the supine position and BP when standing Cardiac output and total peripheral vascular resistance

Cardiac output and total peripheral vascular resistance (The systemic arterial BP is a product of cardiac output (CO) and total peripheral vascular resistance. Changes in fluid volume affect systemic arterial BP and may be assessed by monitoring fluid intake and urine output. CO is determined by the stroke volume multiplied by heart rate. BP in the supine position and BP while standing are used to assess for orthostatic hypotension.)

The health care team is getting ready to perform cardiopulmonary resuscitation (CPR) on a patient. The patient's son tells the nurse not to resuscitate the patient. What is the appropriate action for the nurse to take? Tell the son to hold the patient's hand during CPR. Honor the son's request and stopping the resuscitation. Ask the son if the patient has a do-not-resuscitate order. Check to see if the patient has a living will stating that CPR is not to be used.

Check to see if the patient has a living will stating that CPR is not to be used. (The nurse should determine if the patient has a living will that states that cardiopulmonary resuscitation (CPR) not be used. By law, the nurse must perform CPR for a person who is not breathing or is pulseless unless that person has a do-not-resuscitate (DNR) order. The nurse should not rely on another person's statement over that in a living will. Telling the son to hold the patient's hand does not answer the question of whether to perform CPR. Honoring the son's wishes could go against the patient's wishes if they are not in accordance with the living will.)

The hospice nurse is caring for a patient with esophageal cancer who is near the end of life and has developed severe dysphagia. Which interventions are most appropriate when providing drug therapy to the patient? Select all that apply. Administer drugs through the intramuscular route. Collaborate with a pharmacist experienced in palliation. Administer drugs through the buccal mucosa route, if possible. Crush the sustained-release capsules if the patient is in need of that drug. Discontinue the drugs that are not needed to control pain, agitation, and dyspnea.

Collaborate with a pharmacist experienced in palliation. Administer drugs through the buccal mucosa route, if possible. Discontinue the drugs that are not needed to control pain, agitation, and dyspnea. (Collaboration with a pharmacist experienced in palliation would be beneficial in identifying alternative routes or alternative drugs to control the patient's symptoms. Drugs should be administered through the buccal mucosa route (inside cheek) as it is the least invasive route. The nurse should collaborate with a prescriber and discontinue the drugs that do not help relieve end-of-life symptoms of the patient, such as pain, agitation, and dyspnea. Drugs should not be administered through the intramuscular route in a patient under palliative care as it is considered painful. Sustained-release capsules should not be crushed; instead, another dosage form of the drug should be used, if possible.)

The nurse recognizes signs and symptoms of depression in an 80-year-old patient who is dying from metastatic breast cancer. What does the nurse do initially for this patient? Documents these findings and continues to monitor the patient Assesses these behaviors as normal steps or stages in the grief process for the patient Collaborates with the end-of-life (EOL) care team to manage these feelings in the patient Reduces the quantity of depression-causing opioids that are being administered to the patient

Collaborates with the end-of-life (EOL) care team to manage these feelings in the patient (Behaviors should be assessed and treated with the collaboration of the EOL care team. The nurse may be instrumental in performing a "depression" screening. Feelings of depression —hopelessness, helplessness, unhappiness—are not part of the aging process or the process of dying; they should be aggressively treated. These feelings should not only be documented and monitored, but also should be acknowledged as not a normal part of the dying process and should be treated with psychotherapy or medications or both. Inadequate analgesic pain control is one of the most noted and critical problems, especially in older adults. This scenario would not be a reason for opioid administration to be reduced; such an action is harmful to the patient.)

The nurse is assessing the coping patterns of a newly admitted patient. What will the nurse include in this assessment? (Select all that apply.) Current stressors as perceived by the patient Use of drugs or alcohol Recent weight changes Age and height Temperature

Current stressors as perceived by the patient Use of drugs or alcohol Recent weight changes (Stressors are subjective based on patient perception and assessment of stressors as part of a patient history. Stressors trigger coping behaviors that can include negative uses of drugs and alcohol and appetite changes that affect weight. Age, height, and temperature are not typically altered with coping, although pulse, respiratory rate, and blood pressure may be affected.)

