15H PALLIATIVE AND END-OF-LIFE CARE PART I

The nurse is admitting a 52-year-old father of four into hospice care. The client has a diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear his preference to receive care at home. What intervention should the nurse prioritize in the plan of care? A. Aggressively continuing to fight the disease process B. Moving the client to a long-term care facility when it becomes necessary C. Including the children in planning their father's care D. Supporting the client's and family's values and choices

D

The nurse is admitting a client to palliative care and notices that the client has health care provider orders for life-sustaining treatment (POLST). Which concepts regarding POLST will the nurse use to develop a plan of care for this client? Select all that apply. A. It can be used in any health care setting. B. It names the durable power of health care attorney. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR). E. It specifies the client's preferences for funeral arrangements.

A C D

A pediatric nurse is emotionally distraught by the death of a 9-year-old client who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief? A. Take time off from work to mourn the death. B. Post mementos of the client on the unit. C. Solicit emotional support from the client's family. D. Attend the client's memorial service.

D

The hospice nurse is caring for a 45-year-old parent of three young children in the client's home. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. Which goal of nursing interventions should the nurse identify? A. Helping the family to understand why the client needs to be sedated B. Making arrangements to promptly move the client to an acute-care facility C. Explaining to the family that death is near and the client needs around-the-clock nursing care D. Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

D

As the American population ages, nurses expect to see more clients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care? A. Ongoing acute care B. Restorative measures C. Mobility and socialization D. Incentives to palliative care

B

A client experienced the death of a spouse from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the client will be going through the process of mourning for an extended period of time. What process(es) of mourning will allow the client to accommodate the loss in a healthy way? Select all that apply. A. Reiterating the client's anger at the spouse's care team B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time E. Renewing lifelong commitments to the spouse

B C D

A hospice nurse is caring for a young adult client with a terminal diagnosis of leukemia. When updating this client's plan of nursing care, what should the nurse prioritize? A. Interventions aimed at maximizing quantity of life B. Providing financial advice to pay for care C. Providing realistic emotional preparation for death D. Making suggestions to maximize family social interactions after the client's death

C

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome? A. Inefficiency in the provision of care B. Illness C. Emotional exhaustion D. Social withdrawal

C

One of the functions of nursing care of the terminally ill is to support the client and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply. A. Describe their personal experiences in dealing with end-of-life issues. B. Encourage the client and family to "keep fighting" as a cure may come. C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

C D E

The family of a client receiving palliative care for end-stage congestive heart failure is upset that the client is not eating. Which intervention should the nurse recommend to the family? A. Remove unpleasant odors and sights during meals. B. Withhold antiemetics prior to a meal. C. Coax and cajole the client to eat more. D. Weigh the client daily to assess for weight gain.

A

A client with end-stage kidney disease who immigrated to the United States several years ago is receiving care from family at home. When discussing the option of hospice care with a health care provider, the client and family explain through an interpreter that they do not want hospice care. Which factors are potential barriers to care for this client and family? Select all that apply. A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system D. Wanting to care for the client at home E. Uncertainty about how long the client will live

A B C

The nursing director of a hospice program has observed increasing levels of emotional exhaustion and poor work performance in the nursing staff and believes the staff are suffering from burnout. Which actions can the nursing director take to reduce burnout in the nursing staff? Select all that apply. A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. D. Mandate personal leave days after a client dies. E. Develop programs to increase nurse resilience.

A B C E

A nurse who provides care on an acute medical unit has observed that health care providers are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. A. Financial pressures on health care providers B. Client reluctance to accept this type of care C. Strong association of hospice care with prolonging death D. Advances in "curative" treatment in late-stage illness E. Ease of making a terminal diagnosis

A B D

A client has just died following urosepsis that progressed to septic shock. The client's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what phase? A. Complicated grief and mourning B. Uncomplicated grief and mourning C. Depression stage of dying D. Acceptance stage of dying

B

A client with a terminal diagnosis has asked the nurse about "helping me end my suffering." What is the nurse's responsibility in the domain of assisted suicide? A. Educating the client about the moral implications of assisted suicide B. Discussing concerns and fears with the client C. Identifying resources that meet the client's desire to die D. Telling the client the request is not acceptable

B

A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim? A. To prioritize emotional needs B. To prevent and relieve suffering C. To bridge between curative care and hospice care D. To provide care while there is still hope

B

Clients who are enrolled in hospice care are often believed to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon? A. Unwillingness to overmedicate the dying client B. Rules concerning completion of all cure-focused medical treatment C. Unwillingness of clients and families to acknowledge the client is terminal D. Lack of knowledge by clients and families regarding availability of care

B

The organization of a client's care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice? A. It is based on the participation of clinicians without a team leader. B. It is based on clinicians of varied backgrounds integrating their separate plans of care. C. It is based on communication and cooperation between disciplines. D. It is based on medical expertise and client preference with the support of nursing.

C

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important positive action that can come from a grief support group? A. Providing a framework for incorporating the old life into the new life B. Normalizing adaptation to a continuation of the old life C. Aiding in adjusting to using old, familiar social skills D. Normalization of feelings and experiences

D

The nurse is caring for a client who is having difficulty adjusting to a terminal diagnosis. The nurse notes the client's tears and sits down by the bedside. The client tells the nurse, "There are so many things I still want to accomplish." Which response would be most therapeutic and appropriate for the nurse to make? A. "Can I give you some advice?" B. "Tell me what's most important to you now." C. "Do you want me to call the chaplain?" D. "I have cared for lots of clients in your position. It will get easier."

B