Ch 30- Dying, death, grieving
Which form of grief involves concerns for the future? Disenfranchised Dysfunctional Anticipatory Maladaptive
Anticipatory Anticipatory grief or anticipatory mourning is when a future loss is being mourned in advance. None of the other options are associated with premature mourning for a loss that is likely to occur in the future
What is the basic principle that is associated with hospice care? Family centered care Focus is on care not cure Treating client suffering Promoting client autonomy
Focus is on care not cure Hospice is a multidisciplinary team approach that focuses on patient care, not cures. Palliative care is patient and family-centered care that optimizes quality of life anticipating, preventing, and treating suffering. Palliative care addresses physical, intellectual, emotional, social, and spiritual needs. Palliative caregivers promote patient autonomy, access to information, and choice. Hospice care incorporates many of the principles of palliative care. DIF: Cognitive Level: Apply (Application)REF: page 5TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity
Which question asked by the nurse demonstrates attention to the primary concern of palliative care? "Has your pain medication been effective at keeping you comfortable"? "Do you want to receive your palliative care at home or in an institutional setting?" "Do you have a spiritual provider you want me to be contacted?" "Who will be your acting as your primary care provider?"
Has your pain medication been effective at keeping you comfortable"? Excellent symptom management is a hallmark of palliative nursing. Assessing pain management would reflect such a concern. While the other options present appropriate assessment questions, they do not address the primary issue of palliative care
Which ethical concept regarding client care poses the greatest concern for a nurse providing end-of-life care for a client considering euthanasia? Nonmaleficence Beneficence Autonomy Individual liberty
Nonmaleficence An ethical concept relevant to euthanasia is that of nonmaleficence, or doing no harm and considering whether helping to end life is an act of harm. None of the other ethical concepts is as directly related to the actions of nursing at the end of a client's life
The death of which terminal ill client, who self-administered a lethal dose of medication, resulted in the state of California adopting a Right to Die law? Terri Schiavo Jack Kevorkian Karen Anne Quinlan Brittany Maynard
Brittany Maynard Brittany Maynard was diagnosed with inoperable brain cancer in January of 2014. She and her husband moved from their home state of California to Oregon so that she could participate in Oregon's Death with Dignity Act. On November 1, 2014, Brittany self-administered a lethal dose of medication obtained under Oregon law. After Brittany's death, California Governor Jerry Brown signed a right to die bill into law. While all the other options identify individuals that played a role in the campaign to legalize physician-assisted suicide, none of their deaths resulted in California's adoption of a right to die law.
Which statements identify a client's progress through the stages of grief? Select all that apply. "He didn't die; I'm sure he will be found and be just fine." "I will never accept he's gone; I will never give up looking for him." "If they find him, I'll never doubt miracles again." "I'll never understand why he risked his life by hitchhiking at night." "Knowing he's gone makes me so sad."
"He didn't die; I'm sure he will be found and be just fine." The five stages of grief identified by Kübler-Ross include denial, anger, bargaining, depression, and acceptance. The statement concerning never giving up demonstrates the inability to accept the individual's death. "If they find him, I'll never doubt miracles again." The five stages of grief identified by Kübler-Ross include denial, anger, bargaining, depression, and acceptance. The statement concerning never giving up demonstrates the inability to accept the individual's death. "I'll never understand why he risked his life by hitchhiking at night." The five stages of grief identified by Kübler-Ross include denial, anger, bargaining, depression, and acceptance. The statement concerning never giving up demonstrates the inability to accept the individual's death. "Knowing he's gone makes me so sad." The five stages of grief identified by Kübler-Ross include denial, anger, bargaining, depression, and acceptance. The statement concerning never giving up demonstrates the inability to accept the individual's death DIF: Cognitive Level: Analyze (Analysis)REF: page 3TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity
Which assessment question best demonstrates the nurse's understanding of a dying client's needs? "What are your hopes for your final days?" "Have you completed a Living Will?" "Are you aware of the pain control options available?" "Do you have any concerns about paying for your end-of-life care?"