A hospitalized client of the Islamic (Muslim) religion is dying. What concept does the nurse share with the health care team about this client's beliefs about death? Death is seen as the beginning of a new and better life, with Islam as the vehicle. Life experiences do not affect the individual's preparation for "everlasting life." The timing of death is under the power of the person who is facing death. Plans for burial will take days, maybe even weeks, after the death.

Death is seen as the beginning of a new and better life, with Islam as the vehicle. (The nurse shares the information that, in the Muslim faith, Islam is the vehicle that transports the person to a new and better life on the "other side." This is a fundamental belief of the religion.In Islam, life experiences do affect the person's afterlife existence. Life is meant to be a test of preparation for everlasting life in the hereafter. Muslims believe that God (Allah), rather than the person, has prescribed a time of death for everyone. Preparation for burial takes place as soon as possible after death has occurred.)

When teaching a patient about a new prescription for carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.) Decreases heart rate Promotes excretion of sodium Relaxes muscle tone Peripheral vasodilation Increases urine output

Decreases heart rate Peripheral vasodilation (Carvedilol (Coreg) has the dual antihypertensive effects of reduction in heart rate (beta₁ receptor blockade) and vasodilation (alpha₁ receptor blockade).

What are the purposes of hospice care? Select all that apply. Provides care that postpones death Directs care to provide the relief of symptoms Promotes patient comfort during the dying process Admits patients with a prognosis of 1 year or less to live Implements an interdisciplinary approach to patient care

Directs care to provide the relief of symptoms Promotes patient comfort during the dying process Implements an interdisciplinary approach to patient care (Hospice care uses an interdisciplinary approach to patient care and works toward providing relief of symptoms. Hospice care also promotes patient comfort during the dying process. Hospice care does not postpone or hasten death and admits patients with prognosis of 6 months or less to live.)

The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications? Diuretics and calcium channel blockers ACE inhibitors and diuretics Diuretics and beta blockers ACE inhibitors and beta blockers

Diuretics and calcium channel blockers (Research has demonstrated that African Americans do not typically respond therapeutically to beta blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.)

The nurse is caring for a client who is being treated for hypertensive emergency. Which medication prescribed for the client would the nurse question? Enalapril (Vasotec) Sodium nitroprusside (Nipride) Dopamine (Intropin) Labetalol (Normodyne)

Dopamine (Intropin) (The nurse would question the prescription for dopamine. Dopamine is used for its inotropic and vasoconstrictive properties to raise blood pressure, and would not be used in hypertensive emergency.Enalapril, an angiotensin-converting enzyme inhibitor, may be used intravenously in hypertensive emergencies. Sodium nitroprusside, a direct-acting vasodilator, may be used intravenously to lower blood pressure quickly in hypertensive emergencies. Labetalol, an intravenous calcium channel blocker, is used in hypertensive emergencies when oral therapy is not feasible.)

The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? Dry, nonproductive cough Hypokalemia Fatigue Orthostatic hypotension

Dry, nonproductive cough (ACE inhibitors block the breakdown of bradykinins and may cause a dry, nonproductive cough. ARBs do not block this breakdown, thus minimizing this adverse effect. ACE inhibitors and ARBs are equally effective for the treatment of hypertension, but ARBs do not cause cough.)

The nurse in the cardiology clinic is reviewing teaching about hypertension, provided at the client's last appointment. Which actions by the client indicate that teaching has been effective? Select all that apply. Has maintained a low-sodium, no-added-salt diet Has lost 3 pounds (1.4 kg) since last seen in the clinic Cooks food in palm oil to save money Exercises once weekly Has cut down on caffeine

Has maintained a low-sodium, no-added-salt diet Has lost 3 pounds (1.4 kg) since last seen in the clinic Has cut down on caffeine (Teaching about hypertension has been effective when the nurse notes that the client has been on a low-sodium, no-added salt diet, has lost 3 pounds (1.4 kg) since the last clinic visit, and has cut down on caffeine. Clients with hypertension need to consume low-sodium foods and would avoid adding salt. Weight loss can result in lower blood pressure. Caffeine promotes vasoconstriction, thereby elevating blood pressure.Although palm oil may be cost-saving, it is higher in saturated fat than canola, sunflower, olive, or safflower oil. The goal is to exercise three times and not once weekly.)

Which statement is true regarding hospice care? Care is provided for a period of one year. Patients can be in any stage of serious illness. Hospice care aims to meet the spiritual and physical needs of patients. A consultation is provided to the patient that outlines curative therapies.

Hospice care aims to meet the spiritual and physical needs of patients. (In hospice care, efforts are made to meet the spiritual and physical needs of the patient in order to help the patient to cope with loss. Care is provided in 60- to 90-day periods with an opportunity to continue if eligibility criteria are met. Hospice care is provided to patients who have a prognosis of six months or less to live. Hospice care is provided when curative treatment, such as chemotherapy, has been stopped.)

The nurse is developing a care plan for a patient with ineffective coping skills. Which intervention would be an example of a problem-focused coping strategy? Scheduling a regular exercise program Attending a seminar on treatment options Identifying a confidant to share feelings Attending a support group for families

Identifying a confidant to share feelings (Problem-focused strategies are used to find solutions or improvement to the underlying stressor, such as accessing community resources or attending educational seminars. Exercise, emotional support, and support groups are emotion-based strategies that create a feeling of well-being.)

What are the physical signs and symptoms of approaching death? Select all that apply. Increased sleeping Decreased fluid and food intake Increased circulation to the brain Increased temperature at the extremities Increased disorientation and restlessness

Increased sleeping Decreased fluid and food intake Increased disorientation and restlessness (The dying patient sometimes sleeps for as long as 23 hours a day due to decreased metabolism. Disorientation and restlessness occur following decreased metabolism and slowed circulation to the brain. The patient's metabolic needs are decreased leading to decreased fluid and food intake. The extremities of the patient are cool to the touch due to reduced circulation. There is a decreased circulation to the brain near death.)

Which medication should the nurse question if prescribed together with ACE inhibitors? Docusate sodium (Colace) Furosemide (Lasix) Potassium chloride (K-Dur) Morphine

Potassium chloride (K-Dur) (ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.)

A patient with terminal lung cancer is admitted to a hospice center. What is the focus of hospice care? It allows natural death to take place. It postpones the death of the patient. It facilitates quality of life and peaceful death. It supports functional independence of the patient.

It facilitates quality of life and peaceful death. (The focus of hospice care is to facilitate the quality of life and peaceful death by using an interdisciplinary approach to assess and address the holistic needs of the patient and family. A "do-not-resuscitate" (DNR) order allows a patient to die a natural death. Hospice care does not postpone or hasten the death of a patient. Palliative care supports functional independence of the patient.)

The professional nurse and the nursing student are caring for a group of clients with hypertension. Which problem identified by the nursing student correctly identifies the client at risk for secondary hypertension? Psychiatric disturbance High sodium intake Physical inactivity Kidney disease

Kidney disease (The client who is most at risk for secondary hypertension is the client with kidney disease. Kidney disease is one of the most common causes of secondary hypertension.Psychiatric disturbance can exacerbate essential hypertension, but secondary hypertension is caused by a disease process or drugs. High sodium intake is a risk factor for essential hypertension, not for secondary hypertension, which is caused by disease states or medications. Physical inactivity is a risk factor for essential hypertension.)

The hospice nurse is caring for an older patient with prostate cancer. What are common emotional signs of approaching death? Select all that apply. Letting go Withdrawal Saying goodbye Feelings of anxiety Restlessness and agitation

Letting go Withdrawal Saying goodbye (Common emotional signs of approaching death include withdrawal as the person prepares to let go and say goodbye to surroundings and relationships. Anxiety, restlessness, and agitation indicate fear of impending death and unresolved tasks in life.)

A dying patient becomes increasingly withdrawn and begins to refuse to eat and drink. What intervention does the nurse implement? Offers ice chips Gives intravenous hydration Calls the family to come in right away Brings in the patient's favorite Chinese takeout food

Offers ice chips (The dying patient should not be forced to eat or drink, but small sips of liquids or ice chips at frequent intervals can be offered if the patient is alert and able to swallow. This helps the patient with problems of dehydration and "dry mouth." The dying patient's metabolic needs have decreased, so the patient will not want any food or drink. Calling the family is not yet necessary in this patient's case. Because the dying patient's metabolic needs have decreased, invasive procedures are not necessary at this point.)