"What are your hopes for your final days?" Care of the dying is a nursing responsibility. The focus of this care needs to shift toward the question, "What do you hope for at the end of your life?" rather than managing the cost of medical care. Pain management and advance directives are only individual aspects of end of life care. DIF: Cognitive Level: Analyze (Analysis)REF: page 4TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
Which issue should the nurse discuss when planning end-of-life care for a terminal ill client? Select all that apply. Advance directive planning Hospice admission Cost of needed services Symptom management Curative therapies
Advance directive planning Patients often turn to their nurse for assistance in understanding how to make end-of-life decisions. Appropriate topics include advance directive planning, hospice admission, and symptom management including pain medication. The discussion of financial issues should be referred to social services or a personal finance advisor. Curative therapies are not considered when the client has been identified as having a terminal diagnosis Hospice admission Patients often turn to their nurse for assistance in understanding how to make end-of-life decisions. Appropriate topics include advance directive planning, hospice admission, and symptom management including pain medication. The discussion of financial issues should be referred to social services or a personal finance advisor. Curative therapies are not considered when the client has been identified as having a terminal diagnosis. Symptom management Patients often turn to their nurse for assistance in understanding how to make end-of-life decisions. Appropriate topics include advance directive planning, hospice admission, and symptom management including pain medication. The discussion of financial issues should be referred to social services or a personal finance advisor. Curative therapies are not considered when the client has been identified as having a terminal diagnosis
A client who has recently received a terminal cancer diagnosis has expressed the desire to, "stay out of the hospital and die at home." Which nursing intervention will best help the client achieve this end-of-life goal? Involving the client and his/her family in treatment decisions Encouraging adherence to the medical treatment plan Discussing available pain control measures Assistance with advance care planning
Assistance with advance care planning Advance care planning has helped patients and their families achieve end-of-life goals, avoid hospitalization, and increase hospice and palliative care use. While the other options are appropriate interventions, none are as focused on assuring the client's end-of-life goals that are documented supporting their achievement. DIF: Cognitive Level: Analyze (Analysis)REF: page 7TOP: Nursing Process: PlanningMSC: NCLEX: Safe and Effective Care Environment
Which intervention demonstrates the fulfillment of a moral duty a nurse has to a dying patient? Treating the client respectfully Advocating for the client's right to privacy Assuring the client has the information needed for informed consent Assisting the client in determining their preferences and goals for care
Assisting the client in determining their preferences and goals for care According to the American Nurses Association's Code of Ethics nurses have a moral duty to help patients determine these preferences and goals at the end of life. The remaining options relate to compliance with client rights.
Which assessment findings are associated with approaching death? Select all that apply. Increased drowsiness Increased blood pressure Progressive weakness Decreased heart rate Loss of appetite
Increased drowsiness The process of dying varies based upon the underlying cause. Some general signs of approaching death include growing weakness, loss of appetite, and increased drowsiness, an increase in heart rate, and a decrease in blood pressure. Increased blood pressure The process of dying varies based upon the underlying cause. Some general signs of approaching death include growing weakness, loss of appetite, and increased drowsiness, an increase in heart rate, and a decrease in blood pressure. Progressive weakness The process of dying varies based upon the underlying cause. Some general signs of approaching death include growing weakness, loss of appetite, and increased drowsiness, an increase in heart rate, and a decrease in blood pressure Loss of appetite The process of dying varies based upon the underlying cause. Some general signs of approaching death include growing weakness, loss of appetite, and increased drowsiness, an increase in heart rate, and a decrease in blood pressure.
Which document allows an individual to appoint another person to make health care-related decisions for them if they become unable to do so for themself? Advance directive Living will Do not resuscitate request Power of attorney for health care
Power of attorney for health care A medical or healthcare power of attorney is a document that lets you appoint someone you trust to make decisions about your medical care if you are unable to do so. An advance directive may include a living will, that may include the request not to resuscitate, and/or a power of attorney for health care
Which factor will have the greatest impact on end-of-life nursing care in the coming decades? Technological advancements Decrease in federal funding for healthcare The aging of the Baby Boomers generation The decline in those entering the nursing profession
The aging of the Baby Boomers generation In 2014, the U.S. Census Bureau released a report projecting that the number of Americans over the age of 65 is expected to almost double from 43.1 million in 2012 to 83.7 million by 2050. Every day for the next 19 years, 10,000 baby boomers will be turning 65. This burgeoning sector of the population will place unprecedented strains on a health care system where health spending is growing faster than the overall economy. As this population experiences terminal illness, the need for end-of-life care will increase as well. While the other options are factors, the greatest impact will come from the existence of unprecedented numbers of terminal ill and dying clients
A terminally ill client expresses to the nurse the desire to discuss end-of-life issues. What is likely to be the greatest barrier to that discussion? The health provider's hesitancy to prescribe palliative care The client's lack of knowledge regarding the various issues The family's unwillingness to acknowledge the inevitable The nurse's reluctance to discuss death-related issues
The nurse's reluctance to discuss death-related issues Despite being trained to nonjudgmentally discuss difficult and sensitive issues with patients and families, nurses are often afraid to talk about death. Talking about death is difficult because of the emotions that are involved. While the other options may be factors, the nurse's attitude and willingness to engage in such a conversation initially have the greatest impact.
A dying client's family is concerned that the opioid pain medication being prescribed will hasten the client's death. Why? The Rule of Double Effect (RDE) prevents the use of opioids to facilitate a client's death. There is little research evidence to support that appropriate opioid management will result in an earlier death. Pain management for the terminally ill is the primary concern of the health care team. Addition to the opioid is a greater risk than is the possibility of a premature death.
There is little research evidence to support that appropriate opioid management will result in an earlier death. Pain is sometimes undertreated because the patient and/or family is concerned about sedation, addiction, and/or hastening the demise of their loved one. The RDE is a bioethical principle that allows a physician or APRN to make a decision, such as prescribing adequate pain medication, even though the pain medication might cause the patient to die sooner. There is little evidence, however, to support the concern that appropriate use of opioids will hasten death .DIF: Cognitive Level: Apply (Application)REF: page 13TOP: Nursing Process: PlanningMSC:NCLEX: Safe and Effective Care Environment