Which side effect may occur in a patient who is taking metoprolol? Cough Diarrhea Hypovolemia Orthostatic hypotension

Orthostatic hypotension (Metoprolol is a beta-adrenergic blocker drug and one possible side effect of metoprolol is a drop in blood pressure when changing positions that can cause orthostatic hypotension. An adverse affect of Lisinopril is a cough. Diarrhea is a side effect of aliskiren. A side effect of furosemide is hypovolemia.)

What would the nurse assess to determine if a death has occurred? Select all that apply. Pale-colored body Absence of breathing Rise in body temperature Fixed and constricted pupils Relaxed muscles and sphincters

Pale-colored body Absence of breathing Relaxed muscles and sphincters (When death occurs, the body becomes pale in color due to lack of oxygen, breathing stops as the respiratory system doesn't work, and muscles and sphincters relax. Body temperature does not rise; rather, it drops after death as thermoregulation is not maintained. The pupils become fixed and dilated after death.)

A dying patient cannot swallow and is accumulating audible mucus in the upper airway (death rattles). The nursing assistant reports that these noises are upsetting to family members. What does the nurse tell the assistant to do? Place the patient in a side-lying position so secretions can drain. Position the patient in a high-Fowler's position to minimize secretions. Assist the family in leaving the room so that they can compose themselves. Use a Yankauer suction tip to remove secretions from the patient's upper airway.

Place the patient in a side-lying position so secretions can drain. (Placing the patient in a side-lying position to facilitate draining of secretions (by gravity) is the appropriate nursing care intervention. As secretions diminish, noisy respirations will decrease. Asking the family to leave at this important time is not appropriate. Placing the patient in a high-Fowler's position is ineffective in helping the patient who has lost the ability to swallow; the danger of choking and aspiration would increase. Not only is oropharyngeal suctioning outside the scope of practice of the nursing assistant, it is also not recommended for removal of secretions because it is not effective and may even agitate the dying patient.)

The nurse at the hospice center is caring for a patient approaching death. The patient is unable to cough up secretions effectively. What interventions does the nurse perform for this patient? Position the patient on the side. Massage the patient's forehead. Offer ice chips at frequent intervals. Use moist swabs to keep the lips and mouth moist.

Position the patient on the side. (If the patient is unable to cough up secretions, the nurse should position the patient on the side. The patient is offered ice chips to prevent dryness of the mouth and lips. The patient's forehead is massaged to soothe the restless patient with decreased metabolism and slowed circulation to the brain. Moist swabs are used to keep the lips and mouth moist in patients with reduced metabolic needs.)

A hospice patient has just died. Which of these postmortem nursing tasks is most appropriate to delegate to a nursing assistant? Removing or cutting all IV lines or tubes according to the hospice policy Assessing the patient for cessation of respiratory effort and lack of pulse Notifying the spouse and other family members about the patient's death Documenting the time of death and required assessment data on the chart

Removing or cutting all IV lines or tubes according to the hospice policy (Preparing the body for viewing by the family (such as removing tubing and lines) and/or transfer to the morgue is an appropriate task for unlicensed assistive personnel (UAP). Assessing for signs of life, documenting about the death, and spousal and family notification all require broader education and should be done by licensed nursing staff.)

Inappropriate secretion of which chemical may cause increased peripheral vascular resistance in patients with hypertension? Renin Sodium Aldosterone Angiotensin-converting enzyme

Renin (Inappropriate secretion of renin may cause increased peripheral vascular resistance in patients with hypertension. When the blood pressure (BP) is high, renin levels should decrease because the increased renal arteriolar pressure usually inhibits renin secretion. However, for most people with essential hypertension, renin levels remain normal. Sodium retention inhibits fluid loss, thus increasing blood volume and subsequent BP. Aldosterone works on the collecting tubules in the kidneys to reabsorb sodium. Angiotensin-converting enzyme converts angiotensin I to angiotensin II.)

Which enzyme acts on angiotensinogen to split off angiotensin I as part of a blood pressure (BP) control system? Renin Sodium Aldosterone Angiotensin-converting enzyme

Renin (The kidney produces renin, which acts on angiotensinogen to split off angiotensin I as part of a blood pressure control system. Sodium is not an enzyme; sodium retention inhibits fluid loss, thus increasing blood volume and subsequent BP. Aldosterone works on the collecting tubules in the kidneys to reabsorb sodium. Angiotensin-converting enzyme converts angiotensin I to angiotensin II.)

A patient with a terminal illness is near the end of life. The patient refuses to eat or drink anything. To respect the patient's wishes, the nurse should intervene when the patient's caregiver performs which actions? Select all that apply. Requests an order to give intravenous fluids Allows the patient to refuse eating or drinking Offers small sips of water at frequent intervals Applies moistened swab sticks to his or her lips Coaxes the patient to have fluids, such as juices

Requests an order to give intravenous fluids Coaxes the patient to have fluids, such as juices (When near the end of life, the patient should be allowed to die peacefully without performing unnecessary interventions. The nurse should respect the patient's last wishes and should not push the patient into eating or drinking. Intravenous fluids administration is not needed near the end of life because it could be stressful, painful, and uncomfortable for the patient. If the patient chooses to not eat or drink, the patient should not be forced to do so. Forcing the patient can cause stress and discomfort in the patient. Offering small sips of water at frequent intervals helps keep the patient's oral cavity hydrated. Applying moist swab sticks to the lips also helps prevent dryness of the mouth.)

In compliance with a terminal patient's living will, the health care team removes mechanical ventilation. Which concepts are illustrated in this scenario? Select all that apply. Respect for autonomy Principle of double effect Physician-assisted suicide Voluntary active euthanasia Withdrawal of life-sustaining therapy

Respect for autonomy Withdrawal of life-sustaining therapy (By following the living will, the health care team is respecting the patient's autonomy. Withdrawing life-sustaining therapy is the discontinuation of a therapy that prolongs the patient's life but does not necessarily improve his or her condition; removing mechanical ventilation is an example of this. Administering a life-ending drug with the patient's consent is an example of voluntary active euthanasia. In physician-assisted suicide, the provider gives the patient the means with which to commit suicide. An action that has both bad and good effects illustrates the principle of double effect. Removing mechanical ventilation without patient consent is an example of involuntary active euthanasia.)

Vascular changes to what part of the eye may be a reliable index of the severity of hypertension that can be observed by a skilled health care practitioner? Iris Pupil Sclera Retina

Retina (Funduscopic examination of the eyes to observe vascular changes in the retina is done by a skilled health care practitioner. The appearance of the retina can be a reliable index of the severity and prognosis of hypertension. These changes are not observed in the iris, pupil, or sclera.)

Which vascular assessment by the student nurse requires intervention by the supervising nurse? Measuring capillary refill in the fingertips Assessing pedal pulses by Doppler Measuring blood pressure in both arms Simultaneously palpating the bilateral carotids

Simultaneously palpating the bilateral carotids (The vascular assessment by the student that needs intervention by the supervisor nurse is simultaneously palpating the bilateral carotids. Carotid arteries are palpated separately because of the risk for inadequate cerebral perfusion and the risk for causing the client to faint.Prolonged capillary filling generally indicates poor circulation, and is an appropriate assessment. Many clients with vascular disease have poor blood flow. Pulses that are not palpable may be heard with a Doppler probe. Because of the high incidence of hypertension in clients with atherosclerosis, blood pressure is assessed in both arms.)

Which statement precisely differentiates spirituality and religion? Spirituality is the purpose in one's life; religion is a formal belief system. Spirituality deals with rituals and other practices; religion may or may not include the belief in God. Spirituality helps patients cope with death; religion helps patient to cope with the suffering related to any disease. Spirituality provides a framework for making sense of life; religion invites particular ways of being in the world in relation to others.

Spirituality is the purpose in one's life; religion is a formal belief system. (Spirituality is whatever or whoever offers ultimate purpose or meaning in one's life and may or may not include belief in God; religion is a more formal system associated with beliefs, rituals, texts, and other practices that are shared by a whole community. Both spirituality and religion can help an individual to cope with death and disease. A patient may associate violation of religious values and spirituality as the cause for any long-term pain. Spirituality provides ultimate meaning and purpose in one's life that invites particular ways of being in the world in relation to others, oneself, and the universe. Religion provides a framework that makes the sense of life. Spirituality may or may not include the belief in God. People perform religious rituals and practices.)

In a dying client's hospital room, the nurse overhears family telling the client to "calm down," and observes the client being agitated and making repetitive motions. What action does the nurse take? Asks the family to speak in low tones or whispers to avoid disturbing the client Offers to call and have a hospital chaplain come to help the client calm down Recommends giving the client antianxiety medications to reduce distress Suggests that the family tell the client that things are "all right"

Suggests that the family tell the client that things are "all right" (The nurse suggests that the family reassure the client that things are "all right." When dying clients are agitated or performing repetitive tasks, it is often a sign that they have unfinished or unresolved issues that prevent letting go. Suggesting that family members tell the client that they will be all right and that it is OK to go can help clients relax and let go.The client needs to know that family members are present and are concerned. Having a chaplain calm the client or giving antianxiety medications will not resolve the underlying issue.)

A patient tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking." Which response would be in keeping with the doctor's recommendations? Teaching the patient to recognize, reconsider, and reframe irrational thoughts Encouraging the patient to imagine being in calming circumstances Teaching the patient to use instruments that give feedback about bodily functions Provide the patient with a blank journal and guidance about journaling

Teaching the patient to recognize, reconsider, and reframe irrational thoughts (Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient's manner of thinking.)

A patient with terminal bone cancer passes away under hospice care. The nurse explains to a team member that the patient had a good death. Which activity related to the patient's death supports the nurse's statement? The patient's family was kept away from seeing the patient die. The patient did not give up cancer curative treatment until near death. The patient had endured the cancer-associated pain without analgesics. The patient and the family had been mentally prepared for the departure.

The patient and the family had been mentally prepared for the departure. (A good death is one in which the deceased and the family members are mentally prepared for the death, and the patient's death is in agreement with the family members. This helps reduce the emotional pain associated with the loss. In an ideal situation, the patient's family should be with the patient for a good death; a bad death involves the patient being abandoned. When in hospice care, the curative treatments are stopped. A good death would include adequate pain-relieving measures to promote the patient's comfort.)

A dying patient with dyspnea is prescribed atropine ophthalmic solution 1% every 4 hours. What is the purpose of this drug? To treat bronchospasms To decrease fluid overload To treat respiratory infection To dry up secretions in the respiratory tract

To dry up secretions in the respiratory tract (Secretions in the respiratory tract and oral cavity may contribute to dyspnea near death. Atropine ophthalmic solution 1% may be administered orally every 4 hours to dry up these secretions. Antibiotics are administered to treat respiratory infections. Diuretics such as furosemide are administered to decrease fluid overload. Bronchodilators such as albuterol are administered for bronchospasms via a metered dose inhaler or nebulizer.)

A new case management nurse has been hired at a nursing home to investigate several recent resident deaths at the facility. The nurse understands that because there are many kinds of potential abuse, she will need to assess for what type of factors? Select all that apply. High ratio of overweight residents Unexplained bruising of residents Altered cognitive function of residents Skin breakdown in residents resulting from poor hygiene Documentation of prescribed physical therapy sessions

Unexplained bruising of residents Altered cognitive function of residents Skin breakdown in residents resulting from poor hygiene (In addition to psychological signs such as depression, signs of elder abuse include bruising from physical abuse and skin breakdown from neglect of hygiene and nutrition; frailty and decreased cognitive function are also risk factors for abuse. Overweight residents and following prescribed treatments are not indicators of abuse or neglect.)

A nurse is teaching a larger female client about alcohol intake and how it affects hypertension. The client asks if drinking two beers a night is an acceptable intake. What answer by the nurse is best? a. "No, women should only have one beer a day as a general rule." b. "No, you should not drink any alcohol with hypertension." c. "Yes, since you are larger, you can have more alcohol." d. "Yes, two beers per day is an acceptable amount of alcohol."

a. "No, women should only have one beer a day as a general rule." (Alcohol intake should be limited to two drinks a day for men and one drink a day for women. A "drink" is classified as one beer, 1.5 ounces of hard liquor, or 5 ounces of wine. Limited alcohol intake is acceptable with hypertension. The woman's size does not matter. YIKES)

When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.) a. "You need to have your blood pressure checked once a week and keep track of the readings." b. "If you notice that the symptoms have gone away, you should be able to stop taking the drug." c. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first." d. "If you experience severe side effects, stop the medicine and let us know at your next office visit." e. "Most over-the-counter decongestants are compatible with antihypertensive drugs." f. "Please continue taking the medication, even if you are feeling better."

a. "You need to have your blood pressure checked once a week and keep track of the readings." c. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first." f. "Please continue taking the medication, even if you are feeling better." (Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. Remind the patient not to stop taking the medication just because he or she is feeling better. Abruptly stopping the medication may lead to rebound hypertension. Therapy is often lifelong, even though symptoms may improve. Many over-the-counter drugs, especially decongestants, have serious interactions with antihypertensive drugs. The patient needs to consult his or her prescriber before taking any other medication.)

A nurse is interested in providing community education and screening on hypertension. In order to reach a priority population, to what target audience should the nurse provide this service? a. African-American churches b. Asian-American groceries c. High school sports camps d. Women's health clinics

a. African-American churches (African Americans in the United States have one of the highest rates of hypertension in the world. The nurse has the potential to reach this priority population by providing services at African-American churches. Although hypertension education and screening are important for all groups, African Americans are the priority population for this intervention.)

A client with a history of heart failure and hypertension is in the clinic for a follow-up visit. The client is on lisinopril (Prinivil) and warfarin (Coumadin). The client reports new-onset cough. What action by the nurse is most appropriate? a. Assess the client's lung sounds and oxygenation. b. Instruct the client on another antihypertensive. c. Obtain a set of vital signs and document them. d. Remind the client that cough is a side effect of Prinivil.

a. Assess the client's lung sounds and oxygenation. (This client could be having an exacerbation of heart failure or be experiencing a side effect of lisinopril (and other angiotensin-converting enzyme inhibitors). The nurse should assess the client's lung sounds and other signs of oxygenation first. The client may or may not need to switch antihypertensive medications. Vital signs and documentation are important, but the nurse should assess the respiratory system first. If the cough turns out to be a side effect, reminding the client is appropriate, but then more action needs to be taken.)

The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure? a. Cardiac output and systemic vascular resistance b. Heart rate and peripheral resistance c. Blood volume and renal blood flow d. Myocardial contractility and arteriolar constriction

a. Cardiac output and systemic vascular resistance (Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect.)

When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic? a. Digitalis b. Penicillin c. Potassium supplements d. Aspirin

a. Digitalis (There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.)

When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? a. Impotence b. Bradycardia c. Increased libido d. Weight gain

a. Impotence (Sexual dysfunction is a common complication of antihypertensive medications and may be manifested in men as decreased libido or impotence. The other options are incorrect.)

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine? a. In the morning b. At noon c. With supper d. At bedtime

a. In the morning (It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.)

A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best? a. "Do you have trouble affording your medications?" b. "Most people with hypertension do not have symptoms." c. "You are lucky; most people get severe morning headaches." d. "You need to take your medicine or you will get kidney failure."

b. "Most people with hypertension do not have symptoms." (Most people with hypertension are asymptomatic, although a small percentage do have symptoms such as headache. The nurse should explain this to the client. Asking about paying for medications is not related because the client has already admitted nonadherence. Threatening the client with possible complications will not increase compliance.)

A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers

b. Angiotensin-converting enzyme (ACE) inhibitors (ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough.)

A client has hypertension and high risk factors for cardiovascular disease. The client is overwhelmed with the recommended lifestyle changes. What action by the nurse is best? a. Assess the client's support system. b. Assist in finding one change the client can control. c. Determine what stressors the client faces in daily life. d. Inquire about delegating some of the client's obligations.

b. Assist in finding one change the client can control. (All options are appropriate when assessing stress and responses to stress. However, this client feels overwhelmed by the suggested lifestyle changes. Instead of looking at all the needed changes, the nurse should assist the client in choosing one the client feels optimistic about controlling. Once the client has mastered that change, he or she can move forward with another change. Determining support systems, daily stressors, and delegation opportunities does not directly impact the client's feelings of control.)

A nurse is caring for four clients. Which one should the nurse see first? a. Client who needs a beta blocker, and has a blood pressure of 92/58 mm Hg b. Client who had a first dose of captopril (Capoten) and needs to use the bathroom c. Hypertensive client with a blood pressure of 188/92 mm Hg d. Client who needs pain medication prior to a dressing change of a surgical wound

b. Client who had a first dose of captopril (Capoten) and needs to use the bathroom (Angiotensin-converting enzyme inhibitors such as captopril can cause hypotension, especially after the first dose. The nurse should see this client first to prevent falling if the client decides to get up without assistance. The two blood pressure readings are abnormal but not critical. The nurse should check on the client with higher blood pressure next to assess for problems related to the reading. The nurse can administer the beta blocker as standards state to hold it if the systolic blood pressure is below 90 mm Hg. The client who needs pain medication prior to the dressing change is not a priority over client safety and assisting the other client to the bathroom.)

A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? a. Cardioprotective effects b. Renal protective effects c. Reduces blood pressure d. Promotes fluid output

b. Renal protective effects (ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect.)

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? a. Diarrhea b. Sexual dysfunction c. Urge urinary incontinence d. Impaired memory

b. Sexual dysfunction (Sexual dysfunction is a potential nursing diagnosis related to possible adverse effects of antihypertensive drug therapy. The other nursing diagnoses are not appropriate.)

A student nurse asks what "essential hypertension" is. What response by the registered nurse is best? a. "It means it is caused by another disease." b. "It means it is 'essential' that it be treated." c. "It is hypertension with no specific cause." d. "It refers to severe and life-threatening hypertension."

c. "It is hypertension with no specific cause." (Essential hypertension is the most common type of hypertension and has no specific cause such as an underlying disease process. Hypertension that is due to another disease process is called secondary hypertension. A severe, life-threatening form of hypertension is malignant hypertension.)

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates

c. Nonsteroidal anti-inflammatory drugs (Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure.)

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Potassium-sparing diuretics

c. Thiazide diuretics (The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as one of the first-line treatment for hypertension. The other drug classes are not considered first-line treatments.)

A patient was diagnosed with hypertension. The patient asks the nurse how this disease could have happened to them. The nurse's best response is "Hypertension happens to everyone sooner or later. Don't be concerned about it." can happen from eating a poor diet, so change what you are eating." can happen from arterial changes that impede the blood flow." happens when people do not exercise, so you should walk every day."

can happen from arterial changes that impede the blood flow." (Hardening of the arteries from atherosclerosis can cause hypertension in the patient. Hypertension does not happen to everyone. Changing the patient's diet and exercising may be a positive life change, but these answers do not explain to the patient how the disease could have happened.)

During a follow-up visit, the health care provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, "Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!" What is the best response by the nurse? a. "We need to monitor for drug toxicity." b. "We must watch for increased intraocular pressure." c. "The provider is assessing for visual changes that may occur with drug therapy." d. "The provider is making sure the treatment is effective over the long term."

d. "The provider is making sure the treatment is effective over the long term." (The physician would examine the fundus of a patient's eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment.)

A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic? a. Captopril rarely causes first-dose hypotensive effects. b. Captopril has little effect on electrolyte levels. c. Captopril is a prodrug and is metabolized by the liver before becoming active. d. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active.

d. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active. (A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction.)

An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension

d. Hypotension (The older adult patient is more sensitive to the blood pressure-lowering effects of vasodilators, and consequently experience more problems with hypotension, dizziness, and syncope. The other options are incorrect.)

The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode. alter the internal state by modifying electronic signals related to physiologic processes. replace stress-producing thoughts and activities with daily stress-reducing thoughts and activities. reduce catecholamine production and promote the production of additional beta-endorphins.

switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode. (When the sympathetic nervous system is operative, the individual experiences muscular tension and an elevated pulse, blood pressure, and respiratory rate. Relaxation is achieved when the sympathetic nervous system is quieted and the parasympathetic nervous system is operative. Modifying electronic signals is the basis for biofeedback, a behavioral approach to stress reduction. Altering thinking and activities from more-stressful to less-stressful reflects the cognitive approach to stress management. Reducing catecholamine production is the basis for guided imagery's effectiveness.